Safer Sex

Erectile dysfunction (ED)

ED means an inability to get a good enough erection to achieve satisfactory intercourse. Some sufferers can’t get a hard-on at all; others get one but it isn’t firm enough to penetrate the partner; and others can manage penetration for a bit, but then lose it

Why does ED occur?

ED is very common, and it occurs for a variety of reasons and at different ages.

Teenagers and young men

In younger males, the most frequent cause is anxiety – particularly nervousness about having sex, about causing a pregnancy, or about using a condom. A lot of men in this age group complain that they “can’t get on with a condom” because as soon as they try to put it on, they lose their “stiffy”.

Middle age

Common causes in this age group are overwork, stress, guilt and bereavement (ED often happens when a man who has lost a partner tries to form a new sexual relationship). A few cases are due to diabetes.

Post-middle age

In this group of men, ED gets commoner with increasing age. Nonetheless, 70 per cent of all 70-year-olds are sexually potent.

It is now clear that in a very high proportion of cases, the problem is due to deterioration in the blood vessels that carry blood into the penis. Recent research suggests that in addition there may often be deterioration in the arteries of the brain or the heart. Therefore older men with ED should take care to protect themselves against strokes and heart attacks – for example by keeping their blood pressure and cholesterol down.

Some private clinics suggest a possible cause could be male hormone deficiency and suggest hormone therapy. This can be very costly and it is very rare that the problem is hormonal. Other areas should be explored first before considering going down this route.

What is an erection?

An erection occurs when blood is pumped into the penis and stays there, making it hard. It generally happens because a guy is thinking about sex, or because his penis is being stimulated - or both.

The result is that signals go down the nerves that lead from his spinal cord to his genitals. They tell the blood vessels which supply the penis to open up. Blood flows in and the organ ‘blows up’ like a balloon. A valve mechanism near the base of the penis keeps the blood from flowing out again – a least, until sex is over.

As you can see, getting an erection is a complex process. It’s easy for various factors to interfere with it - for instance, worry, tiredness, too much alcohol or in later life, narrowing of the blood vessels.

Nicotine is now known to narrow those vital blood vessels – which is why ED is much commoner in smokers. But often, there is nothing physically wrong with men who develop ED.

Are many cases due to psychological causes?

Yes, particularly in younger men. In general, erectile dysfunction is quite likely to be psychological rather than physical if the man:

- is still waking with morning erections
- can still get a good erection by masturbation.

Common psychological causes of erection difficulties include:

- nerves

- guilt

- relationship problems

- depression

- exhaustion.

In a lot of cases, ED turns out to be due to a mixture of psychological and physical causes.

What physical causes are there?

Common physical causes include:

- deterioration of the arteries – this is a physical change which is common in older men, including those with high blood pressure

- diabetes

- smoking

- excessive drinking (hence the phrase ‘Brewer’s droop’)

- being obese and out-of-condition

- side-effects of certain drugs, notably ones for blood pressure and depression

- effects of recreational drugs, like cocaine.

Less common physical causes include:

- excessive drainage of blood from the penis (‘venous leak’)

- diseases of the nervous system

- injury to the spinal cord

- major surgery in the abdomen, particularly prostate operations

- hormone problems, including excess production of a pituitary hormone called prolactin.

If you are having problems maintaining an erection you should attend a G.P. who will be able to then give you some form of treatment or refer you if necessary.

What treatments are now available?

Treatment depends on the cause of the ED. For instance, psychological causes may require:

- counselling

- psychotherapy

- relationship counselling.

The treatments for ED that has a physical origin are listed below:

Erection-inducing drugs

They don’t work for everybody, but they do work for the majority – even in diabetes. They can also help people with neurological and spinal problems.

Also, the choice of available drugs means that if one particular drug doesn’t suit you, you can try other drugs until you find one that works.

There are three orally-administered drugs available in the UK. They all have side-effects, only a few of which we can list here. For more information, read the package insert leaflet, and if in doubt ask your doctor.

It is not safe for some people to use these drugs, and some medications interact dangerously with them. Therefore, before going on any of these pills you should always see a doctor, talk things over with him, and have a physical check-up.

You should only get ED drugs prescribed by your doctor and avoid buying them on-line, they may not be what they say.

The oral drugs currently available are:

- Viagra tablets (sildenafil)

- Cialis tablets (tadalafil)

- Levitra tablets (vardenafil)

Viagra (sildenafil)

Widens the bloods vessels, so giving an erection - provided the penis is rubbed. In most men, works within an hour. Effect lasts for about four hours. Easily blocked by food in the stomach.

The most common side-effects are headache, visual disturbances, blocked nose, flushed face, indigestion, palpitations - and dizziness after getting out of bed too quickly! Blue vision occurs at higher doses. Viagra is very dangerous with certain heart drugs. Interacts with many medications.

Cialis (tadalafil)

Works in the same way as Viagra. Side-effects similar to those of Viagra, but also causes back pain and muscle pain. Interactions with other drugs and with grapefruit juice are similar to those of Viagra, but also clashes with the antibiotic clarithromycin and the sedative phenobarbitone.

Levitra (vardenafil)

Works in same way. Side-effects and interactions are similar to those of Viagra. may become more widely available over the counter.

What other drug treatments for ED are there?

It’s also possible to give erection-inducing agents by:

- injections into the penis.

- pellets inserted down the urinary pipe.

What mechanical aids are there for ED?

There are a number of devices that can help men to achieve a better erection and to have successful sex.

Vacuum pumps

A pump is a cylinder which you put over your penis. You then pump out the air. That should ‘suck’ your penis into an erection – which, however, tends to be a bit cold and blue-looking.

Rings

Specially-designed rings which fit round the base of the male organ are often used with vacuum pumps. However, they can be tried on their own. The idea is that the ring helps stop the blood from flowing out of the penis.