Understanding erectile dysfunction
Erectile dysfunction (ED), also known as impotence, is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. ED is a common condition, affecting men of all ages, but it is more prevalent in older men. It can have a significant impact on self-esteem, relationships, and quality of life. ED may occur occasionally or frequently and can vary in severity.
Other symptoms can include:
- Reduced sexual desire
- Difficulty achieving an erection
- Trouble maintaining an erection
Causes of erectile dysfunction
ED can result from a variety of physical and psychological factors, including:
Physical causes:
- Cardiovascular disease: Conditions like atherosclerosis can reduce blood flow to the penis. This is similar to what happens in the blood vessels in the heart which subsequently result in heart attacks.
- Diabetes: High blood sugar levels can damage nerves and blood vessels, leading to ED.
- Hormonal imbalances: Low levels of testosterone or other hormonal disorders can affect sexual function.
- Neurological conditions: Disorders such as Parkinson’s disease, multiple sclerosis, spinal cord injuries and surgery or radiotherapy involving the prostate, lower bowel or bladder can interfere with nerve signals necessary for an erection.
- Medications: Certain medications for high blood pressure, depression, prostate conditions or recreational drugs can cause ED.
- Lifestyle factors: Smoking, excessive alcohol consumption, and lack of physical activity can contribute to ED.
- Obesity: Being overweight can increase the risk of vascular disease and diabetes, both of which are major causes of ED.
Psychological causes:
- Stress: Work or financial stress can interfere with sexual arousal.
- Anxiety: Performance anxiety or general anxiety disorders can prevent erection.
- Depression: Depression can reduce sexual desire and lead to ED.
- Relationship issues: Poor communication or unresolved conflicts can affect sexual intimacy.
- Diagnosis of erectile dysfunction
Diagnosing ED involves a comprehensive evaluation that includes:
- Medical history: You will be seen in clinic by an andrologist* hyperlink? will discuss your medical and sexual history to identify potential causes.
- Physical examination: This may include an examination of the penis and testicles and checking your nerves for sensation.
- Blood tests: These tests can help identify underlying health conditions like diabetes, heart disease, or low testosterone levels.
- Urine tests: Urine tests can detect signs of diabetes and other health conditions.
- Ultrasound: This test can assess blood flow to the penis and may be done in combination with an injection of medication into the penis to stimulate an erection.
- Psychological assessment: Your doctor may ask questions to screen for depression, anxiety, and other psychological causes of ED.
Treatment options for erectile dysfunction
The most important thing you can do is to seek help from a medical specialist e.g. an andrologist. Treatment for depends on the underlying cause and the severity of the condition.
Options include:
Lifestyle changes:
- Quitting smoking
- Reducing alcohol consumption
- Increasing physical activity
- Losing weight
- Reducing stress
Treating underlying medical conditions:
- Optimising control of diabetes and high blood pressure.
Counselling:
- For men whose ED is caused by psychological factors, counselling or therapy can be effective in addressing the underlying issues.
Medication
- Testosterone replacement therapy (TRT) if low testosterone is the cause of ED
- Oral medications: PDE5 inhibitors (Viagra, Cialis, and Levitra) enhance the effects of nitric oxide, a natural chemical the body produces that relaxes muscles in the penis to increase blood flow. They all require you to engage in some foreplay before they work. They differ in terms of how quickly they work, how long they stay in your system and their interactions with food and other medications. They work very well in most men but are not suitable for everyone
Common side effects:
- Headache
- Facial flushing
- Backache
- Visual disturbance
Urethral suppositories: MUSE, a small suppository (pellet) or Vitaros (cream can be inserted into the urethra to increase blood flow and cause an erection if tablets fail or can’t be used. No foreplay is required and there are no drug or food interactions.
Common side effects:
- Penile pain
- Irritation within the urethra
- Priapism (a medical emergency involving a prolonged abnormal erection which will not subside)
Penile injections: Medications can be injected directly into the side of the penis to achieve an erection. You will be taught how to do this by yourself by your andrologist. The erection may appear within 10 mins although it may take longer.
