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Erectile dysfunction or disorder (ED) is the inability to develop and maintain an erection for satisfactory sexual intercourse or activity. For some men erectile dysfunction can appear occasionally from time to time and for others it is an ongoing problem. Erectile dysfunction can have many causes such as tiredness, anxiety or consuming too much alcohol. However, in some cases ED can be caused by underlying health conditions. Treating erectile dysfunction may require a simple lifestyle change, although in some cases, prescription medication can be very helpful in maintaining a satisfactory sex life.
What is Erectile Dysfunction and what causes it?
Erectile dysfunction (ED) is also referred to as impotence. It is a condition that affects men and it's defined by the inability to develop and maintain a satisfactory erection that is required for sexual intercourse or the inability to develop and maintain an erection in response to sexual stimulation.
Erectile dysfunction is a very common issue and can affect a man at any age, although it becomes more frequent with older age. Approximately 50% of men between the ages of 40 and 70 will experience erectile dysfunction at least once.
Erections are produced when a man becomes sexually stimulated or aroused. This arousal causes the brain to send signals to the nerves in the penis, which increase the flow of blood to the penis, causing it to enlarge and harden. If anything interrupts this signalling or blood flow, erectile dysfunction can occur. Interruptions to this process of erection can have physical, psychological or medicinal causes.
Physical causes of Erectile Dysfunction
Conditions such as diabetes, high blood pressure and cardiovascular diseases can affect blood flow to the penis.
Conditions such as underactive thyroid, hypogonadism and Cushing’s syndrome, can affect the hormone levels in the body that are needed to develop and maintain an erection.
Conditions such as multiple sclerosis (MS) and Parkinson's disease affect the body’s nervous system and can interfere with the brain’s signalling.
Conditions like Peyronie’s disease affect the tissue in the penis which can result in the inability to develop an erection.
Psychological causes of Erectile Dysfunction
Mental strains like stress, anxiety and depression can lead to erectile dysfunction.
Your thoughts and feelings can affect your ability to maintain an erection. For example, lack of sexual knowledge can lead to feeling nervous or past sexual abuse can trigger anxiety and stress.
Medicinal causes of Erectile Dysfunction
Certain medicines can cause erectile dysfunction in some men. For example, beta-blockers, diuretics, corticosteroids, antidepressants, antihistamines and cytotoxics.
What are the symptoms of Erectile Dysfunction?
The main symptom of erectile dysfunction is the inability to develop and maintain an erection to achieve sexual intercourse. If you experience erectile dysfunction, it is very important to find out what the underlying cause may be. You can sometimes determine this yourself but if in doubt, it’s always a good idea to seek the advice of your doctor. An example of you determining the cause could be a scenario where you can maintain an erection whilst masturbating but are unable to maintain an erection when trying to engage in intercourse with your sexual partner. This would indicate that the cause of the dysfunction is very likely to be psychological. However, a scenario in which you cannot develop or maintain an erection in any type of circumstance, would point towards an underlying physical cause or in some cases a medicinal cause. If you are taking any prescription medication, it would be a good idea to check the possible side effects of that drug.
The most common cause of Erectile Dysfunction is due to a reduced flow of blood to the penis. For a large number of men, this can be caused by the narrowing of the blood vessels that flow into the penis, disallowing a sufficient amount of blood needed to develop or maintain an erection. Some lifestyle or health factors that can reduce the amount of blood flow to the penis include; excess weight gain, high blood pressure, high cholesterol, smoking and diabetes. As erectile dysfunction can be caused by these underlying health conditions, it may very well act as an early indicator for heart disease and you should therefore get a full check-up with your GP.
If the onset of Erectile Dysfunction occurs slowly, it is more likely to indicate a physical cause, such as the narrowing of blood vessels. However, if Erectile Dysfunction occurs abruptly, it is more likely that the cause is psychological.
Other causes of Erectile Dysfunction can include; injuries and diseases that affect the nerves or blood vessels in the penis; abnormal hormone levels, such as low testosterone; excess alcohol or drug abuse; psychological/emotional problems such as anxiety and stress.
How is Erectile Dysfunction diagnosed?
Erectile dysfunction can be self-diagnosed, as the main symptom is the inability to maintain an erection- which can be fairly obvious and apparent to yourself. However, whenever you experience a new symptom or issue with your bodily functions, it is always recommended that you seek the advice of your doctor. Erectile dysfunction can be a sensitive issue that you may not wish to share or discuss with your doctor. If this is the case, we recommend that you still ask your doctor for a check-up, as erectile dysfunction can be a symptom of underlying health conditions such as cardiovascular diseases, which need to be addressed as soon as possible.
When you consult with your doctor about your erectile dysfunction, they will require you to answer some questions about your sexual history. It is important to be honest about your answers as this will aid diagnosis. Your doctor may ask you questions about:
- Your sexual orientation
- Previous and current sexual partners
- Levels of sexual desire and libido
- How long you’ve been suffering from erectile dysfunction and to what degree you can develop an erection
- Whether or not you’ve been able to achieve orgasm or ejaculation
They may also ask you about more general things such as your overall physical and mental health, drug or alcohol consumption, medications you take and various lifestyle habits (diet, exercise).
Your doctor may perform a number of simple tests to aid diagnosis:
- Blood pressure test
- Height, weight and waist measurements
- Heart rate check
- Blood glucose and lipids test
- Physical examination of penis
If you are over the age of 50 then your doctor may wish to perform a rectal (prostate) exam where they will insert a gloved finger into the anus. This will help rule out underlying health conditions such as prostate cancer.
