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Erectile Dysfunction (ED), also known as impotence, is a common condition marked by difficulty in achieving or maintaining an erection sufficient for sexual activity, often impacting self-esteem and relationships. Effective treatment options include PDE5 inhibitors like Sildenafil (Viagra) and Tadalafil (Cialis), which work successfully for most men.
Erectile Dysfunction (ED), also referred to as impotence, is a prevalent condition characterised by the inability to achieve or maintain an erection firm enough for satisfactory sexual intercourse. While occasional difficulty with erections is common and typically not cause for concern, persistent challenges in achieving or sustaining erections can significantly impact a man’s self-esteem, intimate relationships, and overall quality of life.
ED can stem from various physical, psychological, or lifestyle-related factors, including underlying health conditions such as cardiovascular disease, diabetes, hormonal imbalances, or neurological disorders, as well as psychological factors like stress, anxiety, depression, or relationship issues. Lifestyle factors such as smoking, excessive alcohol consumption, obesity, and lack of physical activity can also contribute to ED.
Treatment options for ED include the use of medications known as Phosphodiesterase Type 5 (PDE5) inhibitors such as Sildenafil (Viagra) or Tadalafil (Cialis). Additionally, lifestyle adjustments such as adopting a healthy diet and regular exercise routine, along with psychotherapy, can play a pivotal role in addressing ED. Other interventions, such as vacuum erection devices, penile implants, or testosterone replacement therapy, may also be considered based on the specific underlying causes and individual needs of the patient. Consulting with healthcare professionals is essential to determine the most suitable treatment plan tailored to each individual’s circumstances.
Erectile Dysfunction (ED), also known as impotence, refers to the difficulty in achieving and/or maintaining an erection adequate for satisfactory sexual intercourse.
In some instances, the penis may become partially erect but not hard enough for effective sexual activity. In other cases, there may be no swelling or fullness of the penis at all.
Erectile Dysfunction is very common, particularly in men over 40. Research indicates that approximately half of men between the ages of 40 and 70 will experience ED at some stage in their lives.
Although ED is a benign disorder, it can have a significant impact on the quality of life of individuals affected by it, as well as their partners and families.
Erectile Dysfunction can occur at any stage of life, but its prevalence increases with advancing age.
Various factors contribute to ED. These factors are typically categorised as those that are physical and those that are predominantly due to psychological and mental health issues.
Physical Causes
About 8 in 10 cases of ED are attributed to physical causes. In most instances arising from physical causes (except those stemming from injury or surgery), ED tends to progress gradually. If the root of ED lies in a physical issue, it’s probable that your sex drive remains unaffected unless there’s an underlying hormonal imbalance. Occasionally, ED can lead to diminished self-esteem, anxiety, and even depression. These emotional responses can further complicate the issue.
Physical causes of ED include:
Reduced blood flow to the penis – This is the most common cause of ED in men over the age of 40. Similar to other areas of the body, the arteries supplying blood to the penis can narrow over time. Consequently, insufficient blood flow may impede the ability to achieve an erection. Various risk factors heighten the likelihood of arterial narrowing, including aging, high blood pressure, elevated cholesterol levels, and smoking.
Nerve damage – Damage to the nerves supplying the penis can result from conditions like stroke, multiple sclerosis, and Parkinson’s disease. Additionally, spinal injuries, surgical procedures near the affected area, and radiotherapy targeting the genital region can also cause nerve damage.
Diabetes – Diabetes stands out as one of the most prevalent causes of ED. It can adversely affect the blood vessels and nerves responsible for supplying the penis, contributing to difficulties in achieving or maintaining an erection.
Hormonal causes – ED can occasionally stem from insufficient levels of testosterone, a hormone produced in the testicles. Low testosterone levels may also manifest in symptoms such as reduced libido and mood changes. Notably, a previous head injury can disrupt the function of the pituitary gland in the brain, which plays a crucial role in regulating testosterone production. Although the connection might not be immediately apparent, head injuries can impact the pituitary gland’s ability to stimulate the testicles to produce testosterone.
