Erectile dysfunction

Erectile dysfunction is the inability to maintain an erection firm enough to have satisfactory sex.

Most sufferers won't discuss it, so it is difficult to know exactly how many men are affected. At least 5% of 40 year old men are impotent, and this increases to over 25% in those over the age of 65.

Half of all cases are caused by medical problems such as depression, anxiety, stress, overwork, thyroid disease, diabetes, anaemia, multiple sclerosis, arterial disease, testicular failure and of course ageing!

Others cases are caused by drugs such as:

• Tablets for high blood pressure e.g. methyldopa, propanolol and certain 'water tablets' - thiazides and spironolactone
• Anti-depressants and anti-schizophrenia drugs
• The peptic ulcer medication cimetidine
• Anti-epilepsy drugs
• Alcohol
• Tobacco

The remaining cases are usually caused by psychological problems. For instance, once the loss of an erection occurs during sex, fear of its recurrence produces anxiety, which can cause impotence. However, counselling and sex therapy has been shown to be effective in treating over half of men with psychological problems.

If you experience ED symptoms, referral to a specialist in genito-urinary medicine is recommended. After removing any possible causes, treatments can include:

• Self injecting vasodilator drugs into the shaft of the penis, which opens up the blood vessels
• Vacuum devices that fit over the penis and draw blood into the penis, producing an erection
• Penile implants or splints, which make the penis rigid enough for intercourse
• Inflatable devices which cause an erection by pumping fluid from a small reservoir in the scrotum into the penile shaft

The latest and most acceptable treatments include:

• MUSE (medicated urethral system for erection), a tiny pellet which, when inserted into the urethra, produces an erection in 5 to 10 minutes and lasts between 30 and 60 minutes. This is now available on NHS prescription
• Viagra, a tablet which produces an erection by improving circulation to the penis. It has become the fastest selling drug ever in the history of medicine, which tells you the real size of the problem of ED!
• Cialis, a similar drug, operates on the same principle

This article was published on Thu 24 December 2009