Living with
Erectile Dysfunction

What is erectile dysfunction?

Erectile dysfunction (previously known as impotence) occurs when you cannot achieve or maintain an erection suitable for satisfactory sexual intercourse. This is because the penis remains flaccid (cannot become erect or firm).

 

Having erectile problems is not uncommon, and occasional episodes, at any age, are considered normal. However, erectile dysfunction can cause distress to sexually intimate couples.
If erectile dysfunction is an ongoing issue for you, and impacts your self-confidence or mental health, then speak to your doctor about possible treatment. You should not be embarrassed if you experience erectile dysfunction and can get treatment at any age.

 

In many instances, ongoing erectile dysfunction indicates underlying conditions related to cardiovascular disease. If you can treat the underlying condition, it may reverse the erectile dysfunction, while other times, medications may be needed to achieve an adequate erection.

How do you know you have erectile dysfunction?

If you have erectile dysfunction you are unable to achieve an erection at any time, either alone or with a sexual partner, and/or you are unable to maintain an adequate erection until completion of sexual intercourse.
You may also experience reduced sexual desire.

 

What causes erectile dysfunction?

While no recent statistics are available for the prevalence of erectile dysfunction in South Africa, Mediclinic refers to studies in the United States that indicate approximately 10 % of men are believed to be affected by erectile dysfunction.
What we do know is that the incidence of erectile dysfunction increases with age: affecting about 5 % of men at the age of 40 years, between 15-25 % of men at the age of 65 years, and 70 % of men by 80 years of age.

 

Achieving a firm erection is a complex process involving the inter-play of the brain, nerves, emotions, hormones, muscles and, importantly, blood vessels.

The penis is made up of smooth muscle which forms two spongy cylinders that run the length of the penis around the urethra (the channel for urine and semen).
An erection begins with sensory and mental stimulation that excites the brain and causes it to send an electrical impulse down the spinal cord. The impulse is then conducted to the peripheral nerves and nerve fibres in the penis which stimulate the smooth muscle in the spongy part of the penis to relax.
When the muscles relax, it allows blood to flow into the spaces in the spongy tissue, causing the penis to swell and become erect. The penis returns to its flaccid state if the muscles contract, stopping the flow of blood into the spongy tissue.
If there is a problem in any of these steps, it may cause erectile dysfunction.
We can therefore broadly separate the causes erectile dysfunction into two groups: physical and psychological.

 

Physical causes are the most common reasons for erectile dysfunction, and include problems with the blood vessels (vascular problems) which make up 48 % of erection problems, problems with the nerves (neurological problems) which account for 14 % of cases of erectile dysfunction, and problems with the structure of the penis or surrounding tissues which only make up 3 % of erectile dysfunction.

The risk factors and physical causes of erectile dysfunction include:

  • Heart disease
  • Atherosclerosis leading to peripheral artery disease
  • High cholesterol
  • Hypertension
  • Diabetes
  • Overweight and obesity
  • Certain neurological disorders, including Parkinson’s disease and Multiple Sclerosis
  • Certain prescription medications (typically anti-hypertensives, diuretics or sedatives)
  • Smoking
  • Injury or surgery to the pelvis, penis or lower spinal cord, including resulting scarring
  • Excessive and frequent consumption of alcohol
  • Treatments for prostate cancer or enlarged prostate
  • Low testosterone (this can include thyroid disorders).

Psychological problems affect the erection process by decreasing arousal (sensory and mental stimulation) needed for erection. These problems cause between 10 % and 40 % of erectile dysfunction cases.
Even in cases where the underlying problem is physical, psychological factors can play a secondary role; for example, from the negative impact of increased anxiety and stress of not being able to achieve or sustain an erection.
If you experience erectile dysfunction that develops abruptly during sexual intimacy with a partner, but you still have early-morning erections and are able to have an erection while masturbating, the problem probably has a psychological cause, such as:

When do you need to see your doctor about erectile dysfunction?

Your general practitioner or family doctor is a good place to start when you have erectile problems.
See your doctor if you experience erectile dysfunction that:

  • Affects your self-image, sense of wellbeing or mental health.
  • Does not improve with erection-producing medication.
  • Occurs with other sexual problems such as premature or delayed ejaculation.
  • Occurs when you have diabetes, hypertension, heart disease or any other known condition linked to erectile dysfunction.
  • Is associated with other symptoms, such as persistent backache, loss of armpit or pubic hair, or mammary tissue/breast enlargement.
  • Occurs after you have experienced any type of injury to your back, legs, buttocks, groin, penis or testicles.
  • Occurs after you have started taking a new medication (particularly anti-hypertensives , diuretics or sedatives) or have recently changed your dosage of these types of medications.

Living and managing

As cardiovascular disease can increase the risk of erectile dysfunction, the best way to prevent and manage erectile dysfunction is by living a healthy lifestyle and by managing any existing health conditions like diabetes and hypertension .
Work with your doctor to manage your erectile dysfunction by:

 

What treatment is available for erectile dysfunction?

Many effective treatments are available for erectile dysfunction.
Your doctor will probably prescribe you medication that is based on the underlying cause of the erectile dysfunction you experience. These will typically be prescribed in combination with suggested lifestyle changes and, perhaps, even if the cause of your erectile dysfunction is physical, you may be encouraged to partake in psychological treatments, such as psychotherapy, relationship counselling or behaviour therapy.

