FAQS on ED

FAQS on ED.
Have a question about impotence? We may have it in our archive.
Dr John ET Pillinger, GP, provides answers to questions from the Ask the doctor service.
Does masturbation cause ED? Are erection problems temporary? What can I do if my GP didn’t help? Can I tackle ED before starting a relationship? What if one ED treatment doesn’t work? ED for 15 years: am I at the end of the road with treatment? My fiancé has had ED for three years. Can you give me some advice? Is there any method of improving sex drive? Erection problems at 22 I have no sex drive Psychological ED? Can a vacuum pump help ED? Herbal help for ED? What are the long-term consequences of injections for ED? Will ED treatment interfere with my angina medication? My medication is causing ED Impotence after prostate surgery Can ED with high blood pressure be treated? ED and alcoholism What are Kegel exercises?
Does masturbation cause ED?
When I was younger I used to masturbate a lot. Can this have caused my condition?
Please read this carefully: frequent masturbation does not cause erectile dysfunction . In fact, the old adage ‘if you don’t use it, you lose it’ is true to a large degree, especially as you get older. So don’t feel remorse or guilt, but approach your doctor for assessment and treatment of your problems. There is a very good chance that successful treatment is available.
Are erection problems temporary?
In the last couple of weeks I’ve been unable to sustain an erection during sex. Is this a permanent problem or is there something that I can do to solve it?
Temporary episodes of erectile dysfunction (ED) are common in all men and usually resolve on their own. They are usually due to the effects of recent stress or anxiety. Anxiety over your ability to sustain an erection is itself a powerful cause of ED, so it’s easy for a vicious circle to develop.
In addition to this so-called ‘performance anxiety’, other sources of psychological impotence can include loss of interest in sex either as a result of a relationship problem, boredom, disinterest or just being out of love.
Talk to your partner about any inner feelings you have, and recruit your partner’s help in overcoming the problem. Take things one at a time, and practice the sexual activities and positions that help you to keep the erection for as long as possible.
If necessary, refrain from penetrative sex completely for two to three weeks and concentrate only on foreplay with the aim of maintaining the erection. This kind of DIY ‘sensate focus therapy’ usually results in a gradual restoration of confidence leading to completely satisfactory intercourse thereafter. Once you have discovered how to overcome performance anxiety, it rapidly disappears.
It’s important to note that physical causes of ED, such as those from hardening of the arteries or diabetes can lead to other serious health consequences as well as causing long-term ED unless adequately investigated and treated.
What can I do if my GP didn’t help?
I told my GP about my problems getting an erection, but he told me with a smile that I had simply lost interest. I find it very embarrassing to talk about anyway. If my GP won’t help, what am I supposed do?
I am very sorry to learn of the difficulties you have experienced when trying to discuss your ED problems. Don’t be too harsh on your GP, though, for he too may be embarrassed to talk openly about such issues with his patients and rather defer to a colleague. Broadly speaking you have four options:
If your relationship with your GP on other issues is satisfactory, you could ask him if there are any doctors in your practice who have a particular interest in this area, who you can see to discuss your symptoms further. If not, there may be a local GP in a neighbouring practice with an interest in ED (there is no harm in asking around locally) who you can arrange to see privately for an initial assessment. If you would rather not go down that avenue of approach, you can ask your GP for a referral to the local NHS ED hospital clinic for a specialist opinion. These clinics are usually overseen by consultant urologists (human plumbers). They are often run by nursing staff who have been specially trained and have time allocated to go over any aspects of ED and its treatment that need a wider explanation. If all else fails, or you don’t feel comfortable with the above, you can always look to change your registered NHS practice altogether to find another GP who is more sympathetic to your position.
Can I tackle ED before starting a relationship?
I’m 30 and I’ve never really had a proper relationship. This is because as soon as I start seeing someone and we get to the bedroom department, they just laugh/walk off/dump me when they find out I can’t get an erection. How do I overcome that? I just go round in circles and don’t see any hope, because I don’t want to go though the embarrassment again of a girlfriend then telling other people about my problem.
