What is erectile dysfunction?
Erectile dysfunction (ED), also known as impotence, is the inability to get and maintain an erection thought to affect up to 40 percent of men over the age of 40.
Is erectile dysfunction a normal part of aging?
Erectile dysfunction is a very common condition, particularly in older men. It is estimated that half of all men between the ages of 40 and 70 will have it to some degree.
Erectile dysfunction can have a range of causes, both physical and psychological. Physical causes include:
- Narrowing of the blood vessels going to the penis—commonly associated with high blood pressure (hypertension), high cholesterol or diabetes
- Hormonal problems
- Surgery or injury
Psychological causes of ED include:
- Relationship problems
Why does it happen?
Predominantly because the penile blood vessels aren’t able to react properly when you attempt to become physically aroused. An erection is essentially a mechanical reaction to sexual stimulation. Penile arteries dilate allowing additional blood to flow into the penile filling chambers (corporal cavities) and then the veins that take the blood back to the body constrict, creating a mechanical pooling effect. Erectile dysfunction occurs when any aspect of that mechanical process doesn’t react properly—e.g. the arteries are blocked up with cholesterol. Often, erectile dysfunction is made much worse by penile inactivity leading to a further weakening of penile blood vessel response, and potentially even to penile shrinkage from chronic inactivity.
What can I do to treat it?
Erectile dysfunction is primarily treated by tackling the cause of the problem, whether this is physical or psychological.
The narrowing of the arteries (called atherosclerosis) is one of the most common causes of ED. In these cases your GP may suggest lifestyle changes, such as losing weight, to try to reduce your risk of cardiovascular disease. This may help to relieve your symptoms as well as improving your general health.
You may also be given medication to treat atherosclerosis, such as cholesterol-lowering statins and drugs to reduce your blood pressure.
A number of treatments have been successful in the treatment of erectile dysfunction. Medication, such as sildenafil (sold as Viagra), can be used to manage it in at least two-thirds of cases. Vacuum pumps that encourage blood to flow to the penis and cause an erection are also successful in 90 percent of cases.
Psychological treatments include cognitive behavioural therapy (CBT) and sex therapy.
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.
What products are available for me to use at home?
All the current treatment options can be self-administered and used at home under medical guidance.
Vacuum erection devices are the most widely used of the device options because of their high degree of success. Being mechanical in nature, success simply relies on the user knowing how to customise and apply their device correctly. They are also very safe as the device is applied externally, so isn’t invasive with no risk of systemic side effects.
How often should I use them?
You can use a vacuum pump as often as you and your partner feel like as they have no residual after effects. Realistically two to three times per day if needed, but most men would require application only one or two times per week.
It is also possible to use the pump two to three times per week therapeutically as a sort of ‘penile gym’ to continually expose penile tissues to mechanical stress. This maintains healthy penile architecture and prevents inactivity-related shrinkage.
When can I expect to resume normal sexual activity?
Normally as soon as you want, but if you have had a pelvic or penile surgery, it is advised to wait at least eight weeks after the surgery to allow for suture lines to knit together properly and for localised swelling and bruising to subside. If chronic erectile dysfunction has lead to penile shrinkage, then it will typically take two to four weeks of daily penile reconditioning to achieve normal penile size and comfort at full erection stretch.
Can anyone use these products?
You should not use a vacuum pump if you have an uncontrolled bleeding or clotting disorder, such as haemophilia, factor 8 deficiency, thrombophilia or Von Willebrand’s Disease, or are undergoing titration—the trial use of a new drug—to thin the blood such as warfarin, clopidogrel or rivaroxaban. During the trial phase, it is possible that normal clotting processes will not be stable and this can adversely increase the risk of developing a penile bruise with vacuum pump usage.
There are no age limitations on using a vacuum pump. Reasonable manual dexterity is required although most men with moderate arthritis still do not have difficulty to use a device.
Should I discuss this with my doctor?
Absolutely. Erectile function can be a barometer for cardiovascular health and therefore may be the first sign of a high cholesterol problem or even diabetes. Your GP will likely screen for conditions commonly associated with erectile dysfunction as well as offer general information about the various treatment options that will be available and safe for your particular medical context. They can also refer you to a local NHS urology centre for specialist advice about managing your sexual dysfunction problem.
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