Erectile Dysfunction

Erectile dysfunction is diagnosed when a man has difficulty achieving and/or maintaining an erection when experiencing arousal, and so cannot engage in satisfactory sexual intercourse. Caused by a lack of blood flow to the penis, in some circumstances, it can lead to social and mental health issues such as anxiety, relationship difficulties and loss of self-esteem.

How does an erection work?

In simple terms, an erection is the process of the increased blood flow into the corpora cavernosum causing the penis to become enlarged, elongated and firm.

The erection process starts with mental or sensory stimulation caused by arousal.

When this happens, impulses are sent from the brain to local nerves to instruct the muscles around the corpora cavernosum to relax. This allows blood to flow through the penile artery and the penis expands. The blood flow to the penis at this point can be eight times that of the normal blood flow.

At the same time, the tunica albuginea membrane around the corpora cavernosum stretches and blocks off the veins that drain the blood. The blood is now trapped in the penis, and the pressure increases allowing the penis to become, and remain, erect. At this point, the blood pressure in the penis can be as much as twice as high as in the rest of the body's circulatory system.

An erection ends when the muscles in the penis contract. The tunica contracts and opens up the channels for draining blood. The deoxygenated blood is then carried away via the deep dorsal veins and the penis becomes flaccid.

Is ED the same as premature ejaculation?

No. Whilst both fall under the category of male sexual dysfunction, they are separate conditions. Impotence is the inability to achieve or sustain an erection after arousal, whilst premature ejaculation occurs when a man can achieve/sustain an erection but reaches orgasm before a satisfactory duration.

Penile anatomy

The penis consists of three main sections or parts:

1. The Root: This refers to where the penis attaches to the pelvic wall and the abdomen.
2. The Shaft (or Body): This is the longest part of the penis and is the visible part that extends from the root to the head.
3. The Glans (or Head): This is the cone-shaped top of the penis. The ridge that separates the shaft from the glans is called the corona. A loose fold of skin called the prepuce, or foreskin, covers the glans of the penis in uncircumcised men.

The shaft of the penis is made up of three columns of erectile tissue, which can be seen in the diagram below.

• Corpora Cavernosum: These are the two columns of erectile tissue that run along the sides of the penis and fill up with blood during an erection. They contain supporting fibres called trabeculae and cavernosal spaces. They are partially separated by the septum, a fibrous partition.
• Corpus Spongiosum: This is the third column of erectile tissue that runs along the front of the penis. The urethra runs through the corpus spongiosum, carrying urine out of the body.
• Tunica Albuginea: This is the membrane that surrounds the corpora providing a tough outer sheath.
• Deep Dorsal Vein: This vein runs the length of the penis shaft. It drains the deoxygenated blood from the glans.
• Cavemosal Artery: These are deep-paired arteries than run near the centre of each of the corpus cavernosum. They allow blood to reach and fill the corpora.

Erectile dysfunction (ED) can be caused either by psychological or physical issues, or sometimes a combination of the two. A great way for a man to identify the underlying cause is to check whether an erection occurs naturally in the morning, and then if there is a struggle to achieve an erection when aroused. Depending on what this comparison shows, there are various physical or psychological causes that can be looked at. However, the primary cause of erectile dysfunction is linked to old age with the following chart detailing just how significant this is. Although, it is important to note that, as you can see, a large percentage of men affected are below the age of 40.

Some of the most common causes of impotence can also include:

Physical vs psychological causes of impotence

When erectile dysfunction is observed in young males, the cause is often assumed to be psychological, however, a physiological issue cannot always be ruled out. This is why it is important to speak with a medical professional, such as a urologist, when first being diagnosed with erectile dysfunction.

Stress, testosterone levels, depression, and relationship problems can all contribute to ED. Older men experience erectile dysfunction at a higher rate than younger men (40% of over 60s), so if you are in the 60+ age bracket then there's really nothing to be alarmed about.

Stress & Depression

ED can be exacerbated by stress at work or at home, as well as bouts of depression. This is because the erection process is reliant on a delicate balance of hormones and nerve impulses, which can be disrupted by depressive episodes. Similar to anxiety, depression can also be brought on by sexual dysfunction itself, due to a loss of confidence and feelings of inadequacy.

Low testosterone levels

Testosterone levels in the male body naturally decrease with age. However, for some men, this is more pronounced than others. If you think you may have low testosterone, it is always sensible to get this checked by a doctor as you may benefit from male hormone replacement therapy.

Pornography

Recent studies have suggested that overconsumption of pornography among young males has led to a rise in 'porn-induced erectile dysfunction'– a psychological phenomenon that can be treated by reducing the use of pornography and seeking the necessary professional assistance.

