Factsheet
The Penis - Erectile Problems
Date 06 February 2008
HOW DOES THE PENIS BECOME ERECT?
The penis is made up of three separate compartments. Two of these contain spongy tissue that can fill up with blood to cause an erection. To get and maintain a firm erection this spongy tissue needs to be in good condition. There also needs to be a good blood supply to the penis and the nerve supply must not be damaged. As well as erections that occur as a result of sexual stimulation, men get between three to five spontaneous erections most nights.WHAT IS ERECTILE DYSFUNCTION (ED)?
This is the new name for what used to be called impotence. It is when a man is unable to get or keep an erection long enough for him to have intercourse and to satisfy both himself and his partner.WHAT CAN CAUSE ERECTILE DYSFUNCTION (ED)?
There are a number of possible causes for ED. Sometimes it is caused by a combination of several factors. Some of these are:- psychological causes, such as stress, anxiety and fatigue.
- performance anxiety. This can occur in a new relationship or where the man feels pressured to perform sexually. If the man becomes concerned about sexual functioning, it can make matters worse.
- chronic diseases, such as diabetes, high blood pressure, Multiple Sclerosis and Parkinson's disease.
- injuries, such as spinal cord damage, pelvic fracture, and after surgery or radiation treatment to the pelvic area.
- penile diseases, such as Peyronie's disease, which can cause painful erections, lumps in the penis, and curving of the penis.
- drugs, such as alcohol, smoking, prescription and recreational drugs.
- weak or inactive pelvic floor muscles.
HOW MANY MEN SUFFER FROM ED?
It is impossible to say how common ED is, since many men never seek help or advice. Erectile dysfunction is believed to be linked with other problems as well - domestic violence, relationship breakdown, excessive use of alcohol and drugs and lack of self-esteem to name a few. If a man thinks he might have erectile problems it is definitely worth discussing things with a doctor as there are now a number of treatments for this condition, which may be of help.WHAT SORT OF THINGS WILL THE DOCTOR DO IF I GO AND SEE THEM ABOUT ED?
The first thing they will probably do is to take your medical history. They might ask you about the following:- whether you have any personal stresses (family, work, financial etc).
- whether you are having relationship problems.
- whether you or anyone in your family has diabetes or heart disease.
- whether you smoke or drink alcohol, and how much.
- whether you use any medications or recreational drugs.
- your physical activity levels and diet.
HOW IS ED TREATED?
There are several different treatments available. The aim is to give you an erection strong enough for sexual penetration. If there are problems with your relationship then these will need to be addressed first. Before starting any treatment you should always check that your partner is willing to start having sexual intercourse again.Counselling will give you information on what is normal and help you with some techniques to relieve stress and improve sex. Counselling takes time and commitment and you should only see a counsellor with special skills in this area.
Sildenafil (Viagra®) or Tadalafil (Cialis®) are oral medications taken between 20 minutes to one hour before you plan to have sexual intercourse. You need to be sexually aroused for these medications to work and it can take anywhere from 20 minutes to four hours to achieve an adequate erection. The tablets may not work as well if you have had too much food or alcohol when you take them.
Before taking any of these medications you should make sure that you are fit enough to have sexual intercourse safely - that means you should be able to walk 100 metres or climb a flight of stairs without getting breathless. You should not use these medications if you have had a stroke or heart attack in the past six months. Some men may get side effects such as headache, flushing of the face, blocked nose, visual disturbance or nausea.
You must never use these medications if you are also using nitrate medication. The combination of the two has been known to cause death in some men. Nitrate medication is most commonly used for angina and other heart problems and can be prescribed as tablets, sprays, injections or patches. It is also in 'poppers' (amyl nitrate), which are used by some men to heighten sexual excitement during intercourse. If you are not sure whether any medications you are taking contain nitrates you should check with your doctor.
A vacuum erection device (VED) is a device used to give a man an erection. A cylinder is placed over the penis and air is pumped out by means of a battery operated or manual pump, drawing blood into the penis. A plastic band is then placed around the base of the penis, which will maintain the erection when the VED is removed. The band can only stay in place for about 30 minutes. The penis will be slightly cooler, bluish and unstable at the position of the ring and will tend to hinge at this point as well. You do need some skill with your hands to be able to use this method successfully. Men who have sickle cell anaemia should not use this method.
Alprostadil (Caverject®) is an injection that a man is taught to give himself into the side of his penis. It is one of the most reliable forms of treatment, but it can be a little tricky to use and some men don't like the idea of injections. You don't need to be aroused for it to work and the erection happens fairly quickly. At present it is available in frozen and powder form.
Some of the possible side effects are prolonged erections, pain at the site of the injection and a risk of scarring in the penis. It does need a fair amount of skill with your hands to use this method of treatment successfully and men using this treatment should have regular checkups with their doctor. Caverject® should not be used by men with Peyronie's disease since it can lead to more severe scarring.
Penile implants are mechanical devices that are inserted into the penis to take the place of the normal spongy erectile tissue. Implants have a high success rate, but are not recommended as the first choice. Possible side effects are shortening of the penis, implant failure, and infection. Counselling is always recommended before a penile implant is inserted.
Pelvic Floor Muscle exercises train men to tighten their muscles as strongly as possible, as if to prevent the passage of gas. They are also coached to retract their penis and lift their scrotum to demonstrate they are using the correct muscle groups. This technique is most suitable for men seeking long-term resolution of erectile dysfunction without pharmacological or surgical intervention.
Androgen (testosterone) Therapy is a controversial form of treatment for erectile dysfunction. If a man has a decreased desire for sex and low testosterone levels (on blood tests), it may be useful. Testosterone can be given as tablets, implants, injections and sometimes, as skin creams or patches. It has been shown that testosterone can increase the risk of prostate cancer, so the doctor will do some tests for prostate disease before you start androgen treatment. Side effects of androgen therapy can include mood changes, swollen breasts and skin reactions.
The most important message for men with ED is that they should not be embarrassed about discussing these symptoms with a doctor. ED could be the first symptom of a more serious health problem that needs to be treated. It is worth remembering there are now many effective treatments that can help.
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For further information
- Contact the Healthline on 1300 658 886.
