Erectile Dysfunction

The erection mechanism is complex. It starts with the brain and mood but involves nerves, arteries bringing blood to the erectile structures (2 cylinders of spongey tissue surrounded by a slightly stretchy fibrous covering) and veins taking it away.

As men get older it may become more difficult for them to achieve and/or maintain an erection. Up to 50% of men between the ages of 40-70 suffer from erectile dysfunction. The anxiety that results may compound the problem.

There are many medical conditions and drug treatments that may cause erectile dysfunction. Of particular note in urology, prostate and bladder cancer treatment such as radiation or surgery, may damage the erectile nerves and cause a temporary or permanent loss of erectile function. Nerve-sparing surgery exists that can lessen the impact on erectile function, however, the suitability of such surgery depends on a number of factors including the stage and extent of the tumour.

Erectile dysfunction treatment

Management of erectile dysfunction is usually approached in a stepwise fashion.

Conservative options initially include general lifestyle modification by stopping smoking, regular exercise, moderating diet and alcohol intake as well as stress management and weight loss. As a rule of thumb, if it’s recommended as healthy for the heart, it will be helpful for erectile dysfunction. Treatment of other medical problems such as uncontrolled hypertension or diabetes is also important as may be modifying/changing medications already being taken. The onset of erectile dysfunction is sometimes linked to heart disease and a general cardiac work-up with your family doctor is an important first step.
Vacuum pumps are plastic cylinders with a hand or battery-operated pump used to draw blood into the penis. A constriction band is then placed around the base of the penis to keep blood in the internal penile spaces. The ring is removed after 30 minutes to prevent tissue damage. This is a generally well-tolerated treatment and is used when medical management fails. Side effects are few but ejaculation may be painful and temporary numbness or bruising can occur. This is by far the cheapest option and is available at adult stores without a prescription.
PDE5 inhibitor tablets can increase blood flow to the penis, thus achieving an erection. The most common forms of this drug group are Viagra (Sildenafil), Cialis (Tadalafil) and Levitra(Vardenafil).
Common side effects of this method include hot flushes, nausea, visual disturbances and headaches for some men. These medications are not able to be taken in certain situations. These include severe heart disease, men taking nitrate medications for heart problems and retinitis pigmentosa (a rare inherited condition causing degeneration of the retina at the back of the eye).
This involves injecting a combination of medications into the side of the penis that dilates the blood vessels enabling them to fill with blood and thus creating an erection. This method is successful for most men, but it is essential to work out an accurate dosage to prevent the erection from lasting too long (known as priapism which can cause damage to the penile tissue). Other side effects may include pain, bruising and scar tissue formation at the injection site.
Surgical implants can be used to help create an erection. Semi-rigid or inflatable implants can be inserted with an operation.
Premature ejaculation is defined as recurrent or persistent ejaculation with minimal stimulation before, during or shortly after penetration. The mechanism for this condition is not well understood however both psychological and physical factors are thought to contribute.
The treatment of premature ejaculation is evolving but includes psychotherapy, behavioural techniques (stop-start and squeeze techniques), topical treatments (local anaesthetic applied in a condom) and antidepressant medications (SSRIs).