Everything you need to know about the causes and treatments of erectile dysfunction

Apr 01, 2022 Erectile Dysfunction

Everything you need to know about the causes and treatments of erectile dysfunction

 

Erectile dysfunction (ED) is a distressing condition where a man is unable to maintain an erection

Also known as impotence, erectile dysfunction is a big fear for many men. It’s very much a taboo subject. Being unable to achieve or sustain an erection can make men feel emasculated and anxious. It affects self-esteem, and relationships and can take the joy out of sex.

Many men encounter erectile dysfunction at some time in their lives and many overcome it to have fulfilling sex lives. Age is a factor, and it’s very common amongst middle-aged men, becomes more frequent with age and can be caused by either psychological or physical conditions.  

Don’t worry, it’s not usually a major cause for concern. Causes are generally psychological. Sometimes, however, ED can be an indicator of other underlying health conditions. So it’s important to book an appointment with your doctor if it’s a regular occurrence.  

Once a man has experienced erectile dysfunction it can have a profound effect on his confidence and worrying about it can increase the chances of it happening again.

Relationship issues are also sometimes an unwanted byproduct of your already unwanted ED. Successful relationships thrive on respect, physical attraction, shared interests, humour, trust and intimacy.  When one of those elements is lacking, the relationship suffers and sometimes even disintegrates. Meaning ED can be a serious problem for relationships and marriages

Pfizer has produced a scale of hardness, which helps to determine the level of erectile dysfunction being encountered. This can be used when couples visit their doctor to discuss the condition.

1.  Penis has increased in size but is not hard.

2.  The penis is harder but not hard enough for penetration.

3.  The penis is hard enough for penetration but still has a softness to it.

4.  The penis is completely hard and rigid. 

In this blog, we’ll explain the common causes and treatments for erectile dysfunction, as well as discuss some common questions about the subject.

 

Causes of Erectile Dysfunction

Most cases of erectile dysfunction are secondary, meaning that you are only just experiencing it after years of successful intercourse. Primary erectile dysfunction is when you have never been able to sustain an erection.

Below are some common causes of impotence.

 

Lifestyle/Physiological Causes of Erectile Dysfunction

If you have no obvious physical problem with the penis, the cause is likely to be psychological. 

Men of all ages suffer from impotence at some time in their lives. There are lots of lifestyle factors that can also have a big impact on your erection performance, and the condition can often be improved with a few simple changes.

Maybe your relationship is going through a bad patch and you are not as close to your partner as you usually are. Difficulties in your marriage or everyday stresses can cause impotence.  

Some lifestyle factors that contribute to erectile dysfunction include:

• Stress

• Anxiety

• Guilt

• Depression

• Tiredness

• Alcohol

• Smoking 

• Relationship issues

• Not being attracted to your partner

If the cause is due to lifestyle factors like smoking and drinking, you should be able to improve your condition with a little bit of work. 

Stress and anxiety are major causes. Cognitive behaviour therapy could help you with this. It changes the way we approach life and helps to overcome the fear that results in impotence. Thinking positively and believing in yourself will improve your confidence.

 

Underlying health causes

Although unlikely, experiencing regular erection issues may be cause for concern.

For example, health conditions such as MS affect the way the nervous system works and makes it very difficult for you to achieve an erection. 

Heart conditions decrease the efficiency of blood flow to the penis making an erection difficult to achieve. 

Diabetes damages blood vessels and affects circulation to extremities and the penis again, affecting the ability to have an erection.  

Erectile dysfunction can be a sign of serious health conditions, such as:

• A stroke (or aftermath of a stroke)

• Heart attack

• Obesity

• Diabetes

• Prostate cancer

• High blood pressure

• High cholesterol

• Atherosclerosis

• Hypertension

• Renal failure

• Hypercholesterolemia

• Cirrhosis

• Neurological diseases 

• Multiple sclerosis

• Parkinson's disease 

 

Diabetes

There are two types of diabetes. The first type is when the body’s immune system attacks and kills the cells that produce insulin. If you have this type you will have to take regular injections of insulin to stay alive. 

Diabetes type two is when the body doesn’t produce enough insulin or cells do not react to it. Often a healthy diet and losing weight can eliminate this version (Source: NHS Choices). 

One complication of diabetes is damage to your blood vessels and nerves. 

This could cause erectile dysfunction. If you manage to control your diabetes many of these complications could correct themselves.

