What is erectile dysfunction and how common is it?
The inability to acquire and sustain an erection is termed erectile dysfunction (ED). It is not uncommon, affecting perhaps 18% of men in their 50s, becoming more common still thereafter, and is often not associated with a loss of sexual desire or libido.
Although common, ED is not trivial and can cause significant distress. Normal erectile function is a complex system involving multiple different inputs and as men age erectile function can naturally diminish. The nervous system, blood flow and hormones are all important elements and have a role to play in erectile function. Getting to the bottom of what is contributing to ED is important and not always straightforward.
What are the common causes of erectile dysfunction?
The most likely to suffer from erectile dysfunction are those with co-existing conditions such as cardiovascular disease, diabetes, high blood pressure, obesity, high cholesterol, testosterone deficiency, smoking, depression and medication use.
Often, ED is an early sign of cardiovascular disease and it is important, therefore, to consider this when first exploring the causes of ED. Assessing blood pressure, blood sugars (diabetes) and kidney function is crucial when determining an underlying cause for ED.
Psychological factors such as depression, stress and relationship troubles can also play a role in erectile dysfunction. Increasingly, excessive use of pornography is a common driver of ED. Performance anxiety is another frequent contributor and often the onset in this scenario is quite rapid.
Medications that can contribute to ED include those taken for blood pressure and antidepressants, and it is worth reviewing these with your doctor.
Hormones can play a role too and assessing them is important. Testosterone is a well-known hormone but also thyroid and prolactin levels can influence erectile function
How can I manage erectile dysfunction?
It is important to ensure that a significant underlying factor contributing to ED such as heart disease or diabetes is diagnosed and managed appropriately.
Hormones should be assessed and if testosterone is unequivocally low, replacement therapy can successfully restore erectile function. Other hormone imbalances can and should be managed too.
In the absence of any reversible cause, Phosphodiesterase-5 inhibitors (PDE5 inhibitors) are the class of drug that have become synonymous with treating erectile dysfunction. They are easy to take and have a good safety record. Such drugs include Viagra (sildenafil) and Cialis (tadalafil).
Tadalafil has a longer duration of action, but they are all very similar in effectiveness. Tadalafil, at a lower dose (5–10 mg), can be taken daily, which is helpful as spontaneity is no longer a concern. It also has an effect of improving urine flow for those who have an enlarged and obstructing prostate gland.
Men who are taking nitrates for heart disease should not take these medications.
What other treatments and lifestyle changes can help?
Should PDE5 inhibitors not be successful, other options include vacuum devices, injectable medications into the penis or medication applied to the urethra. Some men go on to have surgery to implant an inflatable device into the penis to generate an erection.
Alongside all these treatments, it is important to remember that lifestyle measures are significant too. Weight loss and increased exercise are proven to improve erectile function.
If you’re experiencing erectile dysfunction or have concerns about your sexual health, we’re here to help. Book an appointment today by clicking here or calling us on 0207 245 9333. Our team is here to provide expert advice and support tailored to your needs.
About the author
BA (Hons) MB BSMRCGP
“The most fulfilling part of this job is making a real difference to patients with timely diagnoses and supporting them going through a difficult time”.
I enjoy the full variety of General Practice and recognise the benefits in both continuity and time that private care affords. I have a particular interest in disease prevention, chronic disease management and paediatrics.
The key to our success is maintaining and improving our patients’ health, managing chronic disease meticulously and working alongside the best specialists when needed.
