Erectile Dysfunction

What is Erectile Dysfunction?

Erectile dysfunction or impotence is when a man is unable get an erection, maintain the erection or develop enough firmness in his erection to penetrate his partner.  There are a lot of reasons this can happen, both biological and psychological.  It happens very occasional to most men, due to alcohol or drug use, or stress and anxiety.  This is normal.  If it happens most times a man wishes to engage in intercourse, then the reason for the dysfunction should be explored.  There usually is an underlying medical and/or psychological reason.  Other issues that can arise for erectile dysfunction include premature ejaculation, delayed ejaculation and not being able to ejaculate. 

Many men develop erectile dysfunction as they get older.  One in five men over the age of 40 years and one in three men over the age of 70 years has trouble with erectile dysfunction.

If you feel this may be affecting you, please discuss it with your doctor.  Do not feel embarrassed by this, doctors have been trained in dealing with these issues and understand how difficult it can be to discuss erectile dysfunction.

How does this happen?

There are many reasons that this may happen.  To develop an erection, nerves that go to the penis block off the outflowing veins causing two parts of the penis, the corpora cavernosa, to fill with blood, enabling the penis to become rigid.  Following ejaculation or loss of stimulation the nerves cause relaxation and the blood drains from the penis enabling it to become flaccid. 

If any of the above areas do not work properly, i.e. there is damage to the nerves, veins, arteries or if there is a psychological reason such as, anxiety, distress or depression then a man may not be able to develop an erection.

If you are having any issues with your erection, then you need to discuss it with your doctor.  Please do not just order medications from the internet as some drugs such as Viagra and Cialis and others can be dangerous in certain medical conditions such as heart disease.  Often men with erectile dysfunction have underlying heart disease that they are not aware of and the use of certain medication can lead to a heart attack.

How do I fix it?

It is very important to identify a reason for the erectile dysfunction to occur.  Just using medication can place a man’s health at further risk.  Your doctor should spend time with you to explore the possible reasons for the erectile dysfunction and then to address those issues.  Sometimes rectifying the underlying cause will not resolve the lack of erection.

There are several ways to assist a man in developing an erection.  It is important to only use medications that are prescribed by your treating team, as many alternative medications or those purchased via the internet can be of poor quality and dangerous.

Treatments can include:

  • Psychotherapy: if the underlying cause is thought to be anxiety, stress or depression a counsellor or psychologist may be able to assist with talking therapies. Treatment of the anxiety, stress or depression with medication may also be suggested.
  • Medications: there are a number of oral and injectable medications that can be used for erectile dysfunction.  These include alprostadil (Caverject), avanafil (Stendra), sildenafil (Viagra), tadalafil (Cialis), testosterone (Androderm) and vardenafil (Levitra).  The appropriate medication and style of administration will be discussed with you.  If an injectable is suggested, the doctor should demonstrate how the injection should be done.
  • Vacuum Devices and rubber rings: these devices are used to encourage venous flow into the penis and restrict outflow, enabling an erection.
  • Implantable devices: if there is a reason that medications are not suitable, then there are a variety of devices that can be implanted in the penis to enable an erection.

Where can I get more information?