Erectile Dysfunction

What is Erectile Dysfunction?

Erectile dysfunction (ED), also known as impotence, is the inability to gain or maintain an erection hard enough, or for long enough to have sex. While nobody thinks this will affect them, it’s staggeringly common with studies suggesting over 50% of men will be affected at some point in their lifetime. 

What causes Erectile Dysfunction?

Fundamentally, an erection is blood flowing into the penis through a relaxed blood vessel, then becoming trapped by the closing of another vessel, hardening the penis. When the vessel opens, the penis once again softens.

While it is true erectile problems are experienced more commonly in older men, this does not mean that it doesn’t occur in the young. In fact, a study found that ED affected 26% of men under 40 in some way.

There can be a number of causes and factors that contribute to ED. These can be split into two main categories Physical and Psychological.

Physical Factors that cause ED

Blood Vessel Health

Conditions that lead to a narrowing of blood vessels can lead to ED. These include heart disease, high blood pressure, cholesterol, and diabetes. ED may be the first sign of one of these conditions emerging, this is why we encourage a full GP checkup-up for all men, especially if you are more experienced at over 40.

Lifestyle

Lack of fitness, lack of sleep, poor diet, smoking, and excessive alcohol consumption can all lead to ED. The first thing any man should try to improve their ED is to try to address these factors.

Medical Conditions

In addition to blood vessel health, some conditions predispose men to ED. These are Parkinson’s disease, Multiple Sclerosis, low testosterone, and diabetes. 

Prescription Medications

Unfortunately, some medications can affect blood flow and libido. As such, some can cause ED such as medicines for depression, blood pressure, and hair loss. If you are on these medicines, it is important you have a discussion with your GP about your options.

Age

The chances of ED occurring increase with age due to higher rates of medical conditions, medicine usage, and or reduction in sex drive.

Psychological Factors that cause ED

Anxiety

Increased stress and anxiety inside and outside the bedroom can result in ED. With the ever-increasing number of men developing anxiety for various work-related and social reasons, anxiety-related ED is increasingly common. Short-term anxiety-related erectile dysfunction should resolve once the anxiety does. However, for those who have long-standing anxiety, counselling and treatment for the underlying condition may be needed to overcome ED.

Depression

ED is more prevalent in men who are suffering from depression. It’s important if you feel like you might be depressed that you speak to your doctor about your symptoms. Mental health can greatly affect your ability to get an erection and the underlying depression may need to be treated to improve ED. 

Erectile Dysfunction: The Treatment Options

Among men one of the biggest concerns with the condition is the question, is ED permanent? Well not necessarily, many men can treat ED simply by addressing the modifiable risk factors above. For those who can’t or need help while they address them, there are four major treatment options.

Please note that Australian law prevents us from naming specific prescription treatments. After completing an assessment, you will be presented with the treatment options our doctors can prescribe. Our doctors will then assess whether the treatment is suitable for you. You can also seek advice from your local GP or pharmacist.

Tablets for Erectile Dysfunction

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These are your most common treatments and are from a class of drugs called PDE5 inhibitors. These medicines work by relaxing the penile blood vessels allowing blood to flow into the penis. While this drastically improves erectile function, you still require sexual stimulation for an erection to occur. The first generation tablets will take roughly thirty minutes to one hour to kick in while the second, newer medications on the market tend to work faster but cost slightly more.

Erectile dysfunction treatment safety and side effects

Common side effects of these drugs tend to be dizziness and headaches due to how they affect blood vessels. For this reason, they are not suitable for people with health conditions such as low blood pressure or those treated with certain medications such as nitrates for angina. For this reason, it is important your GP knows your full medical history.

Injectable Medicines

An option to treat ED is an injectable medicine into the penis. This option tends to be used only after the tablet option cannot be used. For obvious reasons such as discomfort at the injection site and the invasive nature, it is not always the most popular option, but can be very successful in those who are comfortable with the idea of injections. In fact, it tends to work significantly faster in most men, taking only 5 to 15 minutes to achieve an erection.

Penis Pumps and How They Work

For those who cannot take the tablet options, vacuum penis pumps are another treatment. They work by creating a vacuum environment in a tube around the penis which draws in blood, resulting in an erection. The blood is then trapped with a ring around the base of the penis holding it in.

Penile Implants

These devices are surgically placed into the genitals which can be either semi-rigid or inflatable. Due to their invasive nature, these are usually reserved for only when other treatments have failed or medical conditions leave it as the only option for treating erectile dysfunction. 

Lifestyle treatments for erectile dysfunction

Treating ED isn’t always about drugs or devices, sometimes it’s a change in your lifestyle which may help improve your ED. Changes such as:

Reducing Alcohol

Alcohol consumption can slow down or interrupt the signals of arousal from your brain to the body resulting in ED. It can also cause dehydration affecting the blood flow around the body, affecting the ability to get an erection. This is commonly referred to as “whiskey dick”. Reducing the number of drinks, particularly if you are consuming over 21 standard drinks per week, can drastically improve erectile dysfunction not only on the days of drinking but also in general.

General health and fitness

Losing weight and improving fitness can greatly improve your sex life and ED. A raised BMI can increase your risk of ED by 30-90%. This is usually due to conditions associated with weight such as high blood pressure, high cholesterol, and diabetes. Increasing physical activity slightly to the recommended 30 minutes per day could improve your sex drive and erectile dysfunction. For professional assistance with weight loss, consider speaking to one of our accredited practising dietitians.

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Ensuring you get an adequate amount of sleep is also important. Fatigue resulting from insomnia can greatly affect erection strength and quality.

Attempt to quit smoking or reduce the amount you smoke. Among the many other health benefits, it can result in improved circulation and erection quality.

Management of underlying medical conditions

Sometimes the best treatment for ED is going directly to the cause. This is often a medical condition which perhaps isn’t receiving the treatment it needs. 

High cholesterol can cause deposits of fat in blood vessels, which can cause trouble for blood following easily around the body, which can result in erectile problems. Treating the cholesterol with your GP may result in improved blood flow and subsequently improve your ED.

Low testosterone can lead to a diminished sex drive which can present as ED. Testosterone levels tend to peak at 18 and then reduce with age gradually. When levels get too low it leads to both sexual and mental health problems. 

If you suspect this might be the reason for your ED, it’s important you speak with your GP to get the levels tested and checked against the usual for your age. Treating low testosterone can improve your physical, sexual, and mental wellbeing.

Illicit Drugs

Much like alcohol, consumption of illicit drugs can affect the brain’s communication with the body as well as drastically changing blood pressure. This, in turn, can affect your ability to gain and maintain an erection effectively. If you believe your ED may be caused by drug use, you should get in contact with your GP for ways to decrease or cease use to improve your ED symptoms.

Pelvic exercises

Pelvic floor exercises, also known as Kegels, result in the strengthening of the muscles around the penis. Strengthening these muscles can improve blood flow into the penis which allows you to get erections easier.

Written by Clinical Pharmacist Tyson Wilkman