Erectile Dysfunction

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What is Erectile Dysfunction?

Erectile Dysfunction, also known as ED or impotence, is the inability to achieve or maintain an erection during sexual intercourse. It is a very common condition that is easily treated, either through medical intervention (via the use of medication, gel or pumps), or through counselling.  

What causes Erectile Dysfunction?

An erection happens when you are physically or mentally aroused. Something you have thought, seen, felt, smelt or heard, will cause nerves in the brain to send chemical messages, allowing arteries in your penis to open. In turn, the arteries allow for a rush of blood to enter the penis, so that it can expand in shape and size. A disruption to this process can cause erectile dysfunction. 

There are a number of factors that can affect this process and they are best described by splitting into two; physical factors and psychological factors.

Physical factors of ED are:

  • Conditions that affect blood flow to the penis, such as heart disease, high cholesterol, high blood pressure, diabetes and obesity
  • Conditions affecting the nervous system where the transfer of nerve impulses from the brain to the penis are disrupted; such as multiple sclerosis, Parkinson’s, stroke or spinal injury
  • Conditions that affect the hormonal balance such as an overactive or underactive thyroid, and other conditions that decrease the levels of testosterone, the male sex hormone
  • Conditions that affect the anatomy of the penis such as Peyronie’s disease (resulting in a bent erect penis)
  • Medication induced ED, caused by taking medication that affects hormonal balance or blood flow to the penis

Psychological Factors of ED are:

  • Depression – Low self-esteem and energy levels are two characteristics associated with depression that can affect your sex drive. Low motivation and energy levels can make it difficult to become sexually aroused and peak at sexual performance
  • Stress – A stressful event or period you may be going through will not only have an affect on your mind, but also on your body. Throughout stressful periods, hormones are released into your blood stream, making your body aware that there is a potentially threatening situation ahead. Your mind and body enter into a different state, where perhaps sex drops down the priority list
  • Anxiety – Both chronic anxiety and acute performance related anxiety can have an affect on your sexual ability. Anxiety in general; and being anxious about performing often mean that you are less likely to do so. When this has happened once, it can have a negative impact on your state of mind, which can have a knock-on effect. If not dealt with, anxiety threatens to take the fun out of many of life’s pleasures
  • Relationship problems – It is not uncommon for men to experiencing erectile dysfunction when going through a difficult relationship. Being unable to connect with your partner emotionally can often mean you are unable to connect on a sexual level. Poor communication, arguing and a lack of understanding can change the way you feel towards your partner sexually, meaning you may find it difficult to achieve and maintain an erection.

The cause of Erectile Dysfunction can also be a combination of both physical and psychological factors. For example, a physical issue such as diabetes, high blood pressure or cholesterol can cause poor circulation in the arteries, restricting blood flow to the penis, which may cause you to experience erectile dysfunction. In turn, this can cause you to have anxiety in the future when faced with a potential sexual encounter, which may be another contributing factor to erectile dysfunction.

How can I treat Erectile Dysfunction?

Treatments for erectile dysfunction caused by physical factors may include oral medication (tablets), injections, vacuum pumps and creams. 

For erectile dysfunction caused by psychological factors, you may wish to discuss options with your GP. There are a number of different methods that can be used to help overcome erectile dysfunction such as counselling, sexy therapy or Cognitive Behavioural Therapy (CBT), which helps to train your mind to think in a certain manner. It is common for your therapist to suggest trying a tablet at some stage, as a booster to try and help overcome any mental barriers.

Tablets available are:

  • ​Viagra or Sildenafil (non-branded version of Viagra)
  • Cialis or Tadalafil (non-branded version of Cialis)
  • Levitra
  • Spedra​

How do Erectile Dysfunction drugs work?

These tablets work by inhibiting PDE5. PDE5 is an enzyme that breaks down and destroys cGMP. It is cGMP that is responsible for causing the smooth muscle in the penis to relax and allows a rush of blood into the penis, which in turn causes an erection. Therefore, inhibiting PDE5 will allow cGMP to accumulate and persist longer, causing an erection. 

This process of inhibiting PDE5 will only work once the tablet has been taken and there is sexual arousal. The time taken to work depends on the tablet you take, as does their durations of action. The table at the top explains this is more detail. 

What are the symptoms of Erectile Dysfunction?

  • Erections not long enough for sex
  • Erections not hard enough for sex
  • Inability to achieve an erection

How common is Erectile Dysfunction?

A study conducted by the Journal of Sexual Medicine suggested that ED is more common amongst young men than previously thought. Researchers found that 26% of men under the age of 40 experience some sort of erectile dysfunction. Almost half of these claimed that their erectile dysfunction was severe. 

Erectile Dysfunction can occur at any age, although it is found to be more common as you get older. Approximately 50% of men above the age of 40 experience erectile dysfunction. 

Does ED affect sperm count?

Getting an erection and producing sperm are two separate functions of the body. You may have a perfectly healthy sperm count but may have difficulty achieving or maintaining an erection. This means that once you have identified and treated your ED, it may still be possible to impregnate a partner. 

On the other hand, you may not have a problem with your erections, but you might be finding it difficult to get your partner pregnant. This could mean that you have a low sperm count. 

Either way, both can be treated and it is important to maintain positivity throughout. 

Is Erectile Dysfunction curable?

Erectile Dysfunction treatment predominantly focuses on improving the symptoms of ED, so that you are able to achieve an erection that is hard enough and lasts long enough to engage in sexual activity. Whilst there is no definitive cure for Erectile Dysfunction, making certain lifestyle changes can help you to bring back the ability to perform. Making certain changes such as eating healthily, stopping smoking and exercising can all help to ensure that your body is functioning as it should, as well as boosting testosterone, the male sex hormone. Looking after your mental health by dealing with stress and anxiety levels can also help to keep you relaxed and stimulated during sexual activity, which in turn, will cause an erection.

Is Erectile Dysfunction permanent or temporary?

Some men develop erectile dysfunction as a result of underlying health conditions, taking certain medication or as a result of psychological issues such as stress, anxiety or depression. By addressing these issues, you may find that your temporary sexual dysfunction can be restored back to normal.
Permanent damage to nerves, arteries and old age may play a role in ED that is harder to reverse. However, there are a number of safe and effective treatment options available, meaning that you can enjoy a normal sex life.  

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