Side effects of certain medications – The most frequently prescribed medications associated with ED include Tricyclic/SSRI Antidepressants, Beta-blockers, Diuretics (often referred to as water tablets), and H2 Antagonists like Ranitidine and Cimetidine. Additionally, there are several less prevalent medications that can also potentially lead to ED.
Alcohol and drug abuse – Excessive alcohol consumption and substance abuse can impair nerve function, reduce blood flow to the penis, and interfere with hormone regulation. Chronic abuse can exacerbate underlying health conditions, such as liver disease and high blood pressure, which are known risk factors for ED.
Cycling – ED following extended periods of cycling is fairly common. It’s believed to stem from the pressure exerted on the nerves supplying the penis when sitting on the saddle for prolonged durations. This sustained pressure may impede nerve function post-ride, consequently impacting erectile function.
Excessive outflow of blood from the penis through the veins (venous leak) – This is relatively rare but can be caused by various conditions affecting the penis.
Psychological Causes
Performance anxiety can cause or contribute to ED. For instance, numerous men experience occasional difficulties in achieving or sustaining an erection. If a person encounters one such episode, they may become anxious about potential future occurrences. This anxiety can then hinder their ability to achieve an erection during subsequent encounters, exacerbating the cycle of anxiety.
Several mental health conditions and related factors can contribute to the development of ED. They include:
Typically, ED develops quite suddenly if it is a symptom of a psychological problem. ED issues may resolve when your mental state improves – for example, if your anxiety or depression eases. However, some people become even more anxious or depressed when they develop ED and do not realise it is a reaction to their mental health problem. This lack of awareness can exacerbate the situation, fostering a vicious cycle of escalating anxiety and persistent ED.
As a rule, if there are instances when achieving a satisfactory erection is possible, despite experiencing difficulties most of the time, the likelihood of a psychological factor being the root cause of ED is higher than a physical one.
Erectile Dysfunction shares many risk factors with cardiovascular disease.
The following are all risk factors associated with ED:
Phosphodiesterase Type 5 (PDE5) Inhibitors
Phosphodiesterase Type 5 (PDE5) inhibitors are a first-line treatment option for Erectile Dysfunction. They have about an 80% success rate; however, it should be noted that they will not facilitate an erection unless you are sexually aroused.
This group of medications work by inducing the relaxation of smooth muscle and enhancing blood flow to the penis. They achieve this by modulating cGMP, the chemical involved in widening (dilating) the blood vessels during sexual arousal.
Even if the nerves or blood vessels supplying the penis are not working so well, PDE5 inhibitors can still augment blood flow and stimulate an erection.
There are four different PDE5 inhibitors available in the UK: Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra) and Avanafil (Spedra). Choice depends on individual response and frequency of intercourse.
| Sildenafil (Viagra) | Tadalafil (Cialis) | Vardenafil (Levitra) | Avanafil (Spedra) |
Available strengths
| 25mg, 50mg, 100mg | 2.5mg, 5mg, 10mg, 20mg | 5mg, 10mg, 20mg | 50mg, 100mg, 200mg |
Usual starting dose
| 50mg | 10mg | 10mg | 100mg |
How fast does it work? | 30-60 mins | 30 mins | 30-60 mins | 15-30 mins |
How long does it last?
| 4-6 hrs | 24-36 hrs | 4-6 hrs | 4-6 hrs |
Effect of food
| Sildenafil can be taken with or without food. However, you may find that it takes longer to start working if you take it with a heavy meal | No effect | Can be taken with or without food but preferably not after a heavy or high-fat meal as this may delay the effect | Can be taken with or without food, however, effect may be delayed if taken with food |
Unique feature | The original and most cost-effective treatment choice | The longest acting treatment choice. Nicknamed ‘The Weekend Pill’ as it allows for sexual spontaneity | More effective than other ED treatments in men over 50, as well as those with health risks such as high blood pressure, high cholesterol or diabetes | Fastest acting treatment option |
PDE5 inhibitors should not be taken if you are also using Nitrate medicines (often used to treat angina) such as Glyceryl Trinitrate (GTN), as it can lead to severe hypotension, potentially resulting in heart attack, stroke, or even death. PDE5 inhibitors should also be avoided in individuals taking Alpha-blockers (Doxazosin, Indoramin, Terazosin or Prazosin), unless they are on a stable dose, due to the risk of a sudden drop in blood pressure.
