Erectile Dysfunction (ED) and Impotence

Impotence or Erectile Dysfunction (ED) as doctors prefer to call it, is when a man is not able to achieve or maintain an erection to complete sexual intercourse or another chosen sexual activity. It is one of the most common sexual problems in men and most will experience ED at least once during their lives, however, few actually talk about it.

Impotence problems may occur every time sexual activity is attempted or can be variable. For example you may be able to achieve an erection but fail to get one, or lose it as soon as you try to have sex.

Impotence is usually nothing to worry about, however, most men do worry about it and become so preoccupied with previous erection failures that they are unable to relax and enjoy sexual stimulation. Usually, men who suffer from impotence can feel great mental stress that can damage their personal relationships. Also most men don’t like admitting or discussing the fact that they have a problem and are also too embarrassed to seek help and all this makes the problem worse.

Impotence can happen at any age although it is more common with increasing age.

How does an erection occur?

The penis consists of three blocks of erectile tissue, which are basically spongy cavities. Two of these blocks are at the back of the penis and the third surrounds the urethra (the tube through which urine is passed). An erection occurs when blood flows into these spaces, making the penis stiff and hard. The extra blood inside the penis allows the man to keep his erection until he reaches his sexual climax (has an orgasm). After the orgasm, the blood flows away from the penis and it becomes soft again.

Erections can be triggered through smell, sound, touch, sight or imagination (thinking something sexual).

What causes impotence?

Very often impotence has more than one cause. The causes of impotence can be divided into two categories, psychological and physical or it may be a combination of the two.

A psychological cause can be temporary or long standing and is a more common cause of impotence in men under 35. The most common psychological factors that can cause impotence are as follows:

• Stress.
• Depression.
• Guilt.
• Sexual Confusion
• Relationship difficulties.
• Sexual boredom.
• Bereavement – the loss of a loved one is a common cause of impotence.
• Mental exhaustion and tiredness.
• Worry.

The cause of impotence in men over 35 years of age is usually a physical problem. The most common physical problems that can cause impotence are as follows:

• High blood pressure.
• A specific illness, such as diabetes or multiple sclerosis.
• Injury or major surgery to the pelvic area.
• High cholesterol.
• Age – as men get older there can be changes in circulation or occasionally testosterone levels can fall.
• Atherosclerosis – a condition where the arteries which supply blood to the penis are hardened (blocked) and so the blood flow to the penis is reduced.
• Smoking.
• Drinking too much alcohol, also called “Brewers Droop”.
• Drug abuse.
• Side effects of medical treatment, such as drugs used to treat blood pressure.

What should I do if I believe my partner might be suffering from impotence?

If your partner is avoiding any sexual contact and is constantly making excuses for not wanting sex or is not available for sex, then he may be trying to hide an impotence problem. Examples of this could include:

• Staying up late to ensure you are asleep.
• Working longer hours.
• Complaining of headaches or exhaustion at bedtime.
• Going to bed very early and falling asleep before you have chance to join him.
• Going out more at weekends to avoid sex during the day.
• Inviting people over on a regular basis, to reduce the time you are alone.

If your partner is trying to hide the problem this can make matters worse, as the longer it goes on, the more pressure he will be feeling. Try discussing sexual habits with your partner, many men think that only penetrative sex is satisfactory. Reassure your partner that other forms of sexual activity are just as enjoyable. The man may then feel less pressure and feelings of guilt could be relieved, once he feels less pressure, his ability to get an erection may improve.

Is there anything I can do to prevent impotence problems?

To avoid problems with erections you should eat a healthy balanced diet, take regular exercise, avoid smoking and heavy drinking. You should also try to reduce stress, get plenty of sleep and try to resolve any problems in your relationship that may be causing you stress.

Do I need to go and see a doctor?

If you are unable to get an erection then you should start by trying to make some lifestyle changes. For example cut down on alcohol, quit smoking, take regular exercise and try to reduce stress and worry. If such changes do not solve the problem then you should see your doctor for advice. If you are too embarrassed to see your own doctor you can visit any GUM clinic for advice.

