Erectile Dysfunction and what can be done.

Author: Dr Renee

Hi everyone. Thanks for coming back! So this week I'm going to do a video for men, but not really just for men, because obviously women are often the driving force behind men's health. So I'm sure you'll have something to say about this and you might even need to do some chivvying along to the GP surgery. I'm going to talk about erectile dysfunction.

Erectile dysfunction is otherwise known as impotence. It's when a man can't actually get an erection, or if he does get an erection, he finds it hard to maintain. And it affects lots of people. It affects all ages, all the way through from 16 up to 90. It is true that as a man gets older, he has more chance of having this problem.

For example it's estimated that half of men between the ages of 40 and 70 have some degree of erectile dysfunction and once they reach the age of 70 that figure goes up to 70%, or 7 in 10! So it's a lot of men. So what causes it? There are lots of different causes. One of the main ones is atherosclerosis or in narrowing of the blood vessels. This is something that you hear about in relation to heart attacks or strokes, and it's an important health risk.

And just as it affects the vessels that are leading to the heart and the brain it also affects the vessels that are leading to the penis. And the things that cause it a high blood pressure, high cholesterol, diabetes. So it's a lifestyle disease quite often, but there is a genetic involvement as well. There can be a hormonal reason for erectile dysfunction, so if your thyroid isn't working so well, if you have a testosterone problem, or even Cushing's. There can be a neurogenic reason, which is nerves. So for example people with illnesses such as multiple sclerosis or motor neuron disease or Parkinson's or even diabetes which can affect the way that nerves work, can have a problem. Surgery to the pelvic region or an injury to the head or the pelvic region can actually affect erectile dysfunction. It's estimated for example that between 15 and 25 percent of men who've had a head injury have a degree of erectile dysfunction.

Erectile Dysfunction and what can be done.

And that can quite often be young men obviously, in traffic accidents, in sporting accidents. If you've got an anatomical problem, so if your penis is somehow not shaped in the way it should be like Peyronie's disease, that can actually cause a problem getting an erection. And if you've got psychological problems; so if you have anxiety, depression, self-esteem problems, relationship forming or keeping problems, or even just a problem in your current relationship, it can be a problem. And then many medications can actually cause it so I won't go through the whole list but to give you an idea; antipsychotic medications that people use for psychosis and schizophrenia for example. Antidepressants, some blood pressure tablets called beta blockers.

Steroids; so men who use steroids at the gym to build muscle can actually get testicular atrophy and have erectile dysfunction. So that's something to think about because it's no good one thing looking good if the other isn't working! Some antihistamines can also cause a problem. But the list is endless and I will put some links afterwards to sites where you can actually look at all of these. So when should you see a GP? Well I think if you've been putting up with this problem for more than a few weeks you should see your GP. Just to make sure it isn't an evolving underlying problem that can be dealt with. So that's really important, and I see men all of the time with this problem. So how do we diagnose this? Well initially we'll talk to you to get a really good history of what's been happening, when it happens, what the circumstances are.

We'll ask you questions like 'do you still get morning erections?' Because that gives us a good feel for whether it's an underlying blood vessel problem or whether it's more psychological. We'll examine you to make sure that there isn't an anatomical problem with your genitals. We'll take a history of any drugs or alcohol, what your usage is. And we'll look at your medications to make sure that we aren't giving you something that could be causing the problem. So how can we treat it? Well there are lots of different treatments, so the most important thing is to tackle the cause and quite often that can be the solution. We can give you drug treatments to help, if we can't take away the underlying cause.

There are vacuum pumps which work for 90% of men, so that's quite a good solution sometimes. Surgery is a very rare option that can be used and then psychological treatments. So looking initially at cause, for example atherosclerosis (one of those words) that is one of the most common underlying causes for this. We need to think about that as an overall health risk because it can lead to heart attacks and stroke.

So not only does it affect your ability to get an erection it is actually clogging up the arteries everywhere in your body. So we need to look at lifestyle, make some changes; so a good healthy Mediterranean style diet with high unsaturated fats and no saturated fats, exercise, reduction of smoking/alcohol and drugs. And if possible stopping those things obviously.

Looking at your medications and making sure that there's nothing there that's causing you a problem. And actually adding in medications to control your blood pressure, your cholesterol, and your diabetes, if those are problems for you. And then looking at stress relief as well because stress contributes to the risk in atherosclerosis. Then we have some drugs which can help you get an erection or keep an erection. So the main ones, which most people have heard of, are the phosphatediesterase-5 inhibitors or the PDE-5 inhibitors.

You'll know those as viagra most likely, and Viagra is a table called sildenafil. There are some other ones in the same class; there's Vardenifil, which is levitra and there's avanafil which is Spedra. Now these will last about eight hours when you use them and then there's another one called tadalafil, (another unpronounceable word), which is Cialis. And that one lasts for up to 36 hours, say for example over a weekend. Now they all should be taken on an empty stomach, and they still, and this is a really important point, require you to be aroused so it's not just going to give you an erection when you take a tablet.

You still need the foreplay and the arousal that you usually need before you have sex, so that's important. The one that GP's can prescribe for any patient is, sildenifil. The other ones can be prescribed by GP's but with certain conditions. So you need to speak to a GP to see what category you fall into and what might work for you. If these are not working, the most common reason is that you didn't wait long enough after taking it. The other reason is that you waited too long after taking it. The dose might be too low or you took it at the right time and the dose was right but you didn't have adequate arousal to get an erection.

So with those problems, you can see that a couple of them you can sort out, one of them a GP can sort out, and the other one your partner needs to sort out for you! So what are the cautions? Are there any people that we wouldn't give these medications to? Well we would always assess your cardiovascular disease risk. So if you have hypertension or high blood pressure, coronary heart disease, unstable angina, you've had a previous heart attack, you've got an ischemic optic neuropathy, we would have to think very hard about when will be the right time for you, because we need to get all of those things under control. You shouldn't be having sex for six weeks after you've had a heart attack.