I would agree that you paint a portrait that is often overlooked, because we focus on helping men who are experiencing problems within long-term relationships. It is difficult enough to resume sexual activity after having been bereaved, for example, but many patients have expressed even greater confusion and inner turmoil over their inability to begin sexual activity at all.
When facing this personal dilemma, the first thing you need to do is ensure there is no underlying hormonal or physical problem that makes achieving an erection difficult or impossible. These causes of ED are relatively rare, but do appear from time to time in clinical practice.
However, more often than not, the main driver of ED in this predicament is the anxiety of performance failure and ridicule. Sharing your problem with a doctor will enable him to investigate the possibility of hormonal and physical problems and, once these have been excluded, to focus on psychological and practical issues.
I find most men are reassured to discover they are normal and not alone or unique in this situation. Counselling can also be of help to men outside of relationships in gaining a closer understanding of their own sexual feelings, needs and desires, so to be best placed for achieving their emotional goals.
Medical therapies such as Viagra, Cialis or Levitra can bolster self-confidence and help you to clear the initial hurdles more easily. Indeed, often once an initial success has been achieved, the medication is no longer required on a regular basis and may be used as backup under certain circumstances before being discarded completely.
When aiming for a long-term liaison rather than a one-night stand, it’s important to have an understanding partner.
You may or may not choose to share your feelings and anxieties within the relationship before sexual activity occurs. Although this can be extremely difficult, I am assured by my patients that women can be equally afraid and anxious about being able to satisfy their new partner and may even be relieved to have this channel of communication open and available to them.
What if one ED treatment doesn’t work?
I am 80 years of age and have not had an erection for at least three years. I had prostate treatment in hospital in 1989 and have had no trouble since. I have spoken to my GP and urologist about my problem and did get two prescriptions for Viagra, which didn’t help – but now any mention to them is waved away. Have you any advice?
In my experience, often the initial attempt at treating ED with tablet treatment fails. This happens either as a result of the treatment dosage being too small, or the individual concerned misunderstanding how the treatment works and how to use it to their best advantage. This doesn’t mean that subsequent attempts are doomed to failure.
Viagra works by enhancing the normal erectile mechanism, and so you have to be sexually aroused for it to be effective. It is absorbed through the stomach and consequently food and alcohol may slow the absorption process.
Viagra has its peak effect at around 30-90 minutes after taking the tablet and sexual activity needs to be carefully timed to achieve success. The dosages available are 25mg, 50mg and 100mg.
On the first few occasions of usage, especially after three years of inactivity, there can be sufficient anxiety surrounding the whole event to reduce the chances of success significantly, or a higher dosage may be necessary.
If your GP and urologist felt that you were able to receive Viagra as a treatment for ED, then you would be eligible to try either of the other related drugs available in the same therapeutic group, namely Cialis and Levitra.
Levitra remains active within the body for around four to six hours and Cialis for up to 36 hours or so – therefore timing becomes less of an issue. This can relieve the psychological tension for you and your partner, allowing more in the way of spontaneity thereby increasing the likelihood of mutual fulfilment.
Moving on, injectable therapy with prostaglandin will produce an erection in the vast majority of men in your position with ED. Your GP may be able to advise on this, or your urologist will probably have access to a specialist male nurse at the hospital clinic who could instruct you in injection technique.
Finally, a vacuum device will almost certainly be successful in achieving an erection and can be built into sexual foreplay within the relationship. These devices often prove popular with elderly couples, as they are free from side-effects when used correctly, and non-invasive when compared with injection treatment. They are now available on NHS prescription, as are all of the treatments I have mentioned for a gentleman in your circumstance.
I would recommend that you approach your GP with a view to trying one of the approaches outlined above and sincerely hope that one of these is successful for you.
ED for 15 years: am I at the end of the road with treatment?
I have had ED for 15 years. Last spring, for the first time, I got treatment and was prescribed Cialis. I was able to have satisfactory sex for the first time in 10 years. However, more recently it has ceased to work and I have had repeated failures. I think the Cialis works a bit, but I am starting from a very low baseline. Does this mean I am at the end of the road with impotence treatments?