 

Coronary Artery Disease

This is the most common type of heart disease. Arteries become blocked causing the flow of blood to the heart to decrease significantly. 

This can result in chest pains (Angina). Permanent heart damage is caused when a blood vessel breaks off and stops the blood supply to the heart.

If your body cannot pump enough blood to the heart then it is going to have difficulty reaching your penis. Erectile dysfunction may occur as a result.

If you do get chest pains and don’t feel 100% you must go and see your doctor to discount this serious condition.

 

Dementia

Although studies have not managed to find a direct link between erectile dysfunction and dementia there is believed to be a connection. 

In 2000 a Taiwanese study carried out a random study of 1,000,000 patients and identified 4153 patients newly diagnosed with ED. 

The sample was monitored for seven years and the results showed that patients with erectile dysfunction were 1.68 times more likely to develop dementia. (Source: NCBI). 

Obviously, the results are from a relatively small sample and the risk is small. The reason given for the connection is that people with dementia are likely to suffer from conditions such as; diabetes and coronary heart disease. 

 

Liver Disease

Patients with chronic hepatitis B have been found to be more likely to suffer from erectile dysfunction. 

A very small study conducted on 69 patients with liver disease found that those with chronic hepatitis B were more prone to ED. 

This can be attributed to general ill health and depression suffered as a result of the disease. (Source: NCBI).

Liver disease doesn’t show itself until it is quite advanced so erectile dysfunction may be the very first indication that there is something wrong.

 

Prostate Cancer

Although prostate cancer itself isn’t a cause of erectile dysfunction treatments can be. 

This is because they can damage the nerves and blood vessels. 

Further surgery is an option to reverse the effects but can have varying degrees of success. 

If this is the reason for your erectile dysfunction you could talk to your doctor to discuss treatment.

 

If It Is Not Any Of These What Can Be Done?

If you haven’t got an underlying health condition then that is very good news as there are a number of options available to you. 

First of all, if your erectile dysfunction is due to psychological issues you can have cognitive behaviour therapy.

Treatments such as Sildenafil, Viagra, Cialis, Spedra and Levitra can help you have and maintain an erection.

It must be noted that it is important to follow the guidelines and not exceed the stated dose.  Otherwise, you may make yourself seriously ill. 

Some men are physically unable to achieve an erection due to the structure of their penis and require surgery to rectify the problem.  

 

Medication

The side effects of medication also contribute to erection problems because they inhibit blood flow or suppress the production of testosterone.

These are common:

• Heart medication

• Antidepressants

• Anxiety medication

• Sleeping pills

• Amphetamines

• Painkillers

• Cancer drugs

• Hormone treatments

• Hair loss treatments

• Anabolic steroids

If you are experiencing ED and are taking medication regularly, It’s a good idea to consult your doctor to discover if this could be the cause of your issue. 

Sometimes, even if it is the issue, It is impossible to take you off the medication. In cases like this, your doctor will recommend other options/ medications to treat your ED that won’t clash with your current medication.

 

ED Treatments

Erectile dysfunction treatment varies according to the reason why you have erectile dysfunction.

It is important that you identify the cause of your erectile dysfunction as it may be the sign of an underlying health condition. 

Once the cause of erectile dysfunction is ascertained the condition can be treated. 

Your doctor may do the following things to determine the reason for your erection issues.

 

• Ask lifestyle questions

• Health checks

• Genital examination

• Physical examination

• Blood tests

• Urine tests

• Ultrasound 

• Depression screening 

When you have a reason for your erectile dysfunction your doctor will suggest the most suitable treatment. 

 

Lifestyle changes

The first course of action is to make sure that you get your lifestyle issues under control and see if erectile dysfunction is still an issue. 

Often, adopting a healthy lifestyle will help to overcome the issues causing erectile dysfunction.

This can be achieved through factors including:

 

Exercise

An exercise routine recommended by your doctor can improve erectile dysfunction.  

Exercise is renowned as a wonderful natural way to improve the condition of your body.  Studies have shown that a two-mile walk every day is enough to improve your physical health. Reducing the size of your waist through exercise can have a profound effect on combating erectile dysfunction.

Rigorous exercise is much more effective but gentle exercise is sufficient. If you have a heart condition, exercise may not help you.

 

Eat A Balanced Diet

We often know what a balanced diet involves but tend to choose less healthy options in our everyday eating habits.  

Dr Mucher says. ‘A diet rich in fruit, veggies, whole grains, and fish, and with fewer servings of red meat and refined grains, decreases the risk for ED’. (Source: everydayhealth.com).

