Even in this brave new post-Viagra world, erectile dysfunction is not exactly a frequent topic of conversation. However you may be surprised to learn that the inability to get or maintain an erection is actually very common among men of a certain age – affecting around half of 40 to 70-year-olds at some point.
And while you might be aware of some of the likely causes of this frustrating condition – sometimes still referred to as "impotence" - some of them might come as a surprise. The causes can be broadly divided into physical and psychological ones, though of course it's possible that more than one factor could be involved in an individual case.
Diseases of the heart and arteries are so strongly associated with erectile dysfunction that if you present to a GP with the condition they are likely to refer you for tests in case you are at risk of a heart attack or stroke.
High blood pressure
Having high blood pressure, or hypertension to give it its medical name, is a common cause of erectile dysfunction. The arteries leading to the penis can get damaged, leaving them unable to open to allow blood into the organ so that an erection can be obtained. These arteries can also become thicker or burst as a result of high blood pressure – causing more problems.
And in a cruel twist of fate, some medications for high blood pressure such as beta-blockers and thiazide diuretics have also been found to cause erectile dysfunction.
Doctors usually opt to treat the high blood pressure with medication and/or lifestyle changes in the first instance.
High levels of cholesterol have been associated with a number of serious conditions, including heart attack and stroke. Erectile dysfunction is another side effect of having high levels of total cholesterol in the blood – and the treatment is usually the same as for high cholesterol in general. This means a combination of lifestyle changes and medication in the form of a class of drug known as statins.
It is estimated that up to 75 per cent of diabetes sufferers will experience erectile dysfunction over the course of their life – on average 10 or 15 years earlier than non-sufferers.
It is believed that damage to the nerves around the penis and poor blood flow to the organ can be caused by the condition – especially when poorly managed – but the causation is not fully understood. Better management of diabetes has been shown to have a positive effect on the condition.
Other physical causes
Neurogenic conditions such as Parkinson's disease, multiple sclerosis or those relating to spinal injuries can also cause erectile dysfunction – as can hormone problems such as an under or over-active thyroid gland or Cushing's syndrome.
Erectile dysfunction can be a side effect of a wide range of drugs including antipsychotics, antidepressants, diuretics, corticosteroids, antihistamines and anticonvulsants. Speak to your GP before stopping medication.
A good test of whether your erectile dysfunction is rooted in physical or psychological causes is whether the problem only occurs when you are with a partner. If you are able to sustain an erection by yourself – or even wake up with one – then physical causes are less likely. Anxiety and depression are the two main mental health issues linked to erectile dysfunction – but stress linked to events in the individual's past can also play a part.
Treatment of erectile dysfunction alone
It's usual for the cause of the problem to be treated first, but there is also the option of being prescribed sildenafil (sold as Viagra) as a temporary fix. This is successful in more than two thirds of cases. The use of a vacuum pump to encourage blood flow to the penis is another treatment option – though perhaps a bit of a passion killer, it has been shown to work in around 90 per cent of cases.
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