- Common side effects
- Penile pain
- Priapism ((a medical emergency involving a prolonged abnormal erection which will not subside)
- Penile bruising or bleeding
Devices:
- Vacuum erection devices (VED): Comprise a vacuum tube, a pump and a constriction ring. The ring is placed at the base of the penis with the tube placed over the penis. A vacuum is the created with the pump which draws blood into the penis with the ring ensuring the blood is retained.
Common side effects:
- Penile coldness
- Penile bruising
- Penile prostheses or implants: Surgical implants can provide a permanent solution for ED.
Penile Prosthesis: A comprehensive guide
What is a penile prosthesis?
A penile prosthesis is a surgically implanted device that allows you to control your erections without the need for medications. This device offers a permanent solution to erectile difficulties, providing sufficient penile rigidity for penetrative sexual intercourse. It is associated with very high satisfaction rates among users.
Types of penile prostheses
There are three main types of penile prostheses:
- Semi-rigid
- 2-Piece inflatable
- 3-Piece inflatable
Semi-rigid prosthesis The semi-rigid prosthesis consists of two bendable cylinders implanted into the penis. This option involves a shorter operation and fewer potential complications. However, the erection is not as natural as with inflatable types, and the penis always appears semi-erect, which may require discretion with tight-fitting clothing. To use, you simply bend the penis into a straight position for intercourse and downwards when not needed.
Inflatable prostheses The 2-piece and 3-piece inflatable prostheses consist of more components, leading to slightly longer operations and a higher chance of complications. However, these provide a more natural erection and deflate completely, avoiding any issues with tight clothing. They work via a hydraulic system, where a pump located in the scrotum transfers fluid to the cylinders in the penis to create an erection.
Procedure duration The surgery takes around 1-3 hours, depending on the type of prosthesis chosen.
During the procedure
- You will receive general anaesthesia.
- An incision is made at the junction between the penis and scrotum, and a second incision in the lower abdomen for the 3-piece prosthesis.
- The prosthesis is then inserted, and tunnels are created within the penis for the cylinders.
- The wounds are closed, and a catheter and drain are inserted.
- The penis is wrapped in a compression dressing and the prosthesis is left inflated or upright.
Hospital stay Typically, you will stay in the hospital overnight. The catheter, drain, and dressing are usually removed the morning after surgery. The device will be deflated or repositioned, which may cause brief discomfort.
Post-discharge expectations
- Bruising and swelling of the penis and scrotum.
- Significant pain for up to 6 weeks, requiring strong painkillers.
- No use of the device for at least 6 weeks to allow healing.
- A follow-up appointment 3-4 weeks post-surgery to learn how to use the device.
Possible complications
- Pain
- Infection
- Erosion of the implant
- Mechanical failure
- Injury to nearby structures
- Soft penis head
- Bleeding
Implant longevity
- Semi-Rigid: Likely to last a lifetime
- Inflatable: Typically lasts 8-10 years
Preventing erectile dysfunction While not all cases of ED can be prevented, adopting a healthy lifestyle can reduce the risk:
- Maintain a healthy diet
- Exercise regularly
- Avoid smoking and excessive alcohol consumption
- Manage stress
- Keep regular medical check-ups to monitor and manage any chronic health conditions
Contact us Our urology clinic offers personalised care and the latest treatments for erectile dysfunction. If you are experiencing symptoms of ED, contact our clinic to schedule a consultation with one of our expert consultants. Take the first step towards regaining your confidence and improving your quality of life.
For more information and support, please visit the British Association of Urological Surgeons (BAUS) website or contact our clinic directly.
What is an andrologist?
An andrologist is a specialist in men’s health, focusing on issues related to the male reproductive system and urology. They diagnose and treat conditions affecting male fertility, sexual function, and other reproductive health concerns.