Firstly, let me reassure you there are other treatments for ED that you can consider to provide relief from your symptoms, should Cialis and other related compounds fail to assist your condition.
Before giving up completely on these drugs, you could discuss the possibility of Levitra with your GP. This preparation works for around an average of around five hours and therefore sits between Viagra and Cialis in profile.
Injection therapy, insertion of treatment in pellet form through the eye of the penis (MUSE), and vacuum pump devices can be prescribed to help those men in whom tablet treatments fail.
Bearing these things in mind, it is unlikely that a man in your predicament should feel the end is in sight.
You would appear to have experienced the problem for a significant time from a relatively early age. The fact that Cialis seemed to work initially and has more recently failed to do so could possibly indicate an increasing psychological element to the ED experience.
The take-home message is not to give up, because there are a number of different ways to approach the issue from both a physical and a psychological standpoint. Please see your GP to discuss things and plan what is most suitable for you and your partner.
My fiancé has had ED for three years. Can you give me some advice?
My fiancé has been suffering from ED for three years – as long as we have known each other. I love him very much, but find this very difficult. I’ve tried to gently talk to him about it, but he gets upset, so I’m not sure what to do. The last thing I want is to make him feel anxious, but at the same time I’m feeling increasingly unhappy and isolated. We are getting married this summer and it just doesn’t feel right. I don’t want to be with anyone else, but I can’t imagine never being able to have a physical relationship with him or not knowing if we will be able to have children.
I can understand your frustration and feelings of isolation. Your email raises a number of questions. Firstly, what is the exact nature of his problem?
The definition of ED is ‘the inability to obtain or maintain an erection that is suitable for sexual activity’. This usually implies that penetration is impossible or that the erection dies soon after penetration has been achieved.
There are often other symptoms of sexual dysfunction that can manifest themselves in younger men, such as premature ejaculation. This can become intertwined with ED and heighten feelings of anxiety and male inadequacy.
Clearly you love your fiancé dearly and plan soon to be married. You acknowledge, however, that things are unlikely to work out if the sexual side of the relationship remains unsatisfactory for you both. This needs to be discussed between you now in some detail in a gentle and supportive manner, exploring possible reasons behind the difficulties he experiences.
Sexual problems can often be related to events from previous relationships and/or early experiences in adolescence: anxiety, lack of confidence and a fear of failure often play a large part.
Has he had satisfactory relationships prior to meeting you? Or has he always had problems and is he now over-anxious to achieve, only to fail once more? Is he bothered by the apparent lack of sexual activity or does he have a naturally low sexual drive?
His knowledge of any previous sexual experiences and/or fantasies you may have can also affect his approach to sexual relations and could have a bearing on the overall picture. His GP can talk around these issues with him, should you feel unable to at this stage.
If your fiancé is under 40 years of age, he is more likely to have a largely psychologically-based problem than a purely physical one. Even so, oral therapies such as Cialis, Levitra and Viagra can assist with erectile difficulties, and increase self-confidence to the point that long-term therapy is not required. His GP would be able to prescribe these treatments for him.
Sometimes men don’t wish to contemplate sex because they are depressed. If this is the case, the GP may wish to consider antidepressant therapy. Although antidepressants may reduce libido further, they can often help with symptoms of premature ejaculation.
You both may gain huge benefit from psychosexual counselling as a means of treatment, in addition to those measures outlined above. Going to an organisation such as Relate to talk to a trained counsellor about their treatment programmes will help to put things in perspective. This is best done as a couple.
Relationships are often more complicated than would appear on the surface, and good communication and mutual support are essential for success.
Is there any method of improving sex drive?
Confused terminology surrounds this area. Need, appetite, desire, interest, wanting, urge, instinct and libido may all be used to describe sex ‘drive’.
