Erectile Dysfunction (Impotence):

Erectile dysfunction (impotence) is the persistent or recurrent inability to get an erection sufficient to complete sexual intercourse. It is a common problem affecting at least 1 in 10 men, so there are an estimated 2.3 million men affected in the UK. Unfortunately only about 10% of these actually receive treatment, largely because of men's embarrassment at the thought of discussing it and a belief that nothing can be done for it.

What can cause it ?

There are few men who go throughout life without experiencing a problem at some stage or other with erections. This usually results from anxiety, stress, tiredness or having drunk too much alcohol ('brewers' droop') - and is nothing to worry about. Unfortunately having a problem once can in itself cause ongoing problems because the 'fear of failure' makes men become preoccupied with this and they are unable to enjoy the feelings of arousal associated with sexual stimulation, which leads to no erection!

Impotence was thought to be almost completely caused by psychological factors about 20 years ago, but now we know that physical problems are involved in the majority of those affected. However, it is not uncommon for impotent men to have a combination of psychological and physical causes.

Physical causes of impotence include:

Diabetes (over 35% of all diabetic men suffer from erection problems)
Smoking
Circulation problems
Side-effects of prescribed drugs (eg, some medications used to treat depression and raised blood pressure)
Drug and alcohol abuse
Stroke
Severe chronic diseases, eg liver or kidney failure
Neurological diseases, eg Multiple Sclerosis

These physical causes of erectile dysfunction often come on gradually and impotence in these cases tends to occur irrespective of the particular sexual circumstances.

However, when men can achieve erections under some circumstances but not others it is likely that psychological factors are at work such as:

Anxiety
Stress
Marital problems
Depression

Can it be treated ?

YES! The last few years have seen big developments in impotence treatment. If changes such as trying to reduce stress, anxiety and alcohol consumption don't cure the problem, see your doctor – who will attempt to establish the cause of the problem by asking you questions and examining your blood pressure, nerve reflexes, penis and scrotum. A sample of urine and blood may also be collected to test for diabetes and other problems.

Following this your doctor will be able to offer you the treatment which is best suited to your particular case. A change in your prescription medicines may also be recommended if your problem could be due to or exacerbated by a side-effect of one or other of these.

How can it be treated ?

Counselling:

When psychological factors or difficulties in the man's relationship with his partner are considered an important cause for erectile dysfunction, a course of counselling or couple's therapy may be suggested. This can help couples re-establish a sexual relationship when there has been a long period without sex because of impotence and is sometimes combined with other forms of treatment.

Medication:

The two most effective and simplest forms of treatment that your doctor can prescribe are:

1. Transurethral therapy (MUSE)

This is an effective treatment in which a tiny pellet of drug is placed in the urethra (the tube through which urine is passed) at the end of the penis using a special, needle-free applicator. The drug is then absorbed, giving an erection within 5-10 minutes.

2. Tablet Treatment (VIAGRA)

This too is an effective treatment and (at March 2001) the only tablet licensed for the treatment of impotence. It simply involves taking a tablet one hour before sexual intercourse is planned and has the big advantage of not causing an erection unless the man is "in the mood".

Both Muse and Viagra can only be prescribed on the NHS to men with the following conditions:

Diabetes
Multiple Sclerosis
Parkinson's disease
Polio
Cancer of the prostate
Prostatectomy (removal of the prostate), including transurethral resection of the prostate (TURP)
Surgery in the pelvis
Kidney failure treated by dialysis or transplant
Severe pelvic injury
Single gene neurological disease
Spinal cord injury
Spina bifida
Men who were receiving drug treatment for erectile dysfunction prior to 14.9.98.

For those men who are not eligible for NHS prescriptions from their GP, treatment may be available from specialist hospital clinics when impotence is causing 'severe distress'.

'Severe distress' has been defined as causing -

Significant disruption to normal social and occupational activity
Marked effect on mood, behaviour and environmental awareness
Marked effect on interpersonal relationships

In cases where NHS treatment is not available, drug treatment may be prescribed privately by your GP.

So, remember if you're affected:

It's a common problem
You're not the first and you certainly won't be the last
Help is at hand: all you need to do is ASK

Useful Contacts:

The Impotence Association
PO Box 10296
London
SW17 9WH (Send SAE)
Helpline: 020 8767 7791

Men's Health Matters
100 Blythe Road
London
W14 0HB
Helpline: 020 8995 4448

www.informED.org.uk

www.basrt.org.uk

Disclaimer: This page is for informational purposes only and should not be considered as medical advice or substituted for professional advice. Always consult your doctor with your questions and concerns.