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Erectile dysfunction

More commonly known as impotence, erectile dysfunction is the inability to achieve or sustain an erection for sex. It affects around one in 10 men and has a number of causes which are mainly physical, though there are some psychological causes too. There are a variety of treatment options to suit the majority of men who experience impotence.

About impotence

Impotence occurs when a man has difficulty either getting an erection or keeping one long enough to have sex.

It's one of the most common sexual problems, with half of all men over 40 experiencing it at some point in their lives. However, only about one in 10 men seek help. If you have problems getting or maintaining an erection over several weeks, ask your GP for advice.

Causes of impotence

There could be a number of reasons why you have impotence and sometimes there may be two or three factors present. Around three-quarters of men with erectile dysfunction have physical problems affecting the blood supply to their penis. About one in 10 men will have erectile dysfunction related to psychological factors such as stress at work, performance anxiety or financial worries.

Physical health

A number of conditions may cause impotence, including:

  • high blood pressure
  • high cholesterol
  • sleep apnoea
  • diabetes
  • obesity
  • kidney failure
  • multiple sclerosis
  • Parkinson's disease
  • stroke
  • treatment procedures (such as an operation to remove your prostate gland, or radiation in your pelvic area)
  • hormone imbalances such as hypogonadism which causes low levels of testosterone
  • Peyronie's disease - a condition affecting the sheath that surrounds the erectile tissue of the penis
  • hypospadias - a condition causing the urethra and penis to develop abnormally.

Psychological

Psychological problems can sometimes influence your ability to get and maintain an erection. These could include:

  • feeling anxious, guilty or depressed
  • stress at work
  • relationship problems
  • unresolved issues about sexual orientation
  • sexual boredom.

Lifestyle

Drinking too much alcohol can affect your ability to get and maintain an erection. In the long term it interferes with the production of testosterone, which can reduce your libido.

Smoking damages your blood vessels and this can increase the risk of erection problems. There's also anecdotal evidence suggesting that regular cannabis use plays a role in impotence.

Your risk of impotence may increase if you're physically inactive.

Medicines

The side effects of some medicines, such as high blood pressure treatments and certain antidepressants, can cause impotence. Medicines can also affect your libido or cause problems with erections, ejaculation and achieving orgasm.

Cycling

Cycling for more than three hours a week can increase your risk of impotence due to damaged erectile nerves through contact with the saddle. Your GP may recommend that you stop cycling for a few weeks to allow the nerves to repair and see if there is any improvement. You can also buy saddles that reduce damage to the nerves.

Diagnosis of impotence

It's important to see your GP if you're anxious about your ability to sustain an erection. For younger men, occasional episodes of impotence are common and don't mean you will have persistent problems in the future.

Your GP will ask about your general health and your erections. They'll also ask if you're taking any medicines, and whether there have been any recent changes in your life that might have influenced your sexual health.

Your GP will take your blood pressure and check the pulses in your legs. This helps to indicate how healthy your circulation is. They may also take a blood sample to test for related conditions. They'll examine your penis and scrotum and sometimes your prostate gland.

Your GP may talk with you and your partner together about any physical or psychological factors that could contribute to your impotence. For example, around the menopause, women may experience pain or discomfort during intercourse, which in turn could impact the performance of their sexual partners.

If necessary, your GP may ask you to undergo more specialised tests to assess blood flow and how your nerves are working.

Treatment of impotence

The vast majority of men are given a suitable treatment for their impotence. Talking to a counsellor or psychosexual therapist may help you if the cause is related to anxiety or relationship difficulties.

Self-help

A healthier lifestyle may prevent your impotence getting worse. The following changes can help:

  • quit smoking
  • lose excess weight
  • take moderate-intensity exercise (to the point of feeling warm and slightly out of breath) for at least half an hour on most days of the week
  • eat a balanced diet including at least two portions of fruit and five portions of vegetables a day. Cut down on salty foods and sugary drinks
  • drink alcohol in moderation and avoid using drugs
  • take steps to reduce stress in your life
  • if you have diabetes, manage your blood sugar levels.