What will the doctor do when I visit?

Your doctor will usually begin by asking you many questions, some of which you may find embarrassing, so be prepared. Questions you may be asked could include any of the following:

What sort of erection problems are you having?
Do you have erections at night or first thing in the morning?
Do you believe you have a normal sex drive?
Are you under any stress or do you feel depressed?
Do you have a current partner and if so how do they feel about the problem?
Why do you think you may be having problems with erections?

You may also be asked about your lifestyle, whether you smoke or drink and previous partners. These questions will help the doctor understand whether the problem is physical or psychological and what tests and examinations may be required. If you are waking in the morning with an erection or there are any other circumstances in which you get an erection, then the problem is almost definitely psychological.

Your doctor may perform a general examination by checking your blood pressure and examining your penis and testes. He/she may then ask you to give a blood and urine sample to check levels of glucose (in case you have diabetes) and testosterone. Your doctor will also check your records to see if you are taking any medications that could be causing impotence.

What tests are available?

If your doctor is unable to discover the problem or if there is any evidence of any underlying problem, you may be referred to a hospital for further tests. Tests that might be carried out include measuring the pressure inside the penis, monitoring blood flow in the penis or an x-ray of the penis and the arteries which supply the penis.

Is there any age limit to treatment?

No, men are living longer, have healthier lifestyles and do not automatically resign themselves to the loss of sexual activity.

What treatments are available for impotence?

If the cause of impotence is psychological your doctor may just need to give you lifestyle advice on giving up smoking, drugs or alcohol and suggest ways to relax and alleviate stress. If the problem is guilt, depression or something deeper, then you may be referred to a counsellor or a specialist sex therapist for advice and help.

Impotence can also be treated by hormone therapy, drugs, mechanical devices and surgery. The treatment you receive will depend greatly on the cause of your problem.

Hormone therapy
If your impotence problems are caused by low levels of testosterone then hormone therapy can be given in the form of injections or patches.

Drugs
Drugs can come in the form of injections, transurethral therapy or oral drugs. Injection therapy is probably the most effective way of producing an erection, it involves a drug being injected directly into the base of the penis, which causes an erection. The injection should be given 10 minutes before intercourse and the erection lasts for one to two hours. There are possible side effects, such as prolonged erections (more than 4 hours), this is rare but will require urgent hospital treatment. You will be trained on how to carry out the injection properly, however most men don’t like this form of treatment as they don’t like sticking a needle into their penis every time they have sex.

Transurethral therapy involves a small pellet of drug being inserted a few centimetres into the urethra using a special disposable applicator. The drug is absorbed through the wall of the urethra into the erectile tissue, giving an erection within 5-10 minutes.

The best known oral drug available is Viagra™, which works by helping to relax the blood vessels in the penis allowing blood to flow in. However, Viagra™ will not cause an erection unless the man is sexually stimulated. You must speak to your doctor before taking Viagra™ as it is not suitable for everyone and can have some unpleasant side effects.

Mechanical devices
There are many different devices available which can be applied to the penis to aid erection before sexual intercourse. These devices are usually called vacuum pumps. Vacuum pumps work by inserting the penis into a tight fitting cylinder, a hand-held pump is then used to remove air from the cylinder, creating a vacuum. The resulting suction fills the penis with blood and gives an erection. Once the penis is erect a tight rubber ring is placed around the base of the penis to trap the blood and maintain the erection. Unfortunately, the penis tends to look blue in colour and can be cold to the touch.

Surgery
If all other methods fail you can have surgery, known as penis prosthesis. Penis prosthesis involves the surgical placement of an implant (splint) into the penis under general anaesthetic. There are two main types available, semi rigid rods or an implant that can be inflated when required. The semi rigid rods produce a permanent erection which is slightly softer than normal, so allows the penis to be bent downwards out of the way.