Erectile dysfunction (ED) or impotence is the repeated inability to obtain or maintain an erection that is sufficiently firm to achieve the kind of sex desired by a man and his partner. It can range from total inability to obtain an erection, to an inconsistent ability to do so, or a tendency to sustain only brief erections. These variations make defining ED difficult and it’s extremely common to experience some degree of erectile dysfunction at some point or other – in fact 50% of men suffer erection difficulties at some point in their lives.

Older men may accept ED as a ‘normal’ part of the ageing process without realising it can be treated effectively, and therefore do not seek advice about treatment.

Causes of erectile dysfunction

An erection involves a precise sequence of events – starting with nerve impulses from the brain, through to responses within the muscles and blood vessels within the penis – and so lots of things can potentially cause erectile dysfunction, including physical, psychological and drug-related factors.

Physical causes:

  • Vascular disease
  • Diabetes mellitus
  • Hormone abnormalities such as hyperprolactinaemia
  • Certain prescribed drugs
  • Hypercholesterolemia (high cholesterol)
  • Diseases affecting the erectile tissue of the penis
  • Neurological diseases
  • Severe chronic diseases such as kidney and liver failure
  • Alcoholism and drug abuse
  • Surgery (especially radical prostate and bladder surgery)
  • Injury to the penis, spinal cord, pelvis, prostate or bladder
  • Heavy smoking
  • Being overweight

Drug induced causes:

  • Alcohol
  • Antihypertensives (medication for high blood pressure) e.g. diuretics, beta blockers, methyldopa
  • Cimetidine
  • Marijuana, heroin, methadone
  • Major tranquillisers
  • Tricyclic antidepressants
  • Digoxin
  • Glucocorticosteroids
  • Oestrogen, anti-androgens

Psychological causes of Erectile Dysfunction:

  • Stress and anxiety from work or home
  • Relationship conflicts and dissatisfaction
  • Depression and other psychiatric conditions and their medications
  • Sexual boredom or unresolved sexual orientation

Determining the cause of erectile dysfunction usually begins with an in-depth chat about your medical and sexual history and general health, to help indicate which root to investigate. Physical examinations and tests may also be carried out.

Treatment for Erectile Dysfunction

There’s usually lots that can be done to help erectile dysfunction. This may be something as simple as lifestyle changes, or addressing underlying psychological issues or stress, through to certain medications, injections and surgical implants, depending on the root cause of the problem and the best solution for the individual patient.

It’s always best to seek professional advice before commencing any treatment for erectile dysfunction, however, to ensure underlying causes have been adequately investigated, and that the treatment is appropriate and won’t interact negatively with any other drugs you’re taking.

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Katie.Fraser@hcahealthcare.co.uk