15 September 2017
Ian Pearce, Consultant Urological Surgeon
What is erectile dysfunction?
Erectile dysfunction is the persistent inability to achieve or maintain an erection sufficient for sexual intercourse to the satisfaction of both partners. It may therefore present as an inability to get an erection or with difficulty keeping an erection. This is distinct from premature ejaculation where loss of erection happens after ejaculation which may occur earlier than desired.
How common is erectile dysfunction?
Erectile dysfunction is a very common complaint with over half of all men over 40 complaining of some level of erectile difficulty and over 100,000 new cases present each year in the UK. This is equivalent to over 4000 new cases of erectile dysfunction per year in the Greater Manchester region alone. Approximately one quarter of men suffering from erectile problems are under the age of 40 years.
What causes erectile dysfunction?
Erectile dysfunction is caused by many issues and there is usually a combination of these causes that results in erectile problems. Increasing age is the single most common and influential risk factor with other causes being obesity, lack of exercise, smoking, excess alcohol intake, diabetes and high blood pressure. Major pelvic surgery such as prostate removal for prostate cancer is also a common cause of erectile problems and some medications have also been shown to be linked with erection issues, particularly those used to treat depression, anxiety and prostate cancer.
How can erectile dysfunction be treated?
Erectile dysfunction can be treated in many ways and each patient will usually be managed in a step wise fashion to ensure the greatest chance of success.
Lifestyle modification is advisable in all patients suffering from erectile dysfunction. Men should be advised to undertake moderate exercise, stop smoking and lose weight if overweight. Dietary advice is also important particularly for those patients with diabetes: good control helps to prevent and reduce erectile problems
If lifestyle modification fails to have the desired effect, men can be offered tablet treatment (Viagra, Cialis, Levitra, Spedra). These tablets help men to achieve and maintain an erection with sexual stimulation but are not suitable for all men. In particular men with angina may not be suitable for this form of treatment.
Topical cream is also available and this must be applied to the head of the penis and absorbed some time before sexual stimulation. The same drug can be delivered by an injection into the side of the penis. This will require expert tuition and men can be taught how to inject themselves at home.
The vacuum device for erections is the last non operative option and this involves a vacuum cylinder on the penis which draws blood into the penis causing engorgement and erection. These vacuum pumps may be hand operated or electric.
The final option is a penile prosthesis which requires specialist surgery to place either rigid or inflatable cylinders into the penis to achieve a stiff penis on demand. This type of surgery requires significant and specialist counselling and should be viewed as a last resort when all other options have failed.
Ian Pearce is a consultant urologist specialising in andrology, female incontinence and chronic bladder conditions. For more information or to book an appointment with Mr Ian Pearce, please call 0161 447 6700.
The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other health care professional.