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NHS Greater Glasgow & Clyde

Erectile Dysfunction

Erectile Dysfunction Information

    Overview

    Erectile dysfunction (ED) is the inability to achieve or sustain a hard enough erection to allow penetration during sex, or the loss of an erection during penetrative sex. ED is common and can occur at any age. Men can experience it once or twice in their lives but for some men it can happen more frequently and become a concern. Experiencing ED can be very distressing. The likelihood of experiencing ED increases with age with 52% of men over 40 experiencing it. Certain medical conditions can increase the chance of experiencing ED such as high blood pressure, diabetes and heart disease. Sometimes ED can be the first symptom a man experiences of these conditions. Psychological factors such as stress, anxiety around sexual performance, difficulties in your relationship and depression can also increase your chance of experiencing ED. Some types of medication can increase the chance of ED as well.Achieving an erection requires intact nerve pathways, good blood flow, normal testosterone levels and sexual stimulation/arousal. Any health problems that interfere with these can result in ED.

    Treatment of Erectile Dysfunction

    The treatment offered will depend on the cause of your ED. Many men experience ED associated with a psychological cause such as Performance Anxiety. Some men will have ED related to a physical cause, such as diabetes. Men with ED as a result of diabetes and cardiovascular disease are referred to Urology by their GP. Often there is a psychological element to ED as well as a physical cause. Talking with your doctor will help inform what type of treatment would suit you best. Medication can be a useful tool for treating ED. The most effective way of treating ED is usually a combination of talking therapy and medication. If you are experiencing symptoms of erectile dysfunction, you can speak to your GP about a referral to the Sexual Problems Service and discuss a trial of medication.

    Viagra, Cialis and Levitra

    These belong to a group of drugs called Phosphodiesterase Type 5 Inhibitors (PDE5I). They work to improve blood flow to the penis. You need to be turned on to achieve an erection with these drugs. The most common side effects are: headache, flushing, indigestion, blocked nose and visual disturbance. PDE5I drugs should not be used if you are on Nitrates as it may result in very low blood pressure.

    Alprostadil Alprostadil is a PDEI5 drug which can be administered in several different ways:

    • Muse is a fast acting PGE5I (5-10 minutes) pellet which contains Alprostadil. It is gently inserted into the urethral meatus (where urine comes out of at the penis tip) and the penis is gently massaged to help its absorption.
    • Vitaros is the same medication in a cream form.
    • Cavaject is an injectable form of Alprostadil that you give yourself. It is injected into the side of your penis. This treatment requires a referral to Urology to be taught how to safely perform this.

    A VED is a closed-end clear plastic cylinder with a vacuum pump and constriction rings. The cylinder is placed over the penis and the vacuum pump is used to remove the air from the cylinder. The vacuum reduces the pressure in the cylinder, causing blood to be drawn into the penis resulting in an erection. Once the penis is fully engorged a ring is placed at the base of the penis preventing the blood from draining away. The erection produced using a VED is slightly different to a normal erection. The penile skin is a lower temperature, the veins appear distended and the penile circumference can be increased.

    What happens at an Erectile Dysfunction Appointment?

    At your first appointment with the Sexual Problems Service you will be seen by an experienced sexual problems doctor. You will be asked questions about your lifestyle, health and relationships. A blood test may be taken and your blood pressure checked. You may also be asked if it’s ok to examine your genitals to exclude any physical causes. You might also be given medication to try or given behavioural exercises to practice. At the return appointment you will see the same doctor. Sometimes men attend for several appointments depending on the cause of your ED.