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Erectile dysfunction or impotence, is the persistent or recurrent inability to attain
or maintain an erection sufficient to complete sexual intercourse or another
chosen sexual activity. It is very common and affects at least one in every ten
men. This means that there are an estimated 2.3 million men in the UK suffering
from erectile dysfunction. Regrettably, only about 10% of sufferers actually
receive treatment. The number of men suffering erectile dysfunction increases
with age.

The causes
Most men have an occasional failure to get or keep an erection. It usually results
from stress, tiredness, anxiety, or excessive alcohol consumption. This is nothing
to worry about. However, worrying about it may set the scene for a more
persistent problem due to "fear of failure". Until about 20 years ago, erectile
dysfunction was considered to be caused almost entirely by psychological factors
but we now know that physical conditions are present in about 75% of sufferers.
However, most men with impotence inevitably have a combination of
psychological and physical causes.
Physical causes
Men whose erectile dysfunction is of a physical origin often experience a gradual
onset of erectile failure which tends to occur with all sexual activities.
Physical causes of erectile dysfunction include:
• diabetes
• high blood pressure
• high cholesterol
• side effect of prescribed drugs
• heavy smoking
• neurological diseases, stroke and (rarely) a past head injury
• alcoholism and drug abuse, and other less common causes
Psychological causes
Psychological causes of erectile dysfunction include:
• stress and anxiety from work or home (money or family)
• marital rows and dissatisfaction (as can also occur with premature
ejaculation)
• depression
• sexual boredom
• worries about your sexual orientation

Treatment

There have been major advances in the treatment of erectile dysfunction and the
majority of sufferers can now be treated effectively. Before medical advice is
sought
consider some lifestyle changes.
• stop smoking,
• reduce alcohol intake to less than 30 units a week
• try to reduce stress and anxiety.
• lose weight
Tablets
Tablets are nowadays the first line of treatment There are currently three oral
drugs commonly used for the treatment of erectile dysfunction (See separate
factsheet).
Injection
This is a highly effective form of treatment. The patient (or his partner) is taught
to inject a drug directly into the shaft of the penis when he wants an erection.
Erection usually follows within fifteen minutes of the injection. The procedure is
easy to learn and it doesn't (surprisingly!) hurt to do. Two products are available
– Caverject or Viridal and they are 90% successful

MUSE

MUSE. is a needle-free form of treatment. A small pellet of the drug called alprostadil is
inserted into the urethra (the tube through which urine is passed) using a special
disposable applicator. It is pain free The drug is absorbed through the wall of the urethra
and passes into the erectile tissue, giving an erection within 5 to 10 minutes, with a
success rate of 50% of attempts.
Vacuum pump
The device consists of a plastic cylinder connected to a pump, which may be
either hand or battery driven, and one or more tension rings. For medical
suppliers see separate factsheet
Hormone treatment
Only a small proportion of cases of erectile dysfunction are caused by hormone
abnormalities. The most frequent hormone abnormality is a reduced level of
testosterone (male sex hormone) which can be restored by appropriate
testosterone replacement. It is unwise to take testosterone preparations unless
laboratory investigations confirm there is a deficiency. See separate fact sheet
Penile prosthesis
Essentially this is a splint which is inserted surgically in to the penis. It is a
hydraulic device which causes stiffening of the penis when a pump (implanted in
the scrotum) is activated. As implantation of a penile prosthesis causes
destruction of erectile tissue, and they should never be considered until other
forms of treatment have been tried.

Sex and/or couple's therapy
When psychological factors or difficulties in a man’s relationship with his partner
are can be an important cause for erectile dysfunction. Frequently a course of sex
or couple’s therapy can be very useful in helping couples re-establish a sexual
relationship when there has been a long period without because of erectile
dysfunction. Sex therapy can also be used in combination with other forms of
treatment.
Sharing with your partner
There is the old adage that a "problem shared is a problem halved". Sometimes
partners, unintentionally, put a lot of pressure on men to "perform which can
aggravate the ability to get a satisfactory erection. Discussing the problem often
helps to restore normal erectile function. It is very helpful for you and your doctor
for your partner to go with you to your general practitioner or specialist.
Does your age affect your treatment?
The likelihood of erectile dysfunction increases as you get older but it is your
attitude, not age, that is the biggest barrier in treating the condition. While some
older men and their partners accept loss of erectile function as a part of ageing
and do not want treatment, others are unhappy about losing such an important
part of their lives. It is perfectly satisfactory for men and women to continue an
active sex life way into old age and no one should be denied treatment for
erectile dysfunction solely because they are too old. Don't be put off! Men in their
90s are now seeking treatment for erectile dysfunction and generally respond to
one of the types of treatment available.