A healthy diet can also reduce your weight which is also beneficial to combat erectile dysfunction.

 

Sleep Well

Sleep deprivation reduces the production of testosterone which, in turn, causes erectile dysfunction.

Adopting a regular sleep schedule will not only improve your general health, but it will also encourage the natural release of hormones that are regulated by your body’s internal clock.

 

Stop Smoking

The chemicals in cigarettes can cause vascular disease which, in turn, causes erectile dysfunction. 

Basically, smoking narrows blood vessels, restricting the flow of blood around the body and of course the penis.

 

Regulate your Alcohol Intake

Too much alcohol reduces nitrous oxide production resulting in erectile dysfunction and you not living up to your claims of being an Adonis. You should also try to avoid illegal drugs too. 

Other lifestyle changes such as avoiding stress may also help when it comes to erectile dysfunction. 

However, if symptoms persist and you do not have any psychological or poor lifestyle reasons, then your doctor may prescribe medication.

 

Medical treatment

Viagra (Sildenafil), Cialis, Spedra, and Levitra are PDE-5 inhibitors that help with physical problems with erectile dysfunction. 

They work by increasing blood flow to the penis, allowing an erection to occur.  On average it can take between 30 minutes and an hour for them to take effect. 

Only one tablet (every 24 hours) should be taken on an empty stomach. Depending on which treatment you take the effects will last between 8 hours (Sildenafil) and 36 hours (Cialis). 

This treatment is prescription only and can only be taken after a doctor has confirmed you are healthy enough to take them. 

If you have coronary heart disease or vascular disease they should be taken with caution. 

PDE-inhibitors must not be taken if you have the following conditions; high blood pressure, recently had a stroke, have unstable angina, have recently had a heart attack or have suffered non-arteritic anterior ischaemic optic neuropathy (which is an eye condition that causes loss of vision).  

If you are taking medicines containing nitrates then you cannot use this treatment. It is vitally important that you seek your doctor’s advice before taking these treatments.

 

Therapy/counseling

Erectile dysfunction caused by psychological issues can benefit from counselling. Cognitive behaviour therapy helps you to deal with emotional issues such as stress while couples therapy, talk therapy and sex therapy help couples to overcome relationship problems. 

You can go individually or as a couple. The subconscious tension in a relationship can cause the condition. Talking about the relationship can relieve the tension and help you both find the best way to deal with it.

Erectile dysfunction can affect your marriage. How you both choose to deal with it depends on how much you value your relationship. If there is a mutual understanding of the cause of ED you can both work together to overcome it.

Intimacy is a very important part of any relationship and not being able to have sex can have a negative impact on how couples feel about each other. If the cause is due to relationship issues or stress changes in lifestyle and sex therapy may help.

 

Penis pumps

If you are unable to take phosphodiesterase type 5 (PDE 5) inhibitors due to an underlying health condition, penis pumps can help achieve an erection.

A vacuum pump is a tube that draws the blood into your penis making it erect.  A ring is placed at the bottom of the shaft to maintain the erection. The ring is removed after sex so that the penis becomes flaccid again. Ejaculating is difficult with the band on. 

A Grade 4 erection should be maintained for 30 minutes with this method. It does involve practice but is effective when dealing with most causes of erectile dysfunction.

 

Implants

If your erectile dysfunction is due to the structure of your penis then there are a few surgical procedures available to help you to have an erection.  

These come in the form of rigid or inflatable implants. Implants help men to have erections if they are unable to take medication.

They are available when all other treatments are unsuccessful.

Usually considered the last resort, penile rods are inflatable tubes that are positioned at either side of the penis. They are inserted underneath the skin and can be inflated whenever an erection is required.

 

Intracavernous injections

This is a treatment option for ED where a doctor injects a drug called Alprostadil into the soft tissue in the penis, to open the blood vessels. 

Vitaros Cream is also available as an alternative to the injections and is applied to the tip of the male organ.

 

Is the cause a side effect of the medication?

If you are being treated for any medical conditions then it would be very useful for you to check to see if the medication you are taking causes side effects that promote erectile dysfunction.

If the cause is due to side effects of medication your doctor may be able to alter your dose so you are able to get an erection.

In cases where you are unable to reduce the dose or change your medication, your doctor will likely suggest other methods. 

 

Is the cause an underlying health condition?

Underlying health conditions can sometimes be the cause of your ED issues. 