Drive is defined more specifically as the biological force that makes us seek sexual behaviour (or ‘proceptivity’ – predominantly male) and/or accept sexual behaviour with sexual arousal (or ‘receptivity’ – predominantly female). Sexual drive is an omnipotent force that may give rise to fantasies, daydreams, masturbatory activity or sexual relations.
In sexual surveys, up to 12 per cent of men and 32 per cent of women questioned reported no interest in sexual activity. A ‘loss of libido’ is a common problem that lacks clear definition and is poorly understood.
The hypothalamus area of the brain contains a sexual drive centre that is influenced by testosterone, neurotransmitters such as dopamine, our special senses and neuropeptide chemicals. Research is ongoing into the latter and drugs are currently being developed that may increase sex drive.
It is difficult to say just what represents normal sexual drive and desire. It is much easier to say that a hypersexual drive that leads to antisocial or criminal behaviour is abnormal and unacceptable. Sexual drive leads to desire and sexual behaviour. Whether sexual satisfaction is achieved depends on how near what we get out of the behaviour matches our expectations.
Sexual drive tends to diminish with age and the duration of a relationship. It may also be affected by significant changes in your life, inadequate erotic stimulation, overwork, fatigue from chronic illness and other competing activities pushing sex off the agenda.
You need to consider all aspects of your lifestyle and relationship, in addition to having a formal assessment of your male sex hormone profile through a blood test from your GP, before deciding the best way to achieve increased sexual drive.
Erection problems at 22.
I’m 22 and have recently experienced problems with maintaining an erection. I can become sexually aroused, and achieve an erection, but I’m unable to maintain it for an adequate time. Once the erection is lost, I’m unable to get aroused or achieve another erection.
You may be surprised to learn that you are not alone in experiencing this sort of problem at your age. Generally speaking, erectile dysfunction (ED) is a problem that men are far too reluctant to discuss and seek help over.
At almost any stage of their sexual lifetime, men may fall short of the quality of sexual performance they set for themselves and thereby fail to achieve the consistency they and their partner desire.
The underlying reasons for ED vary from relationship and emotional issues that might contribute to stress during sex to entirely physical problems with the blood or nerve supply to the penis.
In younger men, the underlying factors often revolve around:
simply being too physically or mentally tired to sustain the erection, as a result of over-work or stress. getting to know and trust one another in a new relationship OR when the boundaries of the existing relationship have changed in some way. the adverse effects of social or prescribed drugs and/or alcohol.
It is not uncommon for more than one problem to co-exist.
The main message is to acknowledge the problem with your partner and to seek the help of your own doctor. That way the physical side of things can be checked out. This will usually involve a brief medical examination and some blood tests.
It’s important not to forget the effect ED can have on your confidence within your relationship. There is support and advice available at specialist clinics from counsellors with expertise in psychosexual issues. Relate has trained counsellors that can help, but this is best done as a couple.
One of the things they often suggest as an interim measure is trying other forms of sexual play for a while to remove the performance pressure of attempting to achieve penetrative sex to orgasm.
In conjunction with the psychosexual approach, tablets such as Viagra, Cialis or Levitra can help erectile difficulties, boosting self-confidence to the point that long-term therapy is not required. Your GP would be able to prescribe these treatments for you.
I have no sex drive.
I’m 50 and over the past three years my sex drive has declined: I believe I wouldn’t miss sex if I never did it again. I am happily married and this is causing problems because my wife’s sex drive is strong. I rarely get spontaneous erections at the thought of sex. When I do have sex, a hard erection is difficult to achieve, and nothing like the ones I used to get. I’ve mentioned this to my doctor and he is of the view that if I can perform, even poorly, there is little point in doing anything.
It is not uncommon for some men to experience a gradual decline in their sex drive or libido over time. This comes in part through growing older and often happens as a result of being comfortably settled in a long-term relationship.
However, when a 50-year-old man notices a very marked reduction in sexual drive and desire, such as you describe, further investigation may be required.
A fasting blood sample taken at around 9am can be performed to check the male sex hormone profile. This test tells if there has been a reduction in testosterone level owing to a decline in testicular function or a problem relating to pituitary gland function that could reduce libido.