Binge drinking and smoking

Heavy nights of drinking can lead to temporary erection problems. Alcohol and nicotine affect the blood flow to the penis, and both drinking and smoking can have long-term effects on a man's sexual performance.

Erectile dysfunction and psoriasis

Psoriasis is an autoimmune disease that primarily affects healthy skin cells. It causes the body to overproduce T-cells (every 3-7 days, instead of 3-4 weeks). This results in flaky, silvery patches of skin which generally appear on the elbows, knees, scalp, and back. They can be itchy and lead to an infection if scratched.

Psoriasis has been linked to ED for the following reasons:

• Psoriasis can appear all over the body, including the penis.
• The condition can negatively impact self-esteem.
• Men with psoriasis have an increased chance of suffering from cardiovascular health issues.

There is currently no cure for psoriasis but you can use creams to soothe the skin and help improve sexual confidence. For extreme cases of psoriasis, phototherapy can be used to treat the affected areas.

Is impotence related to other conditions?

Absolutely. Medications, lifestyle and mental health can contribute to the severity of erectile dysfunction. Take a look at the illustration below to get a better understanding of the wide-ranging reasons why you may be experiencing difficulty achieving and maintaining an erection.

Medications - Beta-blockers used to treat conditions such as high blood pressure are known to contribute towards erectile dysfunction.

Being overweight - Being overweight can lead to other health conditions like diabetes and high blood pressure, which are contributing factors to erectile dysfunction.

Diabetes - Conditions such as type 2 diabetes can damage the nerves and blood vessels in the penis, making it difficult to achieve an erection.

Prostate cancer/surgery - Prostate medications and surgery can lead to erectile dysfunction.

Heart disease - Chronic heart problems can cause the arteries to harden. This can affect the blood supply to the penis, causing erection problems.

As impotence can sometimes point towards other conditions such as high cholesterol, diabetes and high blood pressure, it is always best to consult with your GP and get advice relevant to you.

High blood pressure and erectile dysfunction

High blood pressure can have a very negative impact on an individual's sex life, lowering their libido and making it difficult to achieve and maintain erections.

Over time, high blood pressure left untreated can damage the arteries. This makes it difficult for blood to flow effectively through the body without increased strain on the heart, which in turn makes it harder for a man to achieve and maintain an erection. If the heart is overworked, damage can occur to the lining of blood vessels and may lead to atherosclerosis - a narrowing and hardening of the arteries.

If the arteries to the penis and pelvic organs are affected by atherosclerosis, the narrowed arteries may not be able to deliver enough blood to the penile tissue. It has also been suggested that the more advanced your atherosclerosis, the more severe your erectile dysfunction.

Erectile dysfunction as a side effect of medication

Certain medications used to treat high blood pressure can cause erectile dysfunction as a side effect. This can be a frustrating 'Catch 22' situation for many men. If left untreated their high blood pressure can cause erectile dysfunction, but the treatment to control their blood pressure can in itself cause it.

This is due to the effects of beta-blockers, which stimulate the same nerves that facilitate erections, and diuretics, which interfere with the intensity of blood flow to the penis. If you find your medication is negatively affecting your sex life, it is important to speak to your doctor. There are alternatives that may avoid these side effects.

What does the research show?

The British Heart Foundation conducted a survey of nearly 2,000 people in 2014. They found that 70% of men with heart problems had issues with erectile dysfunction. Of those with issues, 46% felt their medication was responsible, 36% felt it was a combination of their condition and their medication and 18% blamed their condition alone.

This finding is consistent with research published in the International Journal of Impotence Research, which found, across multiple studies, that 67-68% of men with hypertension reported erectile dysfunction. In fact, this rose as high as 77% when they looked at those suffering from hypertension and diabetes.

It also found, that in addition to being more prevalent, hypertension also influenced the severity of erectile dysfunction issues. For general sufferers of erectile dysfunction, only 10% describe their issues as severe. However, in the case of men with hypertension, a staggering 45% describe their issues as severe.

Treating ED doesn't only benefit you in the bedroom, it can have wide-reaching positive effects on your entire life. For example, it can boost your self- esteem, improve overall confidence, and even aid blood circulation.

You may even find you have the motivation to make changes you never thought possible, whether that's quitting smoking, cutting back on alcohol or losing weight– confidence is key in all aspects of life.

Although for some men, erectile dysfunction can be resolved with simple lifestyle changes or psychological help, an effective treatment method is generally required. From herbal supplements to prescription medication such as Viagra and Cialis, there are various options available and considered to be effective in treating this condition.

