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ERECTILE DYSFUNCTION

 

Erectile dysfunction (ED) is defined as difficulties in gaining or maintaining an erection sufficient for sexual intercourse. It is quite common and affects approximately 1 in 4 Australian men. The prevalence increases with age. It can have a significant impact on quality of life. Although most of the time ED is amenable to multiple treatments, many men are reluctant to seek help because of embarrassment or stigma associated with it.

 

What are the causes/risk factors for erectile dysfunction?

Most of the time the cause of ED is multifactorial and can be due to any combination of the following factors:

  • Psychogenic – due to psychological factors such as stress and anxiety.

  • Vasculogenic – due to problems with blood vessels which enable erections to occur. This may be an early sign or coronary artery disease (heart disease). Risk factors for cardiovascular disease such as smoking, diabetes, high cholesterol and high blood pressure may contribute.

  • Neurogenic – due to damage to nerves which enable erections, usually with a history of surgery in the pelvis (eg. for prostate, bowel cancer).

  • Hormonal – variations in hormones including testosterone can affect erections and libido (sexual desire)

  • Medications – certain medications such as those used for blood pressure and alcohol can affect erections.

 

What investigations are required for erectile dysfunction?

  • For the majority of men a history and physical investigation is all that is required to diagnose the severity and likely cause(s) of erectile dysfunction.

  • A hormonal analysis is undertaken to screen for reversible causes or if there are concerns on history or examination.

  • Occasionally more specialised tests may be required such as imaging with ultrasound, CT or MRI

 

How is erectile dysfunction treated?

There are a number of treatment options available for erectile dysfunction and they depend on the cause and what has been previously tried.

 

  1. PDE-5 Inhibitors (Eg. Viagra, Cialis, Levitra)

  • These used on demand and are designed to increase the blood flow to the penis to help gain and maintain an erection

  • Side effects may include flushing, dyspepsia, headache, fatigue

 

   2. Intracavernosal injections

  • These are tiny (hidden) needle injections directly into the penis, which can be very effective in men who are unable to have the oral medications or for those in whom they have been unsuccessful

  • A number of different preparations are available

  • Side effects may include pain with erection, bleeding, penile bruising, scarring and rarely a prolonged undesired erection (priapism)

    3. Penile pump (Vacuum device)

  • This is a vacuum device which promotes blood flow to the penis by creating a negative pressure around it. A constriction ring is then applied to the base of the penis to prevent the blood from escaping thus maintaining the erection.

  • It may be useful in men who are unsuccessful with or unable to tolerate the tablets or injections or as an alternative to intracavernosal injections.

  • Side effects may include pain and bruising

    4. Penile prosthesis

  • This is usually the last resort for men who are unsuccessful with or unable to tolerate the tablets, injections or penile pump

  • It involves a procedure to insert a permanent mechanical device which enables the patient to control their erections with a hidden pump in the scrotum