A thyroid function check may also be helpful, as sometimes the thyroid gland can become underactive and this may affect sex drive.
You also mention ‘a slight sugar intolerance’, which means you may be at an increased risk of developing diabetes in the future. Diabetes is commonly associated with erectile dysfunction and, if it is some years since the initial diagnosis of sugar intolerance, it may be that your ability to manage sugar has deteriorated further. Your doctor can determine this from a fasting glucose sample.
Finally, irrespective of what these checks may discover, there is always going to be a degree of anxiety associated with a return to full sexual activity – and particularly when your partner has the more pronounced sex drive.
Therefore it would not be inappropriate for one of the oral therapies such as Cialis, Levitra or Viagra to be prescribed in addition to other therapy to help in the initial stages, even though it may or may not be required long-term depending on the outcome of investigations.
Psychological ED?
I have been suffering from erection problems. This most recently manifested itself during courtship and marriage to a woman that I was deeply in love with although, in retrospect, it’s something I have long had a problem with.
I do not always achieve an erection sufficient for penetration, or I lose the erection once penetration has started. An additional problem has been premature ejaculation as a result, I assume, of trying so hard to maintain my erection.
I realise that I have compensated for this in the past by adventurous sex in order to arouse myself more strongly, but it does occur to me that this intellectual/emotional need for stimulation is potentially the problem rather than a physical one.
I have seen a doctor who referred me to a urologist at my local hospital. This has not been successful. I have had numerous blood tests for diabetes, iron, testosterone etc, but all have proved negative.
I have not continued treatment with the urologist because my wife has left home, and the ensuing drama and stress denuded my libido to nothing and so it seemed pointless.
I am now 36 and generally very healthy. I do not smoke, drink heavily or suffer from stress at work. I am minded now to regenerate my hospital appointments, but the consultant and I did not communicate well because I was nervous. I am hoping that you might be able to offer some advice or points to discuss with the consultant.
I am very sorry to hear of your current circumstances and ongoing problems. I would agree from your comprehensive account that your symptoms of premature ejaculation and erectile dysfunction have largely a psychological rather than a physical basis.
Fortunately, investigations have excluded such medical causes as diabetes and testicular failure, so in theory there is no reason why you should not be able to succeed given the correct help and guidance from an understanding partner.
There are medicines such as Viagra that can help you get an erection, and they may boost your self-confidence enough so you don’t need to use them for long.
Your GP would be able to prescribe these treatments for you and a further visit to the urologist may prove to be unnecessary.
Clearly you are in no position currently to contemplate sex, and your GP may wish to consider antidepressant therapy for symptoms you have been experiencing since your wife left home. Although antidepressants may reduce your libido further, they can often help with symptoms of premature ejaculation.
You do not mention for how long you have been married, but the pattern of sexual problems, behaviour and desire that you describe may be related to events from previous relationships and/or early experiences in adolescence – anxiety, lack of confidence and a fear of failure often play a large part.
If you are still experiencing problems when you are ready to start a relationship once more, you may gain huge benefit from psychosexual counselling as a means of treatment in addition to those measures outlined above. Relate is one such organisation that you can approach. This is best done as a couple, but can be a difficult subject to broach with a new partner.
Can a vacuum pump help ED?
I am unable to get an erection. I have tried Viagra, Viridal Duo and Viagra plus Viridal Duo – none of these have worked. Do you think that an erection pump would work?
Vacuum pumps are now available on NHS prescription for men such as you who qualify for treatment under the selected list scheme.
The initial prescription for the device has to be initiated following an assessment by a specialist based ED clinic, but all subsequent prescriptions for the consumables to go with it can be obtained through your GP.
On the positive side of the equation, these devices are generally suitable for most men with ED, with any side-effects being of a minor nature. They have very few contraindications and are suitable for long-term use.
However, the following are disadvantages for some couples.
