Erectile dysfunction (ED), also known as impotence, is the inability to get and maintain an erection. In some
Most men have occasional times when they cannot get an erection. For example, you may not get an erection so easily if you are tired, stressed, distracted, or have drunk too much alcohol. For most men, it is only temporary and an erection occurs most times when they are sexually aroused.
ED is a very common condition, particularly in older men but it can occur at any age. It is estimated that half of all men between the ages of 40 and 70 will have it to some degree.
ED is usually treatable, most commonly by a tablet taken before sex. You may also receive lifestyle advice and treatments to minimise the risk of heart disease.
- Reduced blood flow to the penis(a rush of blood to the penis is needed for erection): this is the commonest cause of ED in men aged over 40. Smoking, high blood pressure, high cholesterol, obesity and growing older can increase the risk of reduction of blood flow to all parts of the body.
- Diseases that affect the nerves going to the penis e,g stroke.
- Diabetes: one of the most common causes of ED. Diabetes can affect blood vessels and nerves.
- Hormonal causes: a lack of a hormone called testosterone which is made in the testicles (testes).Other symptoms of a low testosterone level include a reduced sex drive (libido) and changes in mood.
- Injury to the nerves going to the penis: eg spinal injury.
- Medication side effects: most common are some antidepressants; beta-propranolol, atenolol, etc; some ‘water tablets’ (diuretics); cimetidine. Many other less commonly used tablets sometimes cause ED.
- Alcohol and drug abuse.
- Cycling: ED after long-distance cycling is thought to be common. It is probably due to pressure on the nerves going to the penis, from sitting on the saddle for long periods. This may affect the function of the nerve after the ride.
- Stress: this can occur due to a difficult work or home situation
- Relationship difficulties.
As a rule, if there are times when you can get a good erection ( eg by masturbating or if your early morning erection is intact ) but at other times you can’t get an erection then a psychological cause for the ED is more likely than a physical cause.
ED causes poor self-esteem, anxiety and even depression. These reactions to ED can make the ED worse and lead to a vicious circle of worsening anxiety, depression and persisting ED.
The good news
These interventions can be creams, medications, devices , urethral prosthesis and injections, counseling and psychosexual therapies and/or refer you on for more specialist support intervention depending on the cause found.
Note that tablets to treat ED will cause an erection only when you are sexually aroused.
The take-home message is to encourage men to overcome barriers and to seek medical advice when affected by Erectile dysfunction.
Always seek professional help. Consult your doctor.
References: Patient.co.uk, NICE CKS, GP notebook .