Erectile dysfunction (ED) is defined as a repeated difficulty to attain or maintain erections sufficient for satisfactory sexual intercourse.
ED is common (52% of men aged 40 – 70 years in one study) and increases dramatically with age. Another study showed however that one in four men first sought medical help for ED when they were aged less than 40 years old. Many go online because of embarrassment and are vulnerable to organizations wanting to capitalize handsomely on this embarrassment.
Step one on presentation to the clinic is a thorough relationship/sexual/medical/psychological /lifestyle history, examination and appropriate investigations to establish the cause if possible. Physical causes include narrowing of the arteries to the penis, nerve damage, low testosterone, certain medications and failure of the venous mechanism that maintains erections.
Psychological (performance anxiety) can result as a consequence of a physical condition (making the problem worse) or can be the whole cause via the extreme anti-erectile properties of adrenaline. The most common cause of this is fear of disappointing our partner and the male strategy of trying harder which will only aggravate the problem.
Treating the underlying cause is the prime goal where ever possible. This can be in conjunction in the medium or long term with a number of treatment options. This includes the familiar medications of Viagra/Cialis/Levitra taken prior to sex or on a daily basis (low dose Cialis). Other treatments consist of Renova Low Intensity Shockwave Therapy, use of a vacuum erection device (VED), penile injections and surgery for insertion of a penile implant.
Psychological support and lifestyle changes such as commencing aerobic exercise can have major benefit.
NB: It is very important to consider what the problem is telling us (the “canary in the pants”). ED can be the first sign of significant blockage to arteries within the body and the risk of heart attack. It can also be a sign of relationship problems, anxiety and stress.