Treating an underlying health condition may help you to regain an erection but this is not always the case. 

It is important to speak to your doctor about this.

Hormone treatment can also cause ED. Hormone treatment is also available if your ED is caused by hormonal issues. Sometimes there is no cure for impotence and couples have to find ways to be intimate without penetration.

 

Erectile Dysfunction FAQ

What is the difference between Viagra and Sildenafil?

Viagra

Viagra is one brand name of a drug that is used to treat erectile dysfunction. Since its launch in 1998, this powerful tablet with its distinctive shape and blue colour has helped millions of men across the world to enjoy a normal and healthy intimate life again. In the medical profession, they are known as phosphodiesterase type 5 (PDE5) inhibitors, which work by relaxing the blood vessels that feed the male organ.

Viagra can be taken in single doses (25mg, 50mg or 100mg)) daily, and because the tablet is absorbed by the body very quickly, it starts to work in less than an hour and could last as long as four hours. It is recommended that you take the Viagra tablet with water. If you experience any side effects you should discuss them with your doctor or pharmacist immediately.

 

Sildenafil

The only difference between Viagra and Sildenafil is possibly the price as the tablet can also be taken daily to treat the symptoms of ED. Sildenafil is a generic medication and also one of the most popular ED prescription medications available these days, and it is also more affordable. It is available in three different strengths, namely 25mg, 50mg and 100mg, but you should discuss your symptoms and your needs with a healthcare provider for the appropriate dosage first.

This article is purely informative and not intended to be a substitute for medical advice so always discuss any possible side effects with a healthcare provider who knows your medical history or consult your doctor or pharmacist for the best treatment for your condition.

 

What is the difference between Cialis and Viagra

Similarities

The effectiveness of all PDE5 inhibitors like Cialis and Viagra is similar because they are both safe and effective in the treatment of male impotence. Although Viagra is known to be the more expensive brand, some men prefer Cialis because of its longer duration of effect.

Just like with any other prescription medicine, you should first talk to your doctor or pharmacist about your symptoms and overall health, before using either one to treat erectile dysfunction. Both are to be taken orally and can be taken daily if required. Both Cialis and Viagra can also be prescribed to treat other medical conditions like hypertension.

 

Differences

One of the differences between Cialis and Viagra is its ingredients, and the other difference is how long each one works and remains active within the body. 

Cialis contains a substance known as Tadalafil, which is a PDE5 inhibitor that increases blood flow to the soft tissue of the male organ, to establish sexual arousal. It is available in strengths of 2.5mg and 5mg.

Tadalafil, therefore, helps you to get sexually aroused (erection) through increased blood flow and keeps you sexually aroused for as long as you need it. 

The medication will take effect under an hour after taking it and could last for up to four or five hours, but it has to be taken regularly for the best results. Most men that have used both, however, said that Cialis is a long-lasting erectile dysfunction tablet, of which the effects have been felt for up to a day, two at most.

Viagra on the other hand contains a substance called Sildenafil, which works the same as Tadalafil by increasing blood flow to the male organ, but it is known to last for several hours only, thus it has a shorter-acting effect on the body. Viagra is available in three different strengths, namely 2,5mg, 5mg and the highest dose which is 100mg.

 

Is erectile dysfunction hereditary?

There is no hard evidence to suggest that erectile dysfunction is genetic. Health conditions that run in families can indirectly cause ED giving the impression that it is hereditary. 

Diabetes and heart disease are two conditions that run in families and contribute to erectile dysfunction. Even when the cause is difficult to find it is highly unlikely to be genetic. 

Avoid self-medicating as it could have serious consequences on your health.

 

When do erectile dysfunction drugs not work?

Here are some simple reasons why your erectile dysfunction drugs may not work:

• You still need to be sexually aroused so you must stimulate your penis through foreplay.

• Avoid eating large meals before intercourse because it can affect your ability to have an erection.

• Rebuild your confidence by enjoying the moment. Things will get much better with time and practice.

• Don't give up even if it didn't work the first time it doesn't mean that it will never work.

• You may need to take a stronger dose — but don't do this without consulting your doctor.

Erectile dysfunction drugs have a profound effect on the circulatory system so it is vital that you only take drugs prescribed by a doctor. 

Buying medication from an unknown source is risky because you don’t know if the ingredients are correct or if you are well enough to take them.

 

How do Erectile Dysfunction Drugs work?

