Erectile dysfunction is defined as the inability to achieve or sustain a hard enough erection to allow penetration or loss of an erection during penetrative sex. Erectile Dysfunction (ED) is common and can occur at any age.

Often men will experience erectile dysfunction 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 and 52% of men over 40 have experienced it.

There are certain medical conditions which can increase the chance of experiencing erectile dysfunction.  High blood pressure, diabetes and heart disease are some of the conditions that can cause it. Sometimes erectile dysfunction is the first symptom of these conditions. Some types of medication can increase the chance of erectile dysfunction.

Psychological factors in your life, such as stress, anxiety around sexual performance, difficulties in your relationship and depression can also increase your chance of experiencing erectile dysfunction.

Mechanism of Erection
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.

The treatment offered will depend on the cause of ED. Many men experience ED from a psychological cause such as Performance Anxiety.

Some men will have ED due to a physical cause, such as diabetes. Even in those with physical causes there is usually a psychological element to their ED. By talking to the doctor they can assess what type of treatment would suit you best.

Medication
Medication can sometimes be a useful tool in treating ED. The most effective way in treating ED is usually a combination of talking therapy and medication.

Viagra, Cialis and Levitra
These drugs belong to the group of drugs called Phosphodiesterase type 5 Inhibitors (PDE5I). They all work through a similar mechanism to improve blood flow to the penis. You need to be turned on (aroused) to achieve an erection with these drugs.

The most common side effects of these drugs are: headache, flushing, indigestion, blocked nose and visual disturbance. PDE5I should not be used if you are on Nitrates as it may result in very low blood pressure.

Alprostadil
Alprostadil is also a PDEI5 drug, which can be administered in several different ways
Vitaros is a fast acting PGE5I (5-10 minutes) cream, 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.

Cavaject is an injectable form of Alprostadil that is given by yourself and is injected into the side of your penis. You need to be taught how to do this and requires referral onto Urology.

Vacuum Erectile Device (V.E.D.)
A V.E.D consists of a closed-end clear plastic cylinder, a vacuum pump and constriction rings. The cylinder is placed over the penis and the vacuum pump is used to remove all the air from the cylinder. The vacuum reduces the pressure in the cylinder, causing blood to be drawn into the penis and thus resulting in an erection. Once the penis is fully engorged a ring is placed at the base of the penis to prevent the blood from draining away. The erection produced by a V.E.D 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. A V.E.D. can be used as part of an erection rehabilitation programme.

At your first appointment you will be asked questions about your lifestyle, health and relationships. A blood test maybe taken and your blood pressure checked.

You may also be asked if I can examine your genitals to exclude any physical causes. You may be given medication to try or given behavioural exercises to practice. You may require several appointments depending on the cause of your erectile dysfunction.

If you are experiencing erectile dysfunction, and it is causing you distress, you can make an appointment with the link below. Alternatively, if you are unsure whether I can help, please email me at enquiries@spg.scot, to discuss further.