Erectile dysfunction (ED) is the inability to get and maintain an erection that is sufficient for satisfactory sexual intercourse. Over the last two weeks I discussed causes. This week i discuss diagnosis and treatment.
If ED has persisted for more than a couple of weeks, an appointment with the GP is the first step. ED that happens all the time may indicate an underlying physical cause, whereas, if it occurs only when attempting to have sex, this might suggest the problem is more psychological.
With evidence of a direct link between Cardiovascular Health and ED, your GP will likely assess this during the consultation. Even in cases of men with mild ED, indications are that they may be 25% more likely to experience heart disease. Furthermore, severity of ED is being increasingly taken as a more positive indicator of potential heart disease than traditional flags such as family history, smoking or high cholesterol.
Once ED has been diagnosed, the course of action taken thereafter will depend on the cause. If ED is caused by one of the underlying health conditions already discussed, the priority will be to treat that first.
Positive changes include: -Quitting smoking; Losing Weight; Starting and maintaining an exercise plan; Stress reduction strategies; Reduction in alcohol intake
If appropriate, the GP may prescribe medication to treat the ED directly. There are a number of ED drugs available. Known as Phosphodiesterase-5 inhibitors (PDE-5), they came on the market in the last 20 years (Viagra® being the first and most famous) and they work by temporarily increasing flow of blood to the penis, enabling an erection to be achieved. To work, PDE-5’s are triggered by sexual stimulation and arousal and in general take 30 – 60 minutes to work. Thus, despite common perception in the general public, they will not cause erection without sexual stimulation.
In Ireland, there are three main types of PDE-5:
The first two types work “on demand” with the patient able to have sex for 1 -10 hours after taking the drug. They are: Sildenafil (Viagra® and other generic equivalents)) and Vardenafil (Levitra®)
The third PDE-5 class works differently from the others, with the effect of a single dose lasting up to 36 hours. This drug is Tadalafil (Cialis®). Tadalafil is more suitable if treatment is required for a longer period of time, (eg) over a weekend.
In general, at least 66% of men have improved erections after taking a PDE-5. PDE-5 inhibitor Side effects: Nausea and / or Vomiting; Flushing; Blocked or runny nose; Visual Disturbances (blue tinge to vision or increased light sensitivity); Back and/or Muscle pain; Headaches. They must be used in caution in those with heart disease.
If the cause of ED is related to depression or anxiety, counselling in the form of Cognitive Behavioural Therapy (CBT) may prove beneficial. If issues like low self esteem, sexuality and / or personal relationships are the cause of ED, sessions with an experienced CBT therapist may help change the patient’s mindset and view on those issues. Relationship therapy with an experienced Psychosexual therapist for individuals and couples may help if the cause of ED is relationship based.
Disclaimer: Please ensure you consult with your healthcare professional before making any changes recommended