Erectile dysfunction medication comes from the PDE-5 inhibitors family of drugs. They work by relaxing the blood vessels allowing blood to flow freely to the penis. 

Viagra is the treatment that is most associated with ED. Sildenafil is the generic version of Viagra. It is considerably cheaper and most likely to be prescribed. 

Cialis contains the active ingredient tadalafil which improves erectile function. There is a, ‘when needed’, version that can be taken up to an hour before intercourse. This should only be taken occasionally. 

Spedra contains avanafil and Levitra contains Vardenafil both relax the blood vessels to the penis. If you follow the dosage instructions correctly you should enjoy active sex life.  However, they may be less effective if you do not.

 

Is Kamagra the same as Viagra?

Kamagra is a treatment designed to be used for erectile dysfunction (ed/impotence).

It’s made in India by a company called Ajanta Pharma and is supposed to work the same as Viagra but is marketed to act faster. Kamagra contains the active drug “Sildenafil” which is available generically in the UK but is also the active ingredient in Viagra. It is available as an oral Jelly, chewable tablet and an effervescent (soluble) tablet. 

So it is the same as Viagra? No, Kamagra is not the same as Viagra. Furthermore, Kamagra is not licensed for issues in the UK. 

It contains a prescription-only drug and therefore men that are purchasing this online, are doing so ILLEGALLY. The equivalent legal medicines are Sildenafil (generic), Viagra, Cialis, Spedra and Levitra. 

Most sites selling Kamagra in the UK will often use the fact that they don’t have an associated consultation process, a prescriber or a pharmacy as a positive point, citing that it increases patient privacy. 

This is not only wrong but is also dangerous. In the UK the government body that regulates medicines is called the MHRA (Medicines and Health Regulatory Authority). 

If a website does not display its logo (found at the bottom of the page on this website) then that website is not selling its medication legally. The MHRA haven’t authorised Kamagra in the UK, therefore use and distribution is illegal in the UK.

 

Is ED a sign of Pulmonary Arterial Hypertension?

Impotence may be a sign of Pulmonary arterial hypertension which is a serious heart condition in over a billion adults every year.

It is a fatal condition claiming 7000 lives globally every year. Men with the condition often suffer from erectile dysfunction so it is important to make sure this is not the root of your problems (Source: Escardio.org).

 

What is Pulmonary Arterial Hypertension?

Pulmonary Arterial Hypertension (PAH) affects the smaller branches in the pulmonary arteries. The artery walls thicken and become rigid making it difficult for blood to flow through them.  

Blood pressure rises, increasing the risk of a heart attack. In rare cases, PAH is hereditary and exists on its own or more commonly occurs as a result of other conditions. 

Conditions contributing to PAH include; scleroderma, hole in the heart, high blood pressure in the liver, HIV, medication, thyroid gland disorders, sickle cell anaemia, glycogen disorders, and certain lung conditions.  

Diagnosis takes a long time because the symptoms are similar to other conditions. Your doctor carries out a number of tests and analyses how it affects your life before being able to make a definitive diagnosis.

Treatment includes; anti-clotting medication, water tablets and oxygen treatment.  Other treatments relax the arteries and reduce blood pressure. In extreme cases, surgery is necessary to clear the arteries. Some people require heart or lung transplants. 

 

Erectile Dysfunction Treatments And PAH

Ironically Viagra, Levitra and Cialis treat both erectile dysfunction and pulmonary arterial hypertension. In fact, the erection inducing qualities of these drugs is a side effect of treatments for PAH. 

This happy accident means there is a chance that impotence as a result of PAH is curable. Viagra, Levitra and Cialis belong to the family of drugs called phosphodiesterase 5 inhibitors.  They treat both PAH and erectile dysfunction because the blood vessels in the lungs are similar to those in the penis. 

You must not take them if you are taking medicines containing nitrates. They work by relaxing the arteries allowing blood to flow better. 

Conditions such as; mountain sickness and Raynaud's disease also respond well to this medication. Some people suffer side effects such as headaches, indigestion, nasal congestion and back pain. 

It is extremely important to keep in close contact with your doctor to ensure there are no adverse effects.

 

Have any more questions about erectile dysfunction?

Now that you’ve read our guide on erectile dysfunction, do you feel like you know everything you need to know about the causes and treatments? If you need any more advice about any products mentioned here, contact us. We’ll be happy to help further with your erectile dysfunction queries. Why not head over to our erectile dysfunction treatments page to see if we have your prescription.