Written by Dr David Delvin, GP and family planning specialist
The outlook for men with erectile dysfunction (ED) has improved
enormously in the first 12 years of this century – so much so that almost all
patients nowadays can be assured of a return to fairly successful
What is erectile dysfunction?
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 they lose it.
Why does ED occur?
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'. We have termed this 'condom collapse syndrome'.
Common causes in this age group are overwork, stress, guilt and bereavement (ED often happens when a widowed man tries to form a new sexual relationship). A few cases are due to diabetes. Alcohol, nicotine and other drugs can be factors, as can obesity.
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 high proportion of cases, the problem is due to narrowing of the blood vessels that carry blood into the penis.
Research, which was carried out in 2007, suggests that in some older men who have erection difficulties, there may also be deterioration in the arteries of the brain or the heart.
In 2008, leading sex expert Dr Geoffrey Hackett said in the British Medical Journal, 'Erectile dysfunction is the manifestation of vascular disease in smaller arteries and can give a two to three year early warning of heart attack.'
This doesn't mean that if you have erection problems, you're about to have either a stroke or a heart problem.
But 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 and getting an adequate amount of exercise. Also, at all costs they should avoid smoking.
You may be surprised to see that I have not listed 'lack of
hormones' as a common cause of ED. In fact, lack of male hormone is pretty
rare. However, it can occur particularly after severe injuries to the testicles
or to the base of the brain.
What is an erection?
Are many cases due to psychological causes?
What physical causes are there?
What should I do if I'm having potency problems?
What will happen when I see a doctor or therapist?
What treatments are now available?
The treatments for the type of ED that has a physical origin are listed below.
It widens the bloods vessels, so giving an erection – provided there is some sexual stimulation – such as rubbing.
In most men, it works within an hour. The effect lasts for about four hours. (This doesn't mean the erection lasts for four hours, rather that an erection can be produced for up to four hours after taking a tablet.) It's easily blocked by food in the stomach.
Viagra still remains the world's most popular ED drug.
At the Vienna International Sexology conference of December 2006, which we attended, it was claimed that its continuing popularity is due to the 'hardness' of the erections it produces.
And it certainly does give you excellent stiffness. However, we're not convinced that it produces greater hardness than the other two drugs.
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, but it only lasts a short time.
Viagra is dangerous with certain heart drugs. It interacts with many medications. Do not drink grapefruit juice on the day of use, because that pushes up the blood level of the drug.
In April 2005, a report from the University of Minnesota suggested that a small group of men have suffered blindness as a result of Viagra use. It was claimed that the drug may rarely cause a serious eye condition called non-arteritic ischaemic optic neuropathy (NAION).
It's apparent that a very small number of British men have suffered similar eye problems. If you are taking Viagra, you should ask your doctor to keep you informed of any further research on this development.
Also, in 2007 concerns began to emerge about whether Viagra could cause deafness. In that year, the American Food & Drug Administration (FDA) told manufacturers of all three ED medicines to mention this possibility more prominently on their leaflets for patients.
And in 2011, a well-argued study published in the respected British journal 'The Laryngoscope' showed that sudden deafness does indeed seem to occur occasionally in men who have recently taken Viagra or one of the other two medicines.
Admittedly, only 47 cases had been reported worldwide, and a mere eight of these had been recorded in the UK. But there were 240 other possible cases in America.
This type of deafness is called sudden sensorineural hearing loss (SSHL).
It generally affects only one ear and mostly seems to happen within 24 hours of taking Viagra or one of the other ED medicines.
As yet, no one has proved that this deafness is definitely due to Viagra, Cialis or Levitra. But if you suddenly lose your hearing after using one of these drugs, do NOT take any more until you have consulted an ear, nose and throat specialist.
Works in the same way as Viagra. Now popular with a lot of men, because its effects last so long – at least 12 hours in most cases, which means sex can be more spontaneous. Manufacturers claim it is not blocked by food.
Side-effects are similar to those of Viagra, but it can also cause 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 phenobarbital.
Cialis is very similar in structure to Viagra and there have been several reports of blindness occurring while on it. Also, it may be a cause of sudden deafness (please see above).
Works in same way. Side-effects and interactions are similar to those of Viagra. Not as long-lasting as Cialis. There have been a very few reports of blindness and deafness (see above).
Please note the alleged relationship between these three drugs and blindness or deafness is still the subject of argument – and litigation. A 'cause and effect' has still not been proved.
However, in 2012 Lloyds and other large British high street chemists are offering a service through which a man can obtain Viagra directly from a pharmacy after undergoing some basic tests and filling in a health questionnaire. There's a back-up from online doctors, but you do not usually meet them face-to-face.
Also, it is now very easy to buy Viagra, Cialis and Levitra through the internet, but I really do NOT recommend this – particularly because criminals have been making a fortune by selling fake tablets on the net.
There is another oral anti-ED drug called 'Uprima', but it was withdrawn from sale in Britain during 2006 – probably for commercial reasons. It's now almost impossible to obtain it.
What other drug treatments for ED are there?
What mechanical aids are there for ED?
A pump is a cylinder that 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 (in fair-skinned men) blue-looking.
Quite a lot of men do use vacuum pumps, as shown by the fact that there are currently no less than 11 different vacuum devices available for prescription by doctors.
However, as is the case with other treatments for erectile dysfunction, you can only obtain them free on the NHS from your GP if you have one of a short list of physical disorders, which were specified by the then Minister of Health back in 1999. The commonest of these disorders is diabetes.
If you don't have one of those disorders, the cost of buying a vacuum cylinder is generally in excess of £100.
Specially-designed rings that 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.
Again, your GP can prescribe these rings, but you would only get them free if you have one of the disorders on the above-mentioned NHS list. Otherwise, the current cost of penile rings is between £10 and £40.
These are supposed to prop the penis up during sex. Not awfully successful, in my view.
Although vibrators aren't often prescribed by doctors (and certainly not on the NHS), I have found that they can be quite useful in urging a lethargic penis into life.
Some vibrating devices, such as the Penisator, actually clip round the male organ.
In December 2006, at the Vienna conference, it was reported that vibrators are surprisingly effective in helping men with spinal injuries to achieve an orgasm – and therefore to have children.
What about surgery?
The following can sometimes be helpful in various ways to ED sufferers and their partners.
The Sexual Advice Association(formerly the Sexual Dysfunction Association) Tel: 0207 486 7262. Provides information only - not treatment.
The Institute of Psychosexual Medicine Tel: 020 7580 0631.
Family Planning Association (FPA) Helpline Tel: 0845 122 8690.
Brook Advisory Centres For Young People Tel: 0808 802 1234.
Relate Tel: 0300 100 1234.
Relationships Scotland Tel: 0845 119 2020.
Relate Northern Ireland Tel: 0289 032 3454.
The College of Sexual and Relationship Therapists (COSRT) Tel: 0208 543 2707.
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|Last updated 07.12.2012
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