There is a certain lack of spontaneity. Erections may be uncomfortable. Erections should not be maintained for more than 30 minutes. Sensation of ejaculation can be impaired and may be difficult to achieve owing to the retention ring at the base of the penis. Your partner may complain that your penis feels cold. You may experience pivoting of the penis at the base in such a way as to cause difficulty in achieving satisfactory sexual activity.
Nevertheless, despite these possible drawbacks, vacuum constriction devices do work for the vast majority of men who suffer from ED, including a significant minority of men for whom no other non-surgical treatment would appear to be successful.
In the light of your experience, the vacuum pump may offer a workable solution to you. I do hope that you are able to find a satisfactory answer to your problems.
I have a patient who, after careful thought and consideration, is undergoing a penile implant operation. Although this procedure is clearly a one-way ticket to success with no turning back, it is occasionally the right answer for some men with ED.
Herbal help for ED?
After having a mild stroke, I can’t achieve an erection like I used to. Are there any herbal remedies that would help me to get a better erection?
I am sorry to hear of your stroke and the erectile difficulties you have subsequently experienced, but I can reassure you that it is very likely your problem can be improved. I would recommend that you arrange an appointment with your doctor to assess your symptoms and the best way to tackle them.
Erectile dysfunction (ED) can be a consequence of arterial disease, but there may be other factors influencing the clinical picture. For example, the nifedipine medication you are taking may cause ED as a side-effect.
You are probably still undergoing adjustment to your new circumstances after the stroke, and depending on any residual disability, may be depressed and suffering erectile problems as a result. So it’s important you undergo a full assessment of the problem and surrounding issues before coming to any definite decisions regarding treatment. This site also provides information on the conventional treatments for ED and also advice on how to discuss ED with a doctor.
Herbal medicines differ from homeopathic medicines in that they are not diluted and shaken after the original plant material has been soaked in alcohol. Instead, the alcoholic solution itself (the tincture) forms the basis of the active ingredient.
Herbal medicines have not attracted a great deal of interest until recently. Pharmaceutical companies are now paying much more attention to these natural materials, but there is little in the way of a solid research base for their use.
A number of herbal remedies have been used in the treatment of impotence, including:
Ginseng is thought to stimulate pituitary activity and through this the libido. Ginkgo Biloba is said to be quite effective in dealing with impotence brought on by circulation problems. Maca, Rosavin (commonly called the ‘Golden Root’) and Muira Puama are also herbal remedies that may be useful.
If you are keen to pursue herbal treatments, do seek the advice of a formally trained and qualified herbal specialist.
What are the long-term consequences of injections for ED?
I’m a 38-year-old guy and I’ve suffered from erectile dysfunction since I was 25. I’ve now met a lovely woman and we are getting married soon and expecting our first child. My problem is that after using all the oral meds, I’ve found they’ve become increasingly unreliable.
To have really good sex I use 20mcg Caverject injection once or twice a week. I never used to like Caverject because my erections would usually last three to four hours. I hope to keep making love for many years yet, but my fear is what will be the long-term consequences of penile injections? How long you can keep doing them before problems of fibrosis? Is there any way you can self-examine for warning signs?
Caverject is still considered an effective and safe treatment for ED if the individual dose is established by your GP and men are trained in the self-injection technique with periodic supervision.
It’s recommended that patients are examined for fibrotic changes in the penis before starting treatment and at subsequent regular reviews.
Men should be specifically warned of the possibility of penile fibrosis and should be instructed on self-examination for thickening at the injection sites, so they may report early changes if and when these occur.
Since 1988, there have been a number of studies looking at the long-term effectiveness and safety of Caverject in patients with ED. Some of these have studied less than 50 men, while others have studied up to 850.
Generally, the incidence of fibrosis in these studies varied between 1 and 8 per cent. In the largest patient group studied, it was 5 per cent. Those men who developed fibrosis seemed to do so within 6-12 months of starting the injections.
A study was also undertaken of 44 patients who had developed fibrotic changes in the penis. Of these patients, 75 per cent were followed up for more than two years. More than half the men experienced improvement of the fibrotic changes without treatment – 25 per cent no longer had clinically detectable penile fibrosis, despite continuing with injection therapy.
