Erectile Dysfunction, Avenue Medical Practice Neat Guideline
Erectile dysfunction (ED) is the inability to get and maintain an erection that is sufficient
for satisfactory sexual intercourse. ED is also known as impotence. ED is a very common
condition, particularly in older men. It is estimated that half of all men between 40 and
70 years of age will experience ED at least once. ED can have a range of causes, both
physical and psychological. Possible physical causes include: heart disease, diabetes,
high blood pressure (hypertension), and hormonal problems.
Possible psychological causes of ED include: stress, anxiety, depression, and relationship
Prognosis Many men will experience episodes of ED that improve without the need for
treatment. Sometimes, persistent ED can be the result of a more serious underlying
health condition, such as heart disease. In such cases, treatment will be needed to treat
the underlying condition. Other causes include head injury, which can result in low levels
of production of the hormone testosterone. Treatment of testosterone can treat ED when
it is caused by head injury. Generally, the prognosis for ED is good. Some men will just
need to make some lifestyle changes, such as losing weight and taking regular exercise.
Other men may need to take medication such as sildenafil (known as Viagra).
Sometimes, erectile dysfunction (ED) only occurs in certain situations. For example, you
may be able to obtain an erection during masturbation, or you may find that you
sometimes wake up with an erection. However, you may be unable to obtain an erection
when you are with your sexual partner. In these circumstances, it is likely that the
underlying cause of ED is primarily psychological. However, if you are unable to obtain
an erection under any circumstances, it is likely that the underlying cause is primarily
When to seek medical advice It is recommended that you see your GP if ED persists
for more than several weeks. Although many websites offer treatments for ED, their use
is not recommended. This is because many of the medications that are offered by these
sites are counterfeit and could be dangerous. Even if the medications that are offered by
websites are genuine, such as sildenafil (Viagra), these tablets are not suitable for
everyone. Therefore, you should only take medication for ED that has been specifically
prescribed for you by your GP. If you have ED, your GP should assess your general state
of health because the condition can be the first sign of more serious health conditions,
Health conditions There are four main types of health condition that can cause ED.
These are described below. Vasculogenic - health conditions that can affect the flow of
blood to your penis. Neurogenic - health conditions that can affect your nervous
system. Hormonal - health conditions that can affect your hormone levels. Anatomical
- health conditions that can affect the physical structure of your penis.
Vasculogenic conditions Examples of vasuclogenic conditions include: heart disease,
arteriosclerosis - hardening of the arteries, high blood pressure (hypertension), and
diabetes - which can affect both the blood supply and the nerve endings in your penis,
Neurogenic conditions Examples of neurogenic conditions include: multiple sclerosis,
Parkinson's disease, spinal injury, or disorder, and tumours.
Hormonal conditions Examples of hormonal conditions include:hypogonadism - a
condition that affects the production of the hormone testosterone, over-active thyroid
gland (hyperthyroidism), under-active thyroid gland (hypothyroidism), and Cushing's
syndrome - a condition that affects the production of a hormone called cortisol.
Anatomical conditions Examples of anatomical conditions include:Peyronie's disease -
a condition that affects the tissue of the penis, and hypospadias - a congenital condition
that causes the urethra (the urine tube) to develop abnormally.
Medicinal causes of erectile dysfunction In some men, a number of medicines can
cause ED, including those that are listed below. Diuretics - medicines that increase the
production of urine, and are often used to treat high blood pressure (hypertension),
heart failure, and kidney disease. Antihypertensives - medicines, such as beta-
blockers, that are used to treat high blood pressure (hypertension). Fibrates -
medicines that are used to lower cholesterol levels. Antipsychotics Antidepressants
,Steroids ,Immunosuppressants - medicines that are used suppress the immune
system. H2-antagonists - medicines that are used to treat stomach ulcers.
Anticonvulsants - medicines that are used to treat epilepsy.
If you are concerned that a prescribed medication is causing ED, you should speak to
your GP about it because an alternative medication may be available.
