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Patient Handout Sexual health Causes | Symptoms | Treatment | Lifestyle & diet | Medicines | Support & resources Erectile dysfunction Overview If you are a man having difficulty maintaining an erection during sexual intercourse, one of the most important things you should know is that you are not alone. Erectile dysfunction (ED), sometimes also known as impotence, is believed to affect around 40% of men at some time in their lives. Usually it’s defined as having difficulty getting or maintaining an erection, or not having a hard enough erection. For some men it is a rare or occasional problem, but for others it is ongoing. While it can be upsetting for the man and their partner, only 12% of men seek help – that’s despite the fact that it is often easily treatable. It s important to note that erectile dysfunction can be an indicator of an underlying cardiovascular condition, or of diabetes, a prostate problem, or anxiety and depression – all of which can be treated. So the message is clear – erectile dysfunction can usually be treated and treating it could save your life as it may be an indicator of a more serious underlying condition. Causes There are many conditions which are known to cause erectile dysfunction, and the most common ones include: ◗◗ Age. The incidence increases with age. ◗◗ High blood pressure, (hypertension). ◗◗ Diabetes. ◗◗ Heart disease. ◗◗ Prostate problems, including an enlarged prostate or cancer. ◗◗ Anxiety. ◗◗ Vascular conditions such as penile arterial disease. ◗◗ Depression. ◗◗ Penile trauma. ◗◗ Congenital disorders. ◗◗ Neurological diseases, including spinal cord injury, multiple sclerosis, and tumours. ◗◗ Psychosis. ◗◗ Relationship issues. ◗◗ Sexual abuse. ◗◗ Stroke. ◗◗ Thyroid disease. ◗◗ Major surgery. ◗◗ Kidney (renal) failure. There are a number of other factors that may contribute to a man’s predisposition to the incidence of erectile dysfunction, including: ◗◗ Smoking. ◗◗ Excessive alcohol consumption. ◗◗ Obesity. ◗◗ Sleep apnoea. ◗◗ Lack of sleep. ◗◗ Substance abuse, including illegal and ◗◗prescription drugs. ◗◗ Some medications. ◗◗ Symptoms Symptoms of erectile dysfunction will vary from man to man, depending on its frequency and severity. Symptoms may include: ◗◗ Difficulty getting and maintaining an erection,despite stimulation. ◗◗ Erections may not remain hard enough for penetration for intercourse. ◗◗ Once penetration has taken place, sometimes erections can not be maintained to continue or complete sexual intercourse. Erectile dysfunction can cause anxiety about sexual performance and this can exacerbate the problem. Treatment options For most men erectile dysfunction can be treated so they can resume normal sexual activity. It is important to note that there are many treatments on the market that claim to address men’s sexual problems, but these can be very costly and most over-the-counter or postal order products are not scientifically validated. Treatments for erectile dysfunction fall into three main categories ◗◗ Non-invasive ◗◗ Minimally-invasive ◗◗ Surgical Sometimes these will be used in combination. ◗◗Non-invasive treatments These are the most popular treatments and include oral medications, commonly Viagra, Cialis or Levitra. These medications work allowing the blood that flows to the penis during an erection to stay there longer, and in doing so, maintaining the erection for longer. It is estimated that medication works in about 70% of patients, but it is not without potential side effects which include facial Reviewed by: Dr Michael Lowy, Sydney Men’s Health, Bondi Junction, NSW flushing, headaches, indigestion and nasal congestion. People with heart problems must not take erectile dysfunction medication without consultation with their doctor, as it may interact with existing heart medications. Other non-invasive treatments include counselling (as well as psychotherapy), and hormone therapy, which may be particularly effective for men with low testosterone levels. Another treatment involves the use of devices such as vacuum pumps. The pump looks like a tube and is placed over the penis. Air is pumped out of the cylinder, raising the pressure that helps to draw blood into the penis, causing it to enlarge. A rubber ring is then placed around the base of the penis, and this helps to maintain the erection. Minimally-invasive treatments Penile injections are the mainline treatment of this approach, but these are not as scary as they sound. This method was widely used until oral medication was introduced, and it remains a popular treatment for men who have undergone prostate surgery or have nerve damage. It is also useful for men who can’t take oral medication because it is not effective or it is not recommended. Once a man learns to self-administer the injection, it is generally easy to use and very effective. The medication increases blood flow, resulting in an erection within about 5 to 10 minutes that can last up to an hour. However, it also has potential side effects, including a painful erection that can last for several hours. This requires medical treatment to avoid permanent penis damage. This side effect is usually the result of injecting too much medication, so care should always be taken to follow the doctor’s prescription instructions. ◗◗ Surgical treatments Penile implants (also known as prostheses), and less commonly, vascular surgery, are possible surgical treatments for erectile dysfunction. Penile implants are usually only recommended after other treatments have been tried and failed. It involves placing an implant into the penis that can be manually squeezed or pumped to create an erection. Similarly, vascular surgery is also generally a last resort treatment. The surgery aims to repair restore blood flow to and from the penis. ◗◗ Patient Handout Sexual health Causes | Symptoms | Treatment | Lifestyle & diet | Medicines | Support & resources Erectile dysfunction Generally erectile dysfunction can be treated by your GP, but sometimes the problem involves complexities that require referral to a specialist or other allied health professionals, such as: ◗◗ Endocrinologist. These specialists work with patients who have a hormonal or metabolic disorder such as diabetes. ◗◗ Urologist. If penile surgery is required you are likely to be referred to this specialist. ◗◗Psychologist or counsellor specialising in sexual disorders if there are psychological issues involved. Lifestyle and diet Staying healthy and on top of diseases such as diabetes, heart disease and high blood pressure are the key to maintaining good erectile function. Regular exercise, a low cholesterol diet, avoiding excessive alcohol, not smoking and maintaining a healthy weight may help reduce the risk of developing erectile. Support and resources Impotence Australia (www.impotenceaustralia.com.au) ◗◗ Andrology Australia (www.andrologyaustralia.org) ◗◗ Mensline Australia (www.menslineaus.org.,au) ◗◗ ItsMyHealth.com.au Reviewed by: Dr Michael Lowy, Sydney Men’s Health, Bondi Junction, NSW