This study therefore suggests the possibility of spontaneous improvement in penile fibrosis in a significant minority of those men developing the problem.
Incidentally, if you find your erections on Caverject are lasting two to three hours, you may need to consider lowering the dose. Your doctor will be able to advise on this and the self-examination techniques.
Will ED treatment interfere with my angina medication?
I have experienced ED for the past four years and it appears to be worsening. In view of my need to take various medicines, including medication for angina, would it be inappropriate to receive treatments such as Viagra, Cialis or Levitra?
On the basis of your current medication regime, it would certainly be inappropriate for you to use these types of medication for your ED.
This is because these drugs are known to interact with tablets containing nitrates (such as your monomax angina treatment), causing a potentially dangerous drop in blood pressure. They shouldn’t therefore be taken with nitrates in any form.
Having said that, there are some heart specialists in the UK who take a very positive approach to the use of these drugs in angina sufferers. Nitrates are not always necessary in the mix of therapy prescribed to keep patients symptom free.
Many symptom-free patients who take non-nitrate treatments for angina and who don’t have heart failure or uncontrolled blood pressure, may be eligible for such ED therapy under the guidance of their GP or cardiologist.
When considering prescribing for ED, the doctor will look at the cardiovascular status of their patient, since there is a degree of cardiac risk associated with sexual activity.
Sexual intercourse equates in energy expenditure to walking 1.5km in 20 minutes. Providing the patient with angina is able to achieve this sort of activity without the need to resort to a nitrate spray or tablets, it is likely they would be able to partake in sexual intercourse safely.
There are other treatments available for ED that are suitable if you take nitrates. For example, vacuum constriction devices are generally suitable for most men with ED: any side-effects are of a minor nature, they have very few contraindications and they are suitable for long-term use.
My medication is causing ED.
In December 1995 I had a heart attack; two years ago I had a stroke. I take 20mg of enalapril and 7mg warfarin daily. I also take 20mg of paroxetine for the depression I suffered after all this. I find it hard to get an erection and it seems my penis has shrunk, which doesn’t do my ego a lot of good either. I have spoken to my doctor about it, and he said the pills I take are the cause. Is there no hope for me?
Your doctor is correct in that both enalapril and paroxetine have been reported to cause sexual dysfunction side-effects in some patients. However, given your past medical history, it is likely that you would experience a degree of ED as a result of your blood vessel disease.
If we take each of the treatments for erectile dysfunction in turn, you will see that there is certainly hope for your problems from the information you have provided. Whether you would be able to receive treatment with Cialis, Viagra or Levitra depends on the condition of your heart after your attack in 1995. Such treatment would be inadvisable if you suffer from angina needing nitrate therapy.
Treatment with injectable therapies would be inadvisable because you are on warfarin, but MUSE, a pellet which is inserted into the opening at the end of the penis, may be of benefit.
Finally, vacuum pump devices are generally suitable for most men with ED: any side-effects are of a minor nature, they have very few contraindications for use and they can be used long term.
Impotence after prostate surgery.
Can I receive help to overcome impotence resulting from a recent radical perineal prostatectomy? If so, what’s available and will a visit to my GP be the next sensible step to take?
You are not alone: it’s estimated that around 60 per cent of men suffer from erectile problems following radical surgery for prostate cancer.
In my experience, it is possible for men to obtain a spontaneous improvement in their ability to achieve satisfactory sexual relations for up to two years after the operation.
The problem of erectile dysfunction is becoming more widely recognised by doctors and a visit to your GP to discuss matters further is certainly the next step to take.
There are a wide range of treatments available for erectile difficulties, including: oral tablet treatment, transurethral therapy (treatment inserted into the tip of the penis), injection therapy and vacuum devices.
Since the introduction of tablet treatment in 2000, this has unsurprisingly become the most popular and commonly prescribed option for men in your situation. You would receive your treatment free of charge on the NHS.
Can ED with high blood pressure be treated?
I have high blood pressure and my doctor tells me I can’t take tablets such as Viagra for ED. Is there any work being carried out on other tablet medication that would be suitable for me?