Psychological causes of erectile dysfunction Possible psychological causes of ED
include: depression, anxiety, stress, and unresolved relationship problems with your
partner. ED can often have both physical and psychological causes. For example, if you
have diabetes, it may be difficult for you to get an erection, which may cause you to
become anxious about the situation. The combination of diabetes and anxiety may lead
Other causes of erectile dysfunction Other possible causes of ED include: obesity,
smoking, alcohol, tiredness, and using illegal drugs, such as cannabis, or cocaine.
Sometimes, cycling can also be a cause of ED. People who spend more than three hours
a week cycling may experience ED due to the saddle placing pressure on the nerves in
Before diagnosing erectile dysfunction (ED), your GP will ask you about your symptoms,
your overall physical and mental health, your alcohol consumption, whether you take
drugs, and whether you are currently taking any medication. Your GP will also want to
know whether your ED is permanent, or only occurs when you are attempting to have
sex with your partner. The former suggests that there is an underlying physical cause,
and the latter suggests an underlying psychological cause. Your GP may carry out a
physical examination of your penis to rule out any possible anatomical causes, such as
Peyronie's disease. Blood tests may also be used to check for possible underlying health
conditions. For example, abnormal hormone levels could suggest a hormonal condition,
such as an under-active thyroid (hypothyroidism), or high glucose levels could suggest
diabetes. A blood pressure test is usually carried out to check if you have high blood
If you have erectile dysfunction (ED), the treatment that you will receive will depend on
the underlying cause of the condition. If ED is due to an underlying health condition,
such as heart disease, or diabetes, that condition may need to be treated first before
treatment for ED can begin. However, in some cases, treating the underlying cause will
The main treatment options for ED are outlined below. Self-help The symptoms of ED
can often be improved by using some self-help techniques, and making associated life
style changes. These include: losing weight (if you are overweight), giving up smoking
(if you smoke), moderating your consumption of alcohol, not using illegal drugs, and
taking regular exercise. If you do a lot of cycling (more than three hours a week), and
you are experiencing ED, you may want to spend a trial period without riding your bike
in order to see if it improves your symptoms.
PDE-5 Inhibitors PDE-5 inhibitors are one of the most widely used and effective types
of medication used to treat ED. They work by temporally increasing the blood flow to
your penis. In England, three PDE-5 inhibitors are available for the treatment of ED.
These are: sildenafil - which is sold under the brand name Viagra, tadalafil- which is sold
under the brand name Cialis, and vardenafil - which is sold under the brand name
When not to take PDE-5 Inhibitors PDE-5 inhibitors are not recommended for people
who are at high risk of coronary heart disease. PDE-5 inhibitors should never be used if
you are also taking medicines that contain organic nitrates because the combination of
the two substances can be extremely dangerous for your heart. Medicines that contain
organic nitrates are often used to treat angina.
You should also not use PDE-5 inhibitors if you take the recreational drug, amyl
nitrate, more commonly known as 'poppers'.
Side effects of PDE-5 inhibitors Side effects of PDE-5 inhibitors are rare and, when
they do occur, they are usually mild. Possible side effects include: headaches, hot
flushes, indigestion, a blocked, or runny, nose, back pain, and disturbances to your
Hormone therapy If a hormonal condition is causing ED, you may be referred to an
Penis pump A penis pump is another method of treatment for ED. It is a simple tube
that is connected to a pump. You place your penis in the tube and pump out all of the
air. This creates a vacuum which causes the blood to rush to your penis. You then place
a rubber ring around the base of your penis in order to keep the blood in place, allowing
you to maintain an erection for around 30 minutes.
Alprostadil can be injected directly into your penis, or a small tablet can be placed
Psychosexual counselling If the cause of ED is thought to be primarily psychological,
you may be referred for psychosexual counselling. Psychosexual counselling is a form of
relationship therapy where you and your partner can discuss any sexual, or emotional
issues, or concerns, that you have that may be contributing to your ED. The counsellor
can also provide you with some practical advice about sex, such as foreplay techniques,
and how to make effective use of other treatments for ED in order to improve your sex
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