Sexual problems such as loss of sex drive and problems with erections are very common.
It can be very upsetting and affect your personal relationships. Embarrassment can often get in the way of seeking help.
Erectile dysfunction (impotence) is not being able
to get or maintain an erection that is firm enough
to have sexual intercourse. It unfortunately becomes commoner as you get older (40% or 4
in 10 men over 40) and in some men can represent early heart or vascular problems.
|There are many causes of erectile dysfunction and they can be physical, psychological or both. A purely psychological problem occurs in very few men (10% or 1 in 10 men). But, psychological issues are often part of the problem. Because many different things may together cause the problem, it is important to look at the whole person when assessing and treating the condition.
Your GP may suggest several appointments to talk about the problems with you and your partner, and you may not need specialist advice or treatment. However, our urologists can help by offering a variety of tests and treatments if the problem is physical. We may recommend that you speak to a psychosexual counsellor if necessary.
Most men have a physical cause (9 in 10 or 90%)
The causes are often:
1. Obesity, high blood pressure, high cholesterol, diabetes and renal (kidney) failure - these conditions are often found together.
2. Hormone problems – a fall in the production of testosterone (the male hormone) can lead to loss of libido (the desire for sex) or there can be disturbances of other hormones.
3. Some prescribed drugs may have side-effects that include erectile dysfunction.
4. Life-style factors such as stress, smoking, alcohol and recreational drug consumption.
5. Neurological problems (conditions affecting the brain, spinal cord and nerves).
6. Pelvic surgery or trauma.
7. Physical abnormalities - such as a tight foreskin and Peyronie’s disease (a condition that causes the erect penis to bend, making intercourse painful or impossible).
Assessment and investigations
Usually organised by your GP but can also take place following referral to one of our urologists
1. A full history including a detailed sexual history to find out why you are having problems with erections and under what circumstances. It is important to tell your GP or urologist if you have uncontrolled ejaculation before or immediately after penetration (premature ejaculation) or frequency of urination and slow urine flow (symptoms associated with the prostate) because they are often associated with erectile dysfunction.
2. Sexual Health in Men (SHIM) questionnaire – To help us find the causes of your conditon and the best way to treat it, we may ask you to fill in a short questionnaire about your symptoms and how they affect you.
3. Physical examination - this will include assessment of the male genitals, pulses in your legs and nerve reflexes in your legs, penis and anus (back passage).
4. Blood pressure
5. Blood tests – to look for abnormalities in the blood such as a raised sugar level which may indicate the presence of diabetes.
6. Urine testing - to see if your urine contains sugar which might mean that you have diabetes.
7. Hormone measurements – blood levels of testosterone and other hormones that may be causing your erectile dysfunction.
Other specific tests that may possibly be arranged by the urologist include:
1. Ultrasound of the penis – to measure the blood flow.
2. Trial of injection of Caverject (a drug that is injected into the penis) – if it results in a good erection it means that the blood supply to the penis is likely to be normal.
1) Prescribed drugs such as Viagra, Cialis or Levitra – These drugs require sexual stimulation to be effective and will not produce an erection without it. They will not affect your sex drive.
a) These drugs should not be taken if you are taking nitrates such as GTN (or Isosorbide) for angina.
b) You should only take these drugs if prescribed by your GP or urologist after a full consultation and discussion about the risks and benefits. It is dangerous to get them from the internet or any other source as it is not possible to ensure the quality of medication obtained in this way.
c) These drugs are only only available on the NHS in certain circumstances (such as if the problem is due to diabetes, pelvic cancer, pelvic surgery or pelvic trauma, or is causing a severe psychological problem.)
If drugs are ineffective or you have side-effects other treatment may be suggested.
2) Penile injection to produce erections – this is a simple way of getting an erection. We will show you how to give yourself the injections and what to do if the errection stays for too long a time.
3) Medicated urethral system for erection (MUSE) – This involves a pellet being put into the urethra (water-pipe). It is only used occasionally today because of its limited success rate and side-effects but for some men it can be effective.
||4) Vacuum erection assistance devices (VEDS) provide a Simple and effective way of getting an erection by drawing blood into the penis and holding it in place with a ring. It lasts for 30 - 45 minutes, is safe and has no known side-effects.|
|5) Penile Prosthesis is an artificial penile implant which is a highly effective treatment. It can be used when all other treatments have failed and there is considerable emotional distress as a result. Major surgery is needed and the operation has a high risk of complications such as infection. It is an expensive operation and your urologist will need to make a special application to your GP for funding.