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Erectile Dysfunction, Avenue Medical Practice Neat Guideline Erectile dysfunction (ED) is the inability to get and maintain an erection that is sufficient for satisfactory sexual intercourse. ED is also known as impotence. ED is a very common condition, particularly in older men. It is estimated that half of all men between 40 and 70 years of age will experience ED at least once. ED can have a range of causes, both physical and psychological. Possible physical causes include: heart disease, diabetes, high blood pressure (hypertension), and hormonal problems. Possible psychological causes of ED include: stress, anxiety, depression, and relationship Prognosis Many men will experience episodes of ED that improve without the need for treatment. Sometimes, persistent ED can be the result of a more serious underlying health condition, such as heart disease. In such cases, treatment will be needed to treat the underlying condition. Other causes include head injury, which can result in low levels of production of the hormone testosterone. Treatment of testosterone can treat ED when it is caused by head injury. Generally, the prognosis for ED is good. Some men will just need to make some lifestyle changes, such as losing weight and taking regular exercise. Other men may need to take medication such as sildenafil (known as Viagra). Sometimes, erectile dysfunction (ED) only occurs in certain situations. For example, you may be able to obtain an erection during masturbation, or you may find that you sometimes wake up with an erection. However, you may be unable to obtain an erection when you are with your sexual partner. In these circumstances, it is likely that the underlying cause of ED is primarily psychological. However, if you are unable to obtain an erection under any circumstances, it is likely that the underlying cause is primarily When to seek medical advice It is recommended that you see your GP if ED persists for more than several weeks. Although many websites offer treatments for ED, their use is not recommended. This is because many of the medications that are offered by these sites are counterfeit and could be dangerous. Even if the medications that are offered by websites are genuine, such as sildenafil (Viagra), these tablets are not suitable for everyone. Therefore, you should only take medication for ED that has been specifically prescribed for you by your GP. If you have ED, your GP should assess your general state of health because the condition can be the first sign of more serious health conditions, Health conditions There are four main types of health condition that can cause ED. These are described below. Vasculogenic - health conditions that can affect the flow of blood to your penis. Neurogenic - health conditions that can affect your nervous system. Hormonal - health conditions that can affect your hormone levels. Anatomical - health conditions that can affect the physical structure of your penis. Vasculogenic conditions Examples of vasuclogenic conditions include: heart disease, arteriosclerosis - hardening of the arteries, high blood pressure (hypertension), and diabetes - which can affect both the blood supply and the nerve endings in your penis, Neurogenic conditions Examples of neurogenic conditions include: multiple sclerosis, Parkinson's disease, spinal injury, or disorder, and tumours. Hormonal conditions Examples of hormonal conditions include:hypogonadism - a condition that affects the production of the hormone testosterone, over-active thyroid gland (hyperthyroidism), under-active thyroid gland (hypothyroidism), and Cushing's syndrome - a condition that affects the production of a hormone called cortisol. Anatomical conditions Examples of anatomical conditions include:Peyronie's disease - a condition that affects the tissue of the penis, and hypospadias - a congenital condition that causes the urethra (the urine tube) to develop abnormally. Medicinal causes of erectile dysfunction In some men, a number of medicines can cause ED, including those that are listed below. Diuretics - medicines that increase the production of urine, and are often used to treat high blood pressure (hypertension), heart failure, and kidney disease. Antihypertensives - medicines, such as beta- blockers, that are used to treat high blood pressure (hypertension). Fibrates - medicines that are used to lower cholesterol levels. Antipsychotics Antidepressants ,Steroids ,Immunosuppressants - medicines that are used suppress the immune system. H2-antagonists - medicines that are used to treat stomach ulcers. Anticonvulsants - medicines that are used to treat epilepsy. If you are concerned that a prescribed medication is causing ED, you should speak to your GP about it because an alternative medication may be available. Psychological causes of erectile dysfunction Possible