Oct 06, 2010
Erectile Dysfunction (Impotence) Treatments
This used to be called impotence until the rather more sensitive erectile dysfunction or “ED” phrase was coined. It actually is a better term because there is a range of ways in which your penis mail fail to live up to expectations, causing embarrassement and disappointment.
Very technically, ED is defined as the inability to develop or keep an erection long enough for the desired sex to occur. This might include masturbation, public sex, penetration and oral sex. It really doesn’t matter why the erection is desired – but if you can’t reliably get one when you need one, then you have ED.
ED is probably the most common sexual problem that a man can experience. Overall, probably around 1 in 4 men have problems. Younger men tend to have more in the psychological problem area with negative embarrassing experiences being reinforced each time the erection fails. Older men have a much higher rate of ED with around 50% plus of men in the 50 to 70 age group in at least one US study reporting it. Remember that ED is a range of conditions – it’s not simply a “dead or alive” condition. Partial erections; erections which start off strong and then fail; erections which are fragile in the sense that it doesn’t take much to make them collapse, are common.
As I say, younger men generally have less physical reason to develop erectile failure. They usually will have strong erections but occasional psychological problems like “performance anxiety” where they worry whether an erection will occur will kick in and cause erectile collapse. Older men, sadly in my age bracket of 40 plus, will tend towards more physical causes with around 5% of us being totally unable to develop an erection of any sort at all.
The reasons for erectile dysfunction have become much clearer over the last 20 years or so. In fact, I’m so old that I can remember the days when as students we were taught that the majority of men with erectile problems had physical disease causing it. We then went almost full circle with the psychological argument taking precedence and suddenly all men with ED had “issues” which you could solve with a jolly good chat with a psychologist.
Luckily things really have changed and mainly with the meteoric arrival of the drug Viagra and then its relatives Cialis and Levitra. These drugs heralded the notion that although there might be a physical or a psychological problem, it was solvable and reliably so, by taking the medications.
The arrival of these medications also opened the box of shame and enabled men to discuss the issues rather more openly. As a GP in NHS practice I would frequently have female patients come to talk to me about their sexual problems and their male partner’s lack of erection.
What finally did become really very clear was that there was a range of interacting physical and psychological elements, all having impact on each other. Physical difficulty caused by disease and or medications would be compounded with realising that once you’d started there had to be the expected outcome which usually involved penetration and ejaculation. Consequently a combined medical and gray-haired psychologist lady approach would often help tease everything out. Unlike women, few men can fake sexual arousal because if the erection isn’t there, well, it’s a difficult one.
There are a number of well-known conditions that will cause or worsen ED. The main ones I’m afraid are self-induced. If you suffer from ED its is worth while having a medical examination and also some blood tests for hormone and sugar levels.
Stress is something that’s often talked about and is a very powerful damper of sexual functioning. It is an awkward one to get around though because its 2010 and life is a blur of work and getting to work and family and responsibility and money etc etc – you know the picture. If you can sort the stress out then its probable that your sexual functioning will return to normal.
Alcohol and recreational drugs are for lots of people the major culprits. I do love a drink but the painful fact is that alcohol, except in very small amounts is very toxic. It’s also very seductive, so that one drink which might just calm the nerves before a potential sexual encounter, will frequently become plenty of drinks, leaving your erection something only to be dreamed of. Depressive illnesses also encourage people to drink far too much alcohol and the combination of the two together really is not a good one.
Recreational drugs – ecstasy, cocaine, crystal meth are widely used. I saw a recent press release saying that cocaine had become the UK drug user’s drug of choice in 2010. The problem with these drugs is that they will often increase sexual desire and feeling of “sexiness” but they equally often will destroy the mechanism so your hydraulics don’t match up with what you’re experiencing in your head. As a result, especially with crystal meth people will become fantastically desperate to achieve firstly an erection and secondly ejaculation. Even if they do, this isn’t enough and as soon as they’re done they’re off on another sexual quest. The result is often unsafe very risky sex, genital injury and sometimes such complete disinhibition that STI’s or STD’s including the blood borne variety HIV and 2010’s new infectious darling, Hepatitis C become a routine.
Diseases such as diabetes, heart disease and high blood pressure also have a marked impact on erectile dysfunction rates. This happens via a combination of routes including the disease process itself and also the medications used to treat the conditions. Very many medications will have an adverse effect on both libido and erectile capability.
Luckily there are now a variety of devices and medications used to treat ED. Although using medications etc is not ideal, it does virtually guarantee an erection.
The medications fall into two main groups – oral and injectable/insertable.
The oral meds began with Viagra or sildenafil. This was the first of a group of drugs called phosphodieterase inhibitors or PD5 inhibitors for short. They work by allowing an increase of blood into the penis and maintaining the erection for longer. It’s a bit like filling a bath – if you turn the taps on full the bath will fill, even though the plug is out. Other drugs like Cialis and Levitra are variations on the same theme but with their own characteristics. Levitra and Viagra are very similar medications being prompt acting with a relatively short duration of action.
Cialis has a longer onset and longer overall effect – in some men up to 3 days. Doctors will try to tailor the medication according to your needs. So for the man who needs an erection in an hours time, Levitra or Viagra are the appropriate drugs. For the man who wants a more normal sexual response over time, then maybe twice weekly Cialis is the way forward.
Other drugs include the injectable Caverject – yep, you have to inject your penis – but the upside is a fantastic stiff erection that you can hang your hat on. Muse is a little pellet which you insert into the urethra – the pipe you pee through – and then massage your penis. Gives a reasonable injection, but stings and burns a little. Also, someone sucking you may end up with a rather medicinal taste…..
Finally, vacuum pumps. These are rigid penis shaped devices slipped over the penis. You vacuum extract the air and suck blood into the penis, then slipped a tight **** ring over the base to keep the blood in. Surprisingly popular, though gives a cold, unattractive blue penis with frequent interruptions to re-inflate it. Not the most magical of moments.