Erectile Dysfunction

What is erectile dysfunction?
Erectile Dysfunction (ED) is a problem partly resulting from the increasing prevalence of diabetes and obesity-related vascular (blood vessel) problems. It is men in the 65 years plus group who have the highest incidence of ED, but it is younger men, who are still more sexually active than their older peers, who feel the most impact from this problem, as they strive to maintain normal sexual activity.

While stress, exhaustion and emotional problems may contribute to ED, in 80-90% of cases there is an underlying physical or medical condition. ED is often an early warning sign of cardiovascular problems such as high blood pressure, arterial plaquing or diabetes. ED suffers are nearly 40% more likely to have high blood pressure compared with non-sufferers.

Vascular disease is by far the most common cause of ED. In order for the penis to become erect, blood must flow easily and freely into the penile arteries which relax and widen allowing more blood in than can escape. This causes the spongy tissues of the penis to swell and harden and become erect. If the arteries become plaqued and partially blocked, this blood flow is inhibited, and full erection becomes difficult or impossible. If this is the cause of a man’s ED, it is important to realise that the arterial blockage in the penis is most likely reflective of a similar arterial condition throughout the rest of the body. ED should always be medically investigated as it may prove to be a first warning sign of underlying undiagnosed arterial disease.

Common causes of erectile dysfunction

• Vascular (blood vessel) problems such as atherosclerosis
• Some drugs, including: antihistamines, antihypertensives (blood pressure medication), antidepressants, antipsychotics, tranquilizers
• Alcohol and tobacco
• Hormonal problems
• Diabetes
• Underactive thyroid
• Low testosterone levels
• High oestrogen or prolactin levels
• Pelvic trauma or injury
• Psychological or psychiatric problems (only 10% of cases), such as stress, anxiety and relationship problems.

Prevention and treatment

1. Start with a visit to your GP or pharmacist
   The medical investigation of ED may include blood tests for cholesterol and other lipid levels and blood pressure checks, to establish if there is a cardiovascular cause of ED. The doctor may also carry out tests for diabetes, hypothyroidism, testosterone, prolactin and oestrogen levels. Many pharmacists are qualified to assess patients for ED and supply treatment without a prescription.
2. Stop smoking and drinking
   Long-term cigarette smoking or alcohol consumption can contribute significantly to the development of ED, as well as increasing the risk of cardiovascular disease. As few as two cigarettes a day have been shown to diminish erectile strength. If you are taking pharmaceutical drugs check with your doctor to ensure that ED is not a recognised side-effect of your medication.
3. Good nutrition
   Optimum nutrition is important for the health of the male reproductive and nervous system. Ensure that you are eating adequate protein; plenty of fruits and vegetables rich in antioxidants; and zinc-rich foods such as shellfish, nuts and seeds, liver, oysters and legumes.
4. Exercise regularly and limit stress
   Regular aerobic activity is vital for the health of the cardiovascular system and consequently, also the health of the penis. Aim to exercise aerobically for at least 30 minutes four times weekly. Check with your doctor before beginning an exercise program. Being overly stressed and anxious can affect both your sex drive and erection, so take a good look at your stress levels and do what you can to restore balance and limit stress.
5. ED treatments
   There is now a wide range of treatment available for men with ED. Pharmaceutical solutions include oral drugs that cause the blood vessels in the penis to relax so that more blood may flow into the penis. This does not happen spontaneously, normal sexual activity is needed. The effects can last for up to 36 hours depending on your choice of medication. Other drug-free treatment options include vacuum pumps; penile implants and vascular surgery. Vacuum pumps work by creating a vacuum around the penis which draws blood into the penis allowing engorgement. Penile implants are surgically inserted into the penis, allowing the penis to be “pumped” up by the patient, at will. Psychotherapy and counselling may also be appropriate ED treatments when there are underlying problems with depression, stress, anxiety or difficulties within a relationship.