In some cases, your doctor may want to carry out a blood test to check the hormone levels. This will help rule out any possible hormonal conditions such as low testosterone (hypogonadism).
Erectile dysfunction (caused by physical problems) is rare in men under the age of 40, so in this case, further testing may be required or you may be referred to a specialist.
What treatments are available for Erectile Dysfunction?
In recent years, the treatments available for erectile dysfunction have greatly improved, with most men being able to resume satisfactory sexual activity. Treatments are usually a combination of medication and lifestyle changes.
The four main medications available to treat erectile dysfunction are:
These four medications are all designed to do the same thing but there are important differentiating features between them. Choosing the right medication will depend on various factors such as your current state of health and whether or not you are taking any other medication. It can also be a case of personal preference. Please note that Viagra is just the branded version of Sildenafil and it actually contains Sildenafil.
Sildenafil / Viagra
- Available in 25mg, 50mg and 100mg tablets
- Should be taken 1 hour before sexual intercourse
- The effects should last between 4-5 hours
- Food can slow down the effectiveness of Sildenafil
Tadalafil / Cialis
- Available in 2.5mg, 5mg, 10mg and 20mg tablets
- The 2.5mg and 5mg tablets are taken once per day
- The 10mg and 20mg tablets are taken when required (before sexual activity)
- Should be taken 30 minutes before sexual intercourse
- The effects should last approximately 36 hours
- These medications are not affected by food
The right dosage strength will not relate to the size of an individual or their blood pressure. It is therefore recommended that all new patients start with a medium strength dose. For Viagra and Sildenafil, this would be the 50mg tablet. For Tadalafil and Cialis, this would be the lowest dose of the ‘when required’ tablet which is 10mg.
When initially using the medication, it should be trialled for at least 4 times before deciding whether the dosage strength is effective enough or is too strong. In some cases, it may be a good idea to try one of the alternative drugs instead of opting for a higher dosage.
These medication needs to be taken before sex and they should be effective for several hours. There are slight variations between these medications in terms of how long the effects last. Although these medications state that the effects last for a certain amount of time, the penis will still need stimulation or sexual arousal to maintain an erection.
The most common side effects of these medications are headaches and flushing.
It is very important to consult with your doctor before attempting to buy these medications and to also purchase them from a trusted online store to avoid buying fake or ineffective versions.
A lot of the time, erectile dysfunction is caused by a psychological issue. If this is the case for you, treatment such as counselling, cognitive behavioural therapy or sex therapy can be very helpful, especially when combined with physical therapy.
When erectile dysfunction does not respond to drug treatment or psychotherapy, your doctor may suggest treatments such as prosthesis, hormone therapy, vacuum devices and in some cases, surgery. These alternatives should only be considered as a last resort when dealing with a severe case of erectile dysfunction.
Listed below are a number of lifestyles changes you can make to reduce the risk or effects of erectile dysfunction:
- Maintaining a healthy weight
- Minimising consumption of fatty and salty foods
- Quitting smoking and drug use
- Minimising alcohol consumption
- Minimising stress levels
- Regular physical exercise
These lifestyle changes can reduce the risk of you developing erectile dysfunction and improve your overall health.
Erectile Dysfunction Misconceptions
Erectile Dysfunction is linked to sexual attraction – False
People are under the notion that if a man needs to take Viagra to maintain an erection, it means he isn't sexually attracted to his partner. This is simply not the case. Even after taking Viagra, a man can only develop an erection if he is properly stimulated.
Of course, there is the possibility that you find your partner unattractive, in which case the cause of the erectile dysfunction would be a psychological one and taking medication to treat it won't help.
Erectile Dysfunction is when you NEVER get an erection – False
There is a belief that if a man doesn’t have erection problems ALL the time, it cannot be Erectile Dysfunction. This is not the case. There are varying degrees and symptoms of erectile dysfunction including; the inability to achieve any erection at all; achieving a mild erection but not enough to enter your partner; developing an erection but not being able to maintain it throughout sexual intercourse.
Erectile Dysfunction only occurs in old men – False
There is a general belief that erectile dysfunction is an issue that only older men have to deal with. This is not the case. Although the likelihood of developing erectile dysfunction increases with age, erectile dysfunction can occur at any age.
Taking Viagra means you will have an erection until the effects of the drug wear off – False
Due to pop culture and the spreading of misinformation, many people are under the impression that Viagra causes a constant erection. This is not the case; without arousal or stimulation an erection cannot be maintained. The active ingredients in Viagra and similar drugs do not automatically provide an erection, but instead open the veins allowing for more blood flow to the penis when stimulated. Theoretically, you could take the appropriate medication and still not achieve an erection if you aren't properly aroused or stimulated.
Sildenafil, Viagra, Tadalafil and Cialis, all work the same way to produce an erection but have subtle differences in how long the effects last and how quick the onset of the effects come about. Cialis and Tadalafil generally have the fastest onset (sometimes within 15 minutes) and have the longest lasting effects (up to 36 hours). Sildenafil and Viagra usually take an average of 30 minutes to start their effects which can last up to 4 hours.
- You should not take more than one Sildenafil or Viagra tablet within a 24-hour window.
- You should not take more than one Tadalafil or Cialis tablet within a 36-hour window and no more than two ‘as required’ tablets in one week. You should not take more than one ‘daily’ tablet of Tadalafil or Cialis within a 24-hour window.