Erectile Dysfunction

Erectile dysfunction is defined as an inability to achieve an erection. It also refers to erections that are inconsistent or only last for a brief space of time. For example, you may have satisfactory sex but find yourself unable to sustain an erection the following day.

For a diagnosis of erectile dysfunction, a man will experience regular problems that are severe enough to interfere with a satisfactory sex life. Experiencing an occasional problem is nothing to worry about, most men find that sometimes they can't perform, but if this turns into a regular issue it's time to seek medical help.

Who is affected by ED?

It's thought over a million Australian men are affected by impotence. Any man is potentially at risk of experiencing erectile dysfunction but the likelihood rises as men age. Men may find as they age erections become less firm, recovery time increases and they take longer to achieve an erection. It's most common in men over 65.

Younger men are not immune to erectile dysfunction. Men in their twenties are more likely to be affected by psychological issues such as performance anxiety, but poor physical health can cause a problem too.

Erectile dysfunction can also affect a man's partner. If you are experiencing erectile dysfunction it can undermine your relationship. It's recommended that you speak to your partner about it openly and honestly. Relationship difficulties can arise without communication and their support is needed during treatment.

There are a variety of factors that influence an erection. They can be split into physical, lifestyle and psychological. Some men may struggle with both, for example a physical problem may lead to the belief he is unable to perform. It can be hard to break away from this cycle of worry.

The physical causes of ED include poor health, lifestyle choice and psychological reasons as follows:

Poor health

• Diabetes - If left uncontrolled, diabetes can damage blood vessels and this restricted blood flow can cause erectile dysfunction. Diabetes may damage blood vessels directly in the penis and cause heart disease.
• Kidney or liver disease - These conditions can damage the circulatory system and alter hormone levels. They can also cause nerve damage.
• Cardiovascular disease - Atherosclerosis and high blood pressure damage arteries and prevent proper blood flow. This poor circulation can lead to impotence.
• Hormone imbalance - An overactive or underactive thyroid can cause erectile dysfunction.
• Neurological disease such as multiple sclerosis and Parkinson's disease affect erectile ability.
• Damage to the genitals, prostate or spinal injuries can cause impotence. A head injury can cause sexual difficulties too.
• Surgical procedures such as prostate operations or bladder surgery can injure nerves near the penis.

Lifestyle

Alcohol can have a profound effect on a man's ability to get or maintain an erection. On occasion overindulging can lead to difficulties.

• Drinking excessive amount of alcohol regularly can lead to long-term problems. Many men don't realise they are drinking more than the recommended limits. Recreational drugs have an effect too.
• Being overweight or obese leads to an increased risk of erectile dysfunction.
• Smoking affects the body's oxygen levels and damages the arteries. If you smoke, you'll be advised to give up. Some men notice an immediate improvement in their erections after quitting.
• Men that take long-term medication may find it interferes with their sexual ability. If you think this is the case speak to your doctor. There are often several different types of medicine that treat an illness, and one may suit you better. Medicines known to cause erectile dysfunction as a side effect include antidepressants, antihistamines, diuretics, corticosteroids and beta-blockers.

Psychological Factors

The mind is a powerful tool. It can create erectile dysfunction without any physical ill health or lifestyle choices. Some of the psychological factors that cause ED are:

• Modern life means stress. This can be caused by work pressures, family difficulties, bereavement or an illness.
• Guilt about unfaithfulness or not spending enough time with your partner can cause impotence, but it doesn't need to be guilty about your partner. Feeling guilty about any aspect of life is enough to cause ED.
• Long-term anxiety and worry can lead to depression. It is difficult to live with and causes erectile dysfunction in some cases.
• Anxious men raise their blood pressure, lower their immune system and create stress that affects the ability to get an erection.
• Younger inexperienced men may worry about their performance and satisfying their partner in bed, although this can happen at any age. Performance anxiety also refers to the vicious cycle of failing to get an erection because you are worried you can't.
• Sexual, physical or mental abuse can lead to issues with sex. You may not think about it directly, but subconsciously it can have an effect.
• Religious, social or morals beliefs can interfere with the process of getting an erection.
• If you no longer find your partner attractive sex can become difficult.