psychological causes of ED include: depression, anxiety, stress, and unresolved relationship problems with your partner. ED can often have both physical and psychological causes. For example, if you have diabetes, it may be difficult for you to get an erection, which may cause you to become anxious about the situation. The combination of diabetes and anxiety may lead Other causes of erectile dysfunction Other possible causes of ED include: obesity, smoking, alcohol, tiredness, and using illegal drugs, such as cannabis, or cocaine. Sometimes, cycling can also be a cause of ED. People who spend more than three hours a week cycling may experience ED due to the saddle placing pressure on the nerves in Before diagnosing erectile dysfunction (ED), your GP will ask you about your symptoms, your overall physical and mental health, your alcohol consumption, whether you take drugs, and whether you are currently taking any medication. Your GP will also want to know whether your ED is permanent, or only occurs when you are attempting to have sex with your partner. The former suggests that there is an underlying physical cause, and the latter suggests an underlying psychological cause. Your GP may carry out a physical examination of your penis to rule out any possible anatomical causes, such as Peyronie's disease. Blood tests may also be used to check for possible underlying health conditions. For example, abnormal hormone levels could suggest a hormonal condition, such as an under-active thyroid (hypothyroidism), or high glucose levels could suggest diabetes. A blood pressure test is usually carried out to check if you have high blood If you have erectile dysfunction (ED), the treatment that you will receive will depend on the underlying cause of the condition. If ED is due to an underlying health condition, such as heart disease, or diabetes, that condition may need to be treated first before treatment for ED can begin. However, in some cases, treating the underlying cause will The main treatment options for ED are outlined below. Self-help The symptoms of ED can often be improved by using some self-help techniques, and making associated life style changes. These include: losing weight (if you are overweight), giving up smoking (if you smoke), moderating your consumption of alcohol, not using illegal drugs, and taking regular exercise. If you do a lot of cycling (more than three hours a week), and you are experiencing ED, you may want to spend a trial period without riding your bike in order to see if it improves your symptoms. PDE-5 Inhibitors PDE-5 inhibitors are one of the most widely used and effective types of medication used to treat ED. They work by temporally increasing the blood flow to your penis. In England, three PDE-5 inhibitors are available for the treatment of ED. These are: sildenafil - which is sold under the brand name Viagra, tadalafil- which is sold under the brand name Cialis, and vardenafil - which is sold under the brand name When not to take PDE-5 Inhibitors PDE-5 inhibitors are not recommended for people who are at high risk of coronary heart disease. PDE-5 inhibitors should never be used if you are also taking medicines that contain organic nitrates because the combination of the two substances can be extremely dangerous for your heart. Medicines that contain organic nitrates are often used to treat angina. You should also not use PDE-5 inhibitors if you take the recreational drug, amyl nitrate, more commonly known as 'poppers'. Side effects of PDE-5 inhibitors Side effects of PDE-5 inhibitors are rare and, when they do occur, they are usually mild. Possible side effects include: headaches, hot flushes, indigestion, a blocked, or runny, nose, back pain, and disturbances to your Hormone therapy If a hormonal condition is causing ED, you may be referred to an Penis pump A penis pump is another method of treatment for ED. It is a simple tube that is connected to a pump. You place your penis in the tube and pump out all of the air. This creates a vacuum which causes the blood to rush to your penis. You then place a rubber ring around the base of your penis in order to keep the blood in place, allowing you to maintain an erection for around 30 minutes. Alprostadil can be injected directly into your penis, or a small tablet can be placed Psychosexual counselling If the cause of ED is thought to be primarily psychological, you may be referred for psychosexual counselling. Psychosexual counselling is a form of relationship therapy where you and your partner can discuss any sexual, or emotional issues, or concerns, that you have that may be contributing to your ED. The counsellor can also provide you with some practical advice about sex, such as foreplay techniques, and how to make effective use of other treatments for ED in order to improve your sex

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