Natural treatments for impotence

Improving your diet and exercise can also remedy erectile dysfunction. As high blood pressure and high cholesterol can damage the arteries, they are less capable of delivering sufficient blood to the penis when aroused. Taking active measures to lower blood pressure and cholesterol has been found to have a positive effect on a man achieving a successful erection. Whilst eating healthily and lowering your cholesterol is always beneficial, these methods alone are not guaranteed to treat work.

A healthy diet - Loading up on fish and low-fat meats, vegetables, whole-grain foods, and fruits is certainly a step in the right direction.

Good communication - This could be in the form of counselling, group therapy sessions, or most importantly, discussing erection problems with your partner. Many of the psychological causes of ED can be resolved through simple communication.

Reducing alcohol - Studies have shown that alcohol doesn't just create short-term ED problems. Symptoms of impotence can often persist for months after a period of heavy drinking.

Quitting smoking - Smoking can clog the arteries and reduce blood flow. Plus, nicotine also restricts your blood vessels.

Combatting stress - Some men have found managing their stress levels (i.e. via meditation) has had a positive effect on both their erection problems and sex drive in general.

Herbal treatments

Opinion on the use of herbal treatments to combat ED is divided, and the effectiveness of the treatment depends on the individual. As ED herbal remedies don't boast the same success rate as prescription treatments, and in nearly all cases, are not subject to clinical studies, it is highly advised for you to consult first with your GP.

Counselling

As previously discussed, counselling is a great option for those suffering from psychologically induced impotence. It has been shown to be exceptionally effective when combined with prescription medication. Counselling can also include psychosexual therapy, as well as Cognitive Behavioural Therapy (CBT).

Vacuum Constriction Devices

VCDs (penis pumps) create a vacuum that draws blood into the penis which causes it to swell and become erect. To date, there is no conclusive clinical evidence to prove the efficacy of vacuum pumps. As the effect is temporary and the usage of respective products doesn't come without risk, it is strictly advised to seek medical assistance before using a VCD.

Surgery

Surgery is usually considered a 'last resort' option, for when all others have proven unsuccessful. The exception is for those who have been in serious accidents, or for men who have damage, disfigurement or anatomical issues with their penis. Other than this, penile implants (semi-rigid and inflatable) can also be viable options. However, these are deemed cosmetic operations and are therefore only available privately.

Testosterone replacement therapy (TRT)

Once a man reaches his thirties, his testosterone levels begin to decrease. There are means of delaying this until later in life, for example, exercise, a healthy diet, and genetics, as well as testosterone replacement therapy (TRT). If you notice a change in your libido, you should have your testosterone levels checked by your doctor.

Prescription medicines

Oral tablets are the most popular form of erectile dysfunction treatment as they have been clinically proven to treat the symptoms of physiologically induced impotence. They can provide either a long or short-term solution. There are many prescription treatments available with varying dosages and strengths including:

• Viagra
• Sildenafil
• Cialis
• Cialis daily
• Levitra
• Levitra Orodispersible
• Spedra

All of the above work by increasing blood flow to the penis. They are grouped together under a drug class called 'PDE5 inhibitors'. They enable the user to achieve a firmer and longer-lasting erection. As these medicines are ineffective without sexual stimulation, it is also important to address any psychological factors.

Ways to prevent erectile dysfunction will depend on pinpointing the relevant causes for you. This may include physical and psychological causes and therefore a range of treatment options. Often altering lifestyle choices can significantly help, but you may require some additional help in the form of counselling or medication.

Here at HealthExpress we only offer medically proven, prescription medication for this condition. Whilst Viagra is the most popular, there are various other active treatments manufactured with the intent of enabling a man to gain and sustain a stronger erection when previously unable to. Each treatment has its individual benefits although they all work in the same way. For example, Cialis Daily is the lowest dosage and can be taken once-a-day, which can be handy for those requiring spontaneity, whilst Levitra is suitable and effective for those with diabetes or high blood pressure.

We understand that this condition may be embarrassing for some men to discuss with others, which is why we offer this premium service geared towards ensuring that you get the most suitable treatment, discreetly and by the next day. If you're not sure which medication is right for you, you can take our free and quick online consultation and one of our doctors can help to recommend a treatment most suited to your individual circumstances.

What do I do if my ED symptoms persist?

If you are experiencing persistent symptoms of ED, the worst thing you can do is experience this condition in silence. The first thing to do is to discuss your condition with your partner and a doctor for emotional and professional support. Talking to someone can also help you to find out the underlying cause for your erection problems.

If you feel too uncomfortable speaking to your doctor, our discreet and confidential consultation service can help. Our service means you can avoid a face-to-face consultation with the doctor and get your treatment delivered to your door. Just complete our short, no-obligation online consultation, where our doctors can help to find the most effective impotence treatment for you.