PDE5 inhibitors are contraindicated in patients in whom vasodilation or sexual activity are inadvisable, or where there is a history of hereditary degenerative retinal disorders, non-arteritic anterior ischaemic optic neuropathy, or recent history of heart attack, stroke or unstable angina. Additionally, PDE5 inhibitors should be avoided if systolic blood pressure is below 90mmHg.
Patients that experience ED should receive six doses of an individual PDE5 inhibitor at the maximum dose (with sexual stimulation) before being classified as a non-responder. Patients who fail to respond to the maximum dose of at least two different PDE5 inhibitors should be referred to a specialist for further evaluation and management.
Alprostadil
Alprostadil is a synthetic version of the hormone Prostaglandin E1 (PGE1), which occurs naturally in the body. It helps treat the symptoms of ED because it is a vasodilator, which means that it widens blood vessels. This improves blood flow to the penis, making it easier to get an erection. Unlike PDE5 inhibitors, sexual arousal is not necessary to obtain an erection. Alprostadil is effective in the majority of men who try it.
Alprostadil is typically reserved for consideration after other treatments, such as PDE5 inhibitors, have been tried and have failed to work. This is because Alprostadil is more likely to cause prolonged painful erections as a side effect.
Alprostadil is administered directly to the penis and is available in several different forms:
Each method of administering Alprostadil comes with its own set of advantages and disadvantages. Determining the most suitable option for you is a personal decision that should be made in consultation with your partner(s) and with the guidance of your healthcare provider.
You should not use Alprostadil if:
Alprostadil is the generic name of the treatment, but it is also known by the following branded versions: Caverject, Viridal Duo, Vitaros, and MUSE.
Vacuum Devices
Vacuum pumps encourage blood to flow to the penis, inducing an erection. They are effective for the majority of men and can serve as an alternative when medication is not suitable or is ineffective.
The process involves placing the penis into a plastic container, after which a pump removes air from the container, creating a vacuum. This action draws blood into the penis, resulting in an erection. Once erect, a rubber band is placed at the base of the penis to maintain the erection. The plastic container is then taken off the penis, which remains erect until the rubber band is removed (which must be within 30 minutes).
Vacuum devices work best when there is a motivated, interested and understanding partner. They may be the treatment of choice in those with conditions preventing the use of medication. Adverse events include pain, bruising, and numbness.
Lifestyle & Other Advice
Symptoms of ED can often be improved by treating underlying causes such as depression, anxiety, and certain hormonal conditions.
Implementing lifestyle interventions, such as exercising more often, losing weight if overweight/obese, stopping smoking, reducing stress, and cutting back on alcohol, can be beneficial in improving ED symptoms.
Cognitive Behavioural Therapy (CBT), couples counselling or sex therapy can be valuable approaches when addressing psychological factors that either contribute to or result from ED.
Certain medications have the potential to induce ED. You should check the leaflet that comes with any medication that you take to see if ED is a possible side effect. If you suspect a medicine that you take to be the cause of ED symptoms, you should consult your doctor before stopping any prescribed treatment. A switch to an alternative medication may be possible.
You should tell your doctor if your condition does not improve despite treatment.
A low sex drive or a history of head injury could indicate a hormonal issue to be the cause of ED. In this situation, a blood test to check the level of the hormone testosterone (and sometimes prolactin) may be advised.
The following may require referral for further assessment or specific diagnostic tests:
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Once your order has been approved by our prescriber, your treatment is then dispensed, packaged, and posted by our regulated pharmacy partner. Your order will arrive as quickly as the next day depending on your selected delivery option.
You can be confident that your treatment will be 100% genuine, safe, and effective as we only use medications procured from licensed manufacturers and trusted UK wholesalers.
Rest assured that your treatment will be delivered in plain packaging for complete discretion.
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