Erectile Dysfunction

erectile-dysfunctionNo matter who you are, most men with erectile dysfunction can be helped.

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About Erectile Dysfunction

Erectile Dysfunction is defined as the failure to maintain a normal penile erection sufficient to achieve ejaculation with penetration. In practice, when patients speak of Erectile Dysfunction or Impotence they mean any significant decrease in strength or duration of erection.

The causes of erectile dysfunction are varied and often involve a combination of both physical and psychological factors.

A Multinational Survey of the Ageing male (MSAM-7) in 2003 showed that Erectile Dysfunction was present in approximately 30% of men aged 50 to 59, 50% in men aged 60 to 69, and 75% in men aged 70 to 80.

Physical Factors

Common physical factors include arterial disease commonly linked to blood lipid disorders, High Blood pressure, Diabetes. Less commonly and especially in Afro-Carribbeans populations Sickle Cell disease. Also diseases of the spinal both nerves and spinal cord eg Multiple Sclerosis.

Toxicity especially from alcohol is a well observed cause of temporary Erectile Dysfunction. Smoking is a potent cause of vascular disease in general and erectile dysfunction in particular, especially when the patient has smoked for many years.

Psychological Factors

Psychologically, as male identity is so closely linked to sexual functioning, any perceived threat to this may translate into Erectile Dysfunction. Embarrassing earlier sexual traumatic events may easily be recalled by conscious or unconscious psychological triggers later, triggering erectile Dysfunction later in life.

Available PDE5 Medications

Depending on your questionnaire response, a recommendation will be made for the most appropriate PDE5 medicine. They are:

Sildenafil (Viagra): this is the parent drug and the one most widely known to the general public. Its onset is typically within 20 to 60 minutes, and effects last 12 to 18 hours in practice. The manufacturer’s literature states it lasts 4 hours but in fact because of psychological and other factors, patients experience benefit the next morning. It is commonly used when intercourse that evening is extremely likely and the most rapid response is desired. While enhanced erection the next morning is evident, the effects have to all intents and purposes ceased by the next night. Dosages of 50 or 100 mg are the most commonly effective. It is now available as a generic drug, with significant cost savings to the patient.

Tadalafil (Cialis): this is about the same in its onset and most patients allow an hour for its effect to be maximal although benefit is noted after 30 – 40 minutes. However, its action is prolonged and if a full 20 mg dose is taken on Friday evening it means that if required at some point up to and including Sunday night, it will be effective. The standard dose of 20 mg is most commonly used.
A 2.5 mg and 5 mg once a day Tadalafil is commercially available but vastly less popular than the 20 mg “weekend dose”. We do not stock this.

Vardenafil (Levitra): this lasts a little longer than Sildenafil but is not much used, as Tadalafil does the same and the benefit lasts longer.

What are the dangers of oral treatments:

These are relatively uncommon but chiefly connected to a dramatic drop in blood pressure, when this class of medicines are combined with Nitrate/ Nitrite Medications. These are used in Angina as Trinitrin (Anginine, Nitrospray) and by some male homosexuals as Amyl Nitrite “poppers” to relax the anal sphincter.
In either case, the combined effect of a Nitrate/ Nitrite and Erectile Dysfunction tablet TAKEN TOGETHER can be to cause the blood pressure to plunge, leading to fainting at the least and death at worst.

What other side effects are noted?

AS this class of medications (PDE5 phosphodiesterases) opens the general circulation, not just in the penis, the patient is generally a little warmer while the medication is acting. The patient may want fewer covers on him in bed. Dull headache is noted by some. This passes and is generally mild, as are back and muscle pains. Facial flushing associated with the increased blood flow is at times noted and will cease in any case once the drug wears off. Nasal stuffiness is usually mild if it occurs and indigestion is occasionally reported. Rarely, Paracetamol is required. Stuffy nose and a bluish tinge to objects seen by the patient are recorded but uncommon side effects.
Rashes may occur, as with any medication.

If in doubt, blame the medication and stop taking it. Contact the askthedoctoruk clinic or your own doctor. Extremely rarely, the vision can be impaired as can hearing. When in doubt, blame the medication.

What other medical treatments exist?

Self injection of blood vessel – active medications into the penis, while extremely effective and rapid in action, have waned in popularity with the arrival of the oral PDE5 medications.

They are still used diagnostically in Urology Clinics etc. Tablets placed inside the penis opening, while effective, have understandably never been popular. Penile pumps with constriction rings are helpful for some but do require a shaved pubic region to achieve an airtight seal. The constriction ring MUST have some sort of handle on either side or penile amputation is possible when the ring becomes imbedded in the engorged penis.

The DIY option of a rubber band is not to be encouraged.
Self help is one thing, but wise use of technology is another.

What non drug options do I have?

Common sense: reduce drinking to a sensible level and do not smoke.

As an Australian doctor used to say “the more you smoke, the less you poke”. While we in UK are more polite, the message remains the same.

Deal with stress. Many men lose sight of the fact that our recent ancestors spent a lot of time fighting for their territories.

Look at an uncastrated tomcat to get the idea. When we stop exhibiting the aggression quite natural to us, largely to avoid legal and personal difficulties, we may then direct the anger inwards. This does us no favours.

I suggest that patients join a gym and name the punching bag. If they are gardeners, to name the weeds as they dig them out. The practice of Martial Arts similarly permits a controlled used of this part of our masculinity.

Running or cycling achieves a fitter body and of course a sense of well being but does not address this warrior part of our natures.

Price List

Medication Strength per dose Pack size Price £
Viagra brand Sildenafil 100mg 4 40
Generic Sildenafil 100mg 3 30
Cialis 20mg 4 50
Cialis 20mg 8 90