Let me reassure you that a diagnosis of high blood pressure (hypertension) is not a reason for being unable to receive the drugs you mention, providing that blood pressure (BP) is adequately controlled.
Indeed, the blood vessel damage that is often associated with sustained high blood pressure is one of the most frequent causes of erectile dysfunction (ED).
Unfortunately, this does not qualify for free NHS prescriptions under the legislation laid down in 1999, unless the individual can be said to be suffering from ‘severe distress’ by a specialist such as a consultant urologist, who then has responsibility for the ongoing prescribing and monitoring of medication.
Hypertension is a common condition affecting about 18 per cent of the population and is a major risk factor for heart disease and stroke, so it is most important that the pressure is adequately controlled.
The optimal standard of BP control that is currently agreed as a ‘yard stick’ is a blood pressure of less than 140/85 for a non-diabetic patient and 130/80 for a patient with diabetes.
Providing BP is managed below these parameters and there are no other contraindications for ED tablet treatment, it is normally considered safe to prescribe these medications.
ED and alcoholism.
I’m a recovering alcoholic and have been dry and sober for seven months. However, every time my partner and I try to have penetrative sex, I lose my erection. This is now causing us both much stress and frustration. I recently saw my doctor – which was bad enough being only 28 – and all he could say was it was all in my head. This made the situation even worse.
I would like to begin by congratulating you on a successful seven months and for having the courage to seek help from your doctor for your ED.
It is true to say that, generally speaking, a relatively young man such as you is more likely to have a psychological origin to their ED problems than a physical one. Nevertheless, the two may co-exist and your history of alcohol addiction could be an extremely significant factor.
It has been estimated that around 60 per cent of chronic alcoholic men suffer sexual dysfunction. Long-term and excessive intake of alcohol may adversely affect the liver and nervous system – with resultant ED and reduced sexual desire being the most common symptoms.
Alcohol abuse may also lead to shrinkage (atrophy) of the testicles, a low blood level of testosterone and reduced sperm production. The occurrence of sexual dysfunction in those men studied is comparable to that of insulin-dependent diabetic men and need not be associated with liver damage.
Up to nine months after giving up alcohol, the percentage of men suffering from sexual dysfunction would appear to remain more or less the same.
It has therefore been suggested that sexual adjustment is one of the last areas of the alcoholic’s relationship to improve, although men who abstain from alcohol can experience a spontaneous recovery of sexual functions – especially when testicular function is maintained.
Also, in men who may have largely ignored their diet for some time, good nutrition can be most important in correcting sexual disturbance and should not be underestimated.
In addition to a general physical assessment, along with appropriate investigation of nutritional and hormonal status and liver function (providing there are no contraindications), help in the form of medicines such as Viagra or Levitra can significantly improve the situation you describe.
As psychological and physical problems often do co-exist, parallel psychosexual counselling for you and your partner may be of assistance.
If you feel the relationship you have with your current GP is unlikely to result in progress on the basis of my general advice, then there may be another doctor in the same practice who would see the matter differently and be prepared to investigate and treat your sexual problems.
If not, you have the right to choose to register with an alternative practice or to request referral to a hospital-based ED clinic.
What are Kegel exercises?
Kegel exercises are pelvic muscle exercises and can be extremely useful in a number of clinical circumstances.
They are used as an additional therapy, when appropriate, for premature ejaculation and other aspects of sexual dysfunction, including erectile dysfunction (ED). The exercises can also help post-prostatectomy incontinence.
Kegel exercises are designed to give better control of the pelvic floor muscles and can be of help in the treatment of male and female sexual dysfunction. This includes erectile dysfunction, particularly where there are significant underlying psychological factors.
Kegel exercises may enhance sexual performance, confidence, control and pleasure. However, the primary use of these exercises relates to the treatment of stress urinary incontinence in women.
The exercises can be difficult to master, so are best taught by professionals. Your GP will be able to give you further information and refer you as appropriate.
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Last updated 27.09.2012.
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