 

Less invasive treatments must be considered first. Oral medication is the usual first-line therapy. Although all oral medications for erectile dysfunction are similar, they may differ slightly in effect and duration, which your doctor will take into consideration when prescribing you treatment.
First-line treatment is usually one of the following medications called phosphodiesterase type 5 (PDE-5) inhibitors that cause an erection on sexual stimulation, by increasing blood flow into the penis:

  • Sildenafil: This medication is most effective taken on an empty stomach an hour before sex. The effect it produces can last for four to five hours or more if you have mild to moderate erectile dysfunction.
  • Vardenafil: This medication is also most effective when taken one hour before sex but can be taken with or without food. Avoid eating high-fat foods before you use this medication, to increase its rate of absorption. It is also effective for four to five hours or more if you have mild to moderate erectile dysfunction. A newer form of the drug can be dissolved on the tongue and might work faster than the tablet that you swallow.
  • Tadalafil: This medication can be taken with or without food, one to two hours before sex. It is effective for up to 36 hours. It can be taken in small daily doses or in a larger dose for a longer period as needed.
  • Avanafil: This medication should be taken 30 minutes before sex depending on the dose, with or without food. Its effects generally last up to six hours.

Please note that sexual stimulation is needed in combination with these medications to achieve successful erection.

 

Ask your doctor whether it is safe for you to take these medications. You may not be able to use one or more of these medications if you use nitrate drugs to treat angina, have low blood pressure or uncontrolled high blood pressure, and if you have kidney or liver disease.

Side-effects do not commonly occur, but when they do they are usually mild and include: flushing (redness, typically in the face or upper chest), headaches, indigestion, increased light sensitivity or blue-tinged or blurry vision, congestion of the sinuses (“stuffy” or “runny” nose) and back pain.

However, speak to a healthcare professional immediately if you experience the more serious side-effects of hearing or vision loss.

Additionally, priapism, or an erection that will not go away and lasts for four hours or more, can also occur and may lead to severe penile damage if you do not seek medical treatment for it immediately.

 

You may consider other treatments of erectile dysfunction as needed. Other treatments include:

  • Alprostadil which is a chemical compound similar to the hormone prostaglandin E that helps relax smooth muscle tissue in the penis, allowing blood to flow through. This can be administered by relatively painless injection (Caverjet) into the base of the penis, using a very fine needle, 5-20 minutes before sexual intercourse, and will last 30-60 minutes. Alternatively, it can be administered by the Medicated Urethral System for Erection (MUSE) which uses a disposable applicator to squirt a small amount, about the size of half a grain of rice, of pre-measured dose into the opening at the tip of the penis. This may cause discomfort or pain to some extent.
  • If all other forms of treatment have not worked or have not delivered the result you desired, you may choose to use a vacuum pump to draw blood into the penis to make it erect or to undergo surgery to insert fluid pumps or bendable rods into the penis.
Sources

Statistics: Mediclinic. (n.d.) Erectile dysfunction (impotence). Available from: https://www.mediclinicinfohub.co.za/erectile-dysfunction-impotence/

 

Mayo Clinic staff. (n.d.) Diseases and Conditions: Erectile dysfunction. Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776

 

The Urology Care Foundation. (2018) What is Erectile Dysfunction. American Urological Association. Available from: https://www.urologyhealth.org/urologic-conditions/erectile-dysfunction(ed)

 

Willacy H. (2019) Erectile Dysfunction. Men’s Health. Available from: https://patient.info/mens-health/erectile-dysfunction-impotence#nav-2

 

National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.) Erectile Dysfunction (ED). NIH, US Department of Health and Human Services. Available from: https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction

 

Mayo Clinic staff. (n.d.) Diagnosis and Treatment: Erectile dysfunction. Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/diagnosis-treatment/drc-20355782

 

Mayo Clinic staff. (n.d.) Viagra and other oral medications. Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/in-depth/erectile-dysfunction/art-20047821

 

Martin M. (n.d.) How does erectile dysfunction (ED) medication work? HealthGuide. Available from: https://www.getroman.com/health-guide/how-erectile-dysfunction-medication-works/

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Sources

Statistics: Mediclinic. (n.d.) Erectile dysfunction (impotence). Available from: https://www.mediclinicinfohub.co.za/erectile-dysfunction-impotence/

 

Mayo Clinic staff. (n.d.) Diseases and Conditions: Erectile dysfunction. Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776

 

The Urology Care Foundation. (2018) What is Erectile Dysfunction. American Urological Association. Available from: https://www.urologyhealth.org/urologic-conditions/erectile-dysfunction(ed)

 

Willacy H. (2019) Erectile Dysfunction. Men’s Health. Available from: https://patient.info/mens-health/erectile-dysfunction-impotence#nav-2

 

National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.) Erectile Dysfunction (ED). NIH, US Department of Health and Human Services. Available from: https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction

 

Mayo Clinic staff. (n.d.) Diagnosis and Treatment: Erectile dysfunction. Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/diagnosis-treatment/drc-20355782

 

Mayo Clinic staff. (n.d.) Viagra and other oral medications. Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/in-depth/erectile-dysfunction/art-20047821

 

Martin M. (n.d.) How does erectile dysfunction (ED) medication work? HealthGuide. Available from: https://www.getroman.com/health-guide/how-erectile-dysfunction-medication-works/