So we just need to make sure that things under control and the timing is right. And that you're not currently suffering any of those diseases, you know, in an uncontrolled way. We also need to weigh up the risks of benefits of having sex or not, because we know that having sex is good for your mental health and your well-being, so its important and if we can get you there we will. It's important if you've got an anatomical problem, we think about that first, because getting an erection might actually make that worse and be painful .For men that are at risk of priapism, which is a painful erection that's permanent and doesn't go down because the penis fills with blood and becomes engorged; men who have sickle-cell disease can be risk of that. So we need to think about that. Certain medications, like long-acting beta blockers or nitrates that you would take for angina - you can't have the PDE-5 inhibitors with those medications and that's really important. If you take illegal drugs, like poppers, that have nitrates in them, you shouldn't have these drugs - it can be dangerous. And if you have a low blood pressure we have to think about it because it will lower your blood pressure slightly.

So that. Said you've been cleared by your GP and they've been prescribed, are there any side effects? Well, as with any drug, of course there are. So headaches and migraines are quite common, visual disturbance, blocked or runny nose, indigestion, nausea, flushing, vomiting, muscle and back pain are some of the more common ones. But I must admit I don't actually have men coming back complaining of the side effects. They're either tolerable or they don't get them. So testosterone is another medication that could be used in this scenario. Men, as they get older, have lower levels of testosterone naturally, they gradually decline.

And also men that have got a congenital problem, like hypogonadism, can have lower levels of testosterone. They usually work best, or testosterone does, in conjunction with the PDE-5 inhibitor. The most important thing to say is that won't be prescribed for you at GP level. If you're going to be prescribed testosterone it needs to be done by a specialist.

A GP will then probably carry on, but initially it needs to be done by a specialist. Now I mentioned vacuum pumps and they really can be successful. It's a device which fits over the penis and you pump the air out of it and that draws blood into the penis and causes an erection. You can get bruised when you use it. And obviously it's not particularly spontaneous in terms of having sex but it does work well. And so you can't use it, because of the bruising, if you've got a bleeding disorder, because it could cause a haematoma which is a much bigger clot of blood. But they do work very well.

Unfortunately, they're not always available on the NHS but they might be, so speak to your GP, it does vary area by area. Constriction rings can also be used once you've got an erection to maintain an erection. And they're often used in conjunction with the PDE-5 inhibitors and they can also be used in conjunction with the vacuum pump, so that's worth thinking about. Now I mentioned surgery. Surgery really is a last resort when it comes to erectile dysfunction and it really is use with on what other treatments fail. So for younger men that have had a pelvic area injury that needs repairing or some other solution, if there's an anatomical problem that can be sorted out through surgery, then it will be used.

You may have heard of penile implants which can either be semi-rigid, so they help you get an erection, but they don't give you the full erection, or inflatable that you can use when you need an erection. These unfortunately are not available on the NHS but they are used. The evidence for them is poor, which is why they're not used on the NHS. Psychological input is really important because it's a massive area especially for the younger man, when it comes to erectile dysfunction. So counselling is really important and quite often in the form of CBT, or cognitive behaviour therapy, And we've talked about that a lot; it's a really useful counselling tool, it's difficult but when done properly it works well. There's a special kind of counselling for erectile dysfunction called sensate focus.

And it's couples therapy. So you go together and you agree initially a period of time, weeks or even months, where you won't have sex at all. Then you initially start exploring each other's bodies but not the genital areas over a period of weeks. Then eventually you move on to the genital areas and then eventually full penetrative sex. And that can work really well, so that's another thing that's worth thinking about. There are some other solutions out there.

There isn't that much evidence behind it but there are people who say works well for them. Acupuncture for example has been used by some men. Pelvic floor strengthening has been shown to have some benefit and I think people mainly associate pelvic floor with women, and of course in women it is massively important, but men also have a pelvic floor and improving it and toning it can help with erections and how strong they are and how how well they can be maintained. And then there's another treatment called low intensity shock wave therapy. Now none of these have that much evidence behind them but I will put some details in the comments afterwards so you can look at them for yourselves. So I think the most important thing to say about erectile dysfunction is; again it's one of those embarrassing topics that a lot of men don't want to talk about and it's kind of self-fulfilling because once it doesn't happen you're going to worry that it's not going to happen next time and that's in itself puts stress on you and it probably won't happen! So you have to think about going forward sooner rather than later. So as I've said, if it's lasting for more than a few weeks, go and see your GP. I promise you that I see men about this as my male colleagues in women about female things.

We're seeing you as a doctor, don't be embarrassed, it's something that we talk about all the time and we have solutions, as you've seen, that we can offer you. Sex is really important for healthy relationships and for people's self-esteem, and that's why it's important that you sort out this problem because if you don't sort it out, you can't have sex, and that's not going to make you feel good about anything in life. And we all want everybody, men and women, to feel good about things and healthy relationships are good for people. So see your GP, just answer their questions, tell them what's going on and see what can be done.

So I hope that's helped. Please ask me any questions you want to in the comments afterwards and I'll always answer them, as I do. Make any suggestions for the future in terms of other topics and I will do other topics for men as well as women! And hopefully you can spread the word, get people to subscribe and enjoy the videos that I give you in the future! Thanks for watching again, it's really appreciated.

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Erectile Dysfunction and what can be done.

Hi everyone. Thanks for coming back! So this week I'm going to do a video for men, but not really just for men, because obviously women are often the driving force behind men's…

By: Dr Renee