Medicines

If your GP thinks prescription medicines are causing or contributing to impotence, you may be able to switch to an alternative medicine.

Trialling a medicine that will help you keep an erection is the next step. There are different types of medicine known as phosphodiesterase type-5 (PDE5) inhibitors and the three most commonly used are sildenafil, tadalafil and vardenafil. They work in the same way to relax the blood vessels in your penis so more blood can flow into it, leading to an erection. They don't increase your libido so you will still need sexual stimulation. The medicines will enable you to have erections for several hours.

Although these medicines are proven to be effective, they may cause side effects including headaches, nausea, indigestion and flushing. You shouldn't take PDE5 medications if you're using nitrates for angina (chest pain) or other heart conditions as they may cause your blood pressure to drop and lead to other complications, including heart problems. If you have any medical conditions affecting your heart and blood vessels, talk to your GP about whether you can use these impotence medications.

All of these medicines are only legally approved for use in men and haven't been shown in clinical trials to be safe for women.

If your impotence is being caused by a hormonal imbalance, your GP may refer you for hormone replacement therapy.

Talk to your GP about which medicine is most suitable for you.

The risks of buying medicines online

If you're considering buying impotence medicines on the internet, take care to ensure that any purchase you make is from a credible, regulated and legal website. If not, there's no guarantee that what you purchase will be safe or effective.

Research shows that erectile dysfunction medicines sold over the internet may contain anything from zero active ingredients (the medicine causing the therapeutic effect) to almost two and a half times the acceptable level of the active ingredients, as well as unapproved and toxic materials like lead and mercury.

Before purchasing impotence medication from the web, visit your GP for an accurate diagnosis and an appropriate treatment plan. This is particularly important because impotence can be a sign of other health problems.

Alternative treatments

An external vacuum pump device is available which works by pumping out the air from the penis and sucking blood into it. You can use this device with a constriction band to trap blood inside the penis. Other options include having surgery to increase blood supply to the penis, although this is rare, or having a penile implant. Ask your GP for more information about these alternative treatments.

Further information

Andrology Australia
www.andrologyaustralia.org

Sources

American Urology Association Foundation (AUAF). Non-Surgical Management of Erectile Dysfunction (ED). [online] Linthicum, MD: AUAF. Jan 2011 [Accessed 14 July 2011] Available from: http://www.urologyhealth.org/urology/index.cfm?article=60

American Urology Association Foundation (AUAF). Surgical Management of Erectile Dysfunction (ED). [online] Linthicum, MD: AUAF. Jan 2011 [Accessed 14 July 2011] Available from: http://www.urologyhealth.org/urology/index.cfm?article=28

Andrology Australia. Erectile Dysfunction (impotence). [online] Clayton, VIC: Andrology Australia. Nov 2010 [Accessed 14 Jul 2011] Available from: http://www.andrologyaustralia.org/

Andrology Australia. Erectile dysfunction: Diagnosis and management. [online] Clayton, VIC: Andrology Australia. May 2010 [Accessed 14 Jul 2011] Available from: http://www.andrologyaustralia.org/

British Society for Sexual Medicine. Guidelines on the management of erectile dysfunction. [online] UK: British Society for Sexual Medicine. 2009 [Accessed 14 Jul 2011] available at http://www.bssm.org.uk/downloads/BSSM_ED_Management_Guidelines_2009.pdf

McVary KT. Clinical practice: Erectile dysfunction. N Engl J Med. 2007; 357(24):2472-81.

Urological Society of Australia and New Zealand (USANZ). Urologists Warn Against Purchasing Erectile Dysfunction Medication Online. [online] Edgecliff, NSW: USANZ. Jun 2010 [Accessed 14 Jul 2011] Available from: http://www.usanz.org.au/uploads/29168/ufiles/Urologists%20warn%20of%20Online%20Viagra%20purchases_16June%202010.pdf (PDF, 68.8Kb)

Last published: 30 October 2011

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This information has been developed and reviewed for Bupa by health professionals. To the best of their knowledge it is current and based on reputable sources of medical research. It should be used as a guide only and should not be relied upon as a substitute for professional medical or other health professional advice.

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