Erectile dysfunction

Erections occur because sexual stimulation triggers the release of chemicals that cause columns of tissue in the penis to become full (engorged) with blood. Anything that affects the mind, blood vessels or nervous system can cause erectile dysfunction.

At some stage of their lives most men have temporary difficulty getting and maintaining an erection. This is usually due to stress, alcohol, or tiredness. However, persistent, long-term problems getting and maintaining an erection hard enough to have the type of sex you and your partner want is known as erectile dysfunction or impotence. It is a serious problem that can affect men of all ages, but is more common in men aged 40-70, more than half of whom have some degree of erectile dysfunction.

It is estimated that the majority of cases of erectile dysfunction have an underlying physical cause, although emotional and psychological factors may also be involved. Fewer than 20% of cases are purely psychological.

It is important to dispel a few myths. erectile dysfunction does not occur because of:

• loss of interest in sex (libido),
• lack of strength or manhood,
• sterility, or
• reduced virility.

It is not a natural consequence of ageing and there is no muscle in the penis to tire. However, it is more common in older men, with one in five men aged 70 having persistent erectile dysfunction.

Causes of erectile dysfunction or impotence

If you can achieve an erection by masturbating, or sometimes get an erection in the morning or during the night naturally, then erectile dysfunction is probably due to psychological reasons, relationship problems, or drugs, rather than any other physical causes.

The most common causes of erectile dysfunction are outlined below.

• Physical – approximately eight out of 10 erectile dysfunction cases are due to physical causes. These can include ageing combined with arteriosclerosis (hardening of the arteries) and smoking, but also diabetes, drug misuse, Alzheimer’s disease, Parkinson’s disease, hormone deficiency, kidney failure, Peyronie’s disease, as well as neurological disorders, such as multiple sclerosis (MS), spinal, or back injuries, and other chronic (long-term) illnesses.
• Psychological – conditions such as depression, anxiety, stress, and trauma may be contributory causes of erectile dysfunction.
• Relationship issues – such as performance anxiety, poor communication, sexual inexperience, reduced attraction, fear of intimacy, and infidelity, may all contribute to erectile dysfunction.
• Medication, alcohol, and smoking - erectile dysfunction can also be caused by the use of antidepressants and antihypertensives, smoking, and regular heavy alcohol consumption.

Rarely, hormonal conditions can cause erectile dysfunction. For example:

• abnormally low levels of the male hormone testosterone (hypogonadism), or
• producing too much of the pituitary hormone prolactin (hyperprolactinaemia).

Tests and treatments for erectile dysfunction

Tests for physical causes of erectile dysfunction include genital examination, urine and blood tests, and a blood supply test (Alprostadil injection).

In the majority of cases erectile dysfunction can be treated. Treatment options are listed below.

• Medication – including Viagra and Apomorphine (Uprima).
• Injections into the penis – Viridal and Caverject.
• Urethral pellets – MUSE (Medical urethral system of erection).
• Hormonal treatment – testosterone replacement therapy.
• Vacuum devices – battery operated suction pump.
• Counselling and cognitive therapy – couples or relationship therapy.
• Psychosexual therapy – using the sensate focus technique.
• Surgery – penile implant.

Most men experience erectile dysfunction at one time or another. To decrease your chances of it becoming a persistent problem here are some lifestyle suggestions you could adopt:

• don’t smoke, drink excessively, or use illegal substances,
• exercise regularly,
• maintain a healthy diet that is rich in fruit and vegetables,
• try to keep your stress levels low – if you do experience stress or depression speak to your doctor who can offer advice,
• get plenty of sleep, and
• have regular medical screenings and check-ups to make sure problems are detected early to avoid long-term complications.

An erection that won’t go down

The medical name for an erection that won’t go down is a priapism. Rather than being a good thing, it can be a nuisance, as it is more likely to happen when you don’t have any sexual desire. It can also damage the tissues in the penis, and is usually extremely painful.

It occurs because the blood in the penis that makes it erect cannot escape. It happens because of prolonged sexual desire or as a side effect to some types of medication. Sometimes it can be because medication for impotence has worked too well. Rarely, it is because of an underlying condition such as sickle-cell anaemia or a prostate problem.

If an erection lasts for three or four hours or more, it is likely to be a priapism and you should get urgent medical attention.

If a priapism has lasted under 4-6 hours, it can usually be treated with decongestant medicines by a doctor.

However, if you have had an erection for longer than six hours, a doctor will usually need to release blood from the penis using a needle and syringe. The doctor will also try to find out the cause of your priapism and treat you for this if necessary. In some cases, surgery may be required to avoid causing permanent damage to the penis.

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2. The infections you can catch through oral sex
3. Sexually transmitted infections (STIs)
4. Chlamydia — a sexually transmitted disease
5. Symptoms and causes of chlamydia infection
6. Testing for, and treating chlamydia
7. Genital herpes during pregnancy
8. Sexually transmitted disease: the complications of chlamydia
9. Lessons on genital human papilloma virus (HPV) infection
10. Treatment for genital human papilloma virus (HPV) infection

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