In today’s blog, we will be touching up on a sensitive topic that can affect up to one in five men under 40. Erectile dysfunction or impotence, commonly referred to as ED, is the inability to get or keep an erection firm enough to have sexual intercourse. Occasional ED is quite common and can be linked to acute problems such as stress or alcohol, however, frequent ED could be sign of an underlying condition that may need to be addressed by a professional. It is important that you do not confuse ED with other male sexual problems such as premature/delayed/absent ejaculation or lack of sexual interest.
There are two main symptoms of ED:
- Trouble getting an erection
- Trouble keeping an erection
ED is generally caused by an underlying condition that needs to be treated in order to hence treat ED too.
When a man becomes aroused, his brain sends signals to the nerves in his penis. The nerves increase the blood flow to the penis, causing the tissue to expand and harden. Anything that interferes with the nervous system or the blood circulation could lead to erectile dysfunction.
There are four main types of health conditions that can cause physical problems resulting in erectile dysfunction. These are:
- conditions affecting the flow of blood to your penis – vasculogenic
- conditions affecting your nervous system, which is made up of your brain, nerves and spinal cord – neurogenic
- conditions affecting your hormone levels – hormonal
- conditions affecting the physical structure of your penis – anatomical
Examples of vasculogenic conditions that cause erectile dysfunction include:
- cardiovascular disease – a disease of the heart or blood vessels, such as atherosclerosis (hardening of the arteries)
- high blood pressure (hypertension)
- diabetes – a condition caused by high blood sugar levels. This can affect both the blood supply and the nerve endings in your penis, so it is also a neurogenic condition
Erectile dysfunction is strongly associated with cardiovascular disease. For this reason, it may be one of the first causes your GP considers when making a diagnosis and planning your treatment.
Examples of neurogenic conditions that cause erectile dysfunction include:
- multiple sclerosis – a condition that affects the body's actions, such as movement and balance
- Parkinson’s disease – a condition that affects the way that the brain coordinates body movements, including walking, talking and writing
- a spinal injury or disorder
- a stroke – a serious condition that occurs when the blood supply to the brain is interrupted
Examples of hormonal conditions that cause erectile dysfunction include:
- hypogonadism – a condition that affects the production of the male sex hormone, testosterone, causing abnormally low levels
- an overactive thyroid gland (hyperthyroidism) – where too much thyroid hormone is produced
- an underactive thyroid gland (hypothyroidism) – where not enough thyroid hormone is produced
- Cushing's syndrome – a condition that affects the production of a hormone called cortisol
Other physical problems
Men who cycle for more than three hours per week may be recommended to try a period without cycling to see if this helps improve erectile dysfunction. Riding in the correct position with a properly fitted seat may also help to prevent regular cycling from leading to erectile dysfunction.
Penis injuries or surgical treatment of the penis, pelvis or surrounding areas can sometimes lead to erectile dysfunction. Erectile dysfunction is also thought to occur in up to 15-25% of people who experience a severe head injury.
Certain medicines can cause erectile dysfunction as a side effect. Some include, but are not limited to:
It is important to seek medical advice if you think ED may be a side effect of a medicine you are taking. Stopping medicines without consulting a healthcare professional can be extremely dangerous.
Possible psychological causes of erectile dysfunction include:
There are many emotional issues that may also affect your physical ability to get or maintain an erection. These include:
- relationship problems
- lack of sexual knowledge
- past sexual problems
- past sexual abuse
- being in a new relationship
Diagnosis and treatment
Erectile dysfunction (ED) can often be diagnosed by your GP. They will talk to you about your situation and may carry out a physical examination.
Your GP may ask you about:
- your symptoms
- your overall physical and mental health
- your alcohol consumption
- whether you take drugs
- whether you are currently taking any medication
If you do not want to talk to your GP about erectile dysfunction, you can visit a genitourinary medicine (GUM) clinic. You can find your nearest GUM clinic on the British Association for Sexual Health and HIV (BASHH) website.
If your erectile dysfunction is caused by an underlying health condition, such as heart disease or diabetes, that condition may need to be treated first. In some cases, treating the underlying cause may also resolve the problem.
If you are taking medication that can cause erectile dysfunction, there may be an alternative. It is important never to stop taking a prescribed medication unless you are advised to do so by your GP or another qualified healthcare professional responsible for your care.
Treatments for ED can include medication therapy, vacuum pumps, hormone therapy, surgery and psychological treatments. Which treatment you require will depend on the underlying cause of your condition. Your doctor will be the best person to help you with that.