What causes an erection?

For a man to get an erection several psychological and physical factors are in play.

First he must be mentally stimulated. Factors like stress, anxiety, and worry can prevent an erection occurring even before physical reactions take place. Once a man sees, hears or is otherwise mentally stimulated brain sensors send chemical messages to blood vessels. The penile blood vessels open so extra blood can enter the penis. The extra blood enters the usually empty corpora cavernosa chambers. When the blood is in place the arteries trap it there until the brain chemicals tell it to relax and release. This extra blood creates an erection.

If any part of this process is interrupted or fails to begin then an erection won't occur. It's a complex process with plenty of scope for problems.

If you think you are experiencing impotence, then it's best to see your doctor. Many men deal with erectile dysfunction, there is no reason to be embarrassed or worried. It may be a sign of serious ill health and needs medical investigation.

Your doctor will carry out the following:

Physical Examination - The doctor may check your penis for signs of abnormality such as Peyronie's disease (an unnaturally curved penis). They may also ask if your penis is sensitive to touch or notice sexual characteristics, such as breast growth, which may mean there is a hormonal issue to deal with.

Patient History - Your doctor will ask many questions. It is best to answer these as honestly and fully as you can because this can uncover whether the problem is psychological or physical. They will ask about your drinking and medical/recreation drug habits too.

Symptom monitoring

If the cause can't be identified at your consultation you will be asked to monitor symptoms. Getting an erection during the night means the issue is not likely to be physical. 'Wet dreams' are a sign of nocturnal erections. Your doctor may give your equipment to test whether or not you have nocturnal erections.

You may also be asked to uncover at which point the erection fails. For example, do you struggle to get an erection, or does it fail during sex? This can pinpoint the cause.

Once the cause is understood erectile dysfunction can be successfully treated with lifestyle changes, counseling or medications.

The best way to prevent erectile dysfunction is to lead a healthy life. Many of the physical factors that cause impotence are related to an unhealthy lifestyle, so there are ways to help prevent it.

• If you are overweight, improving your diet and exercising can be all it takes to see an improvement in your sexual health. Healthy foods increase artery health and ensure more blood can reach the penis.

In general what is bad for your heart is bad for your penis. Start exercising gently if you haven't for a while and build up your cardiovascular strength. It's been found that excessive pressure on the area between the penis and anus can cause problems with blood vessels, cycling, for example, can cause excessive pressure in that area.

• Men with diabetes need to ensure it is well managed to avoid penile tissue damage.
• If you drink excessively, smoke or use recreational drugs, cut back or stop altogether. These activities have a big impact on your erections.
• If you are currently taking treatment for a health condition, it may be the medications causing impotence. Don't stop taking them. Speak to your doctor about swapping to another type instead.
• Make sure you have a healthy work-life balance. Stress and pressure can cause erectile difficulties even if you feel you have them under control. Adrenaline causes the blood vessel to contract, blocking blood from the penis.
• If you have experienced past trauma, or hold strong beliefs that prevent your sex life you can undergo counseling or talking therapies.
• Other lifestyle changes include sleeping more, drinking water and relaxing.

There are many ways to treat erectile dysfunction. They involve medications, lifestyle changes counseling, physical support, and surgical methods. Surgery is a last resort and will only be considered when other methods have failed. Treatment is often successful and men should not be concerned about approaching their doctor for help.

Pills vs Surgery vs Therapy vs Lifestyle Choice

Lifestyle changes include quitting smoking, weight loss, cutting back on alcohol and taking up exercise. For some men, this can be all that's needed to restore erections.

Therapy uses non-invasive techniques that reduce the amount of anxiety associated with sex. It's often used to treat psychological ED issues.

There are many medications available to treat impotence. They vary from pills to injections and suppositories. These can be very effective and work by relaxing the blood vessels to boost blood flow.

Vacuum devices, known as penis pumps, are useful tools if medication is not an option. A penis pump pulls blood into the penis and is held there with a ring. The penis returns to a flaccid state after the ring is removed

Surgical treatment includes penile implant surgery. Either flexible rods or air-filled sacks are surgically placed in the penis. These can be erected or inflated when necessary.