Erectile Dysfunction (Impotence) - Treatment

Sometimes direct treatment of the cause may restore erectile function, for example, through testosterone replacement, resolving substance abuse problems or withdrawing medications that may be causing the erectile dysfunction. Mostly, treatment aimed at directly restoring erectile function is necessary.

There are many treatments aimed at restoring erectile function. Many other products claim to treat or even cure erectile dysfunction. These products are often expensive and usually have not been adequately tested for either their side effects or results. Treat such products with caution and use only under the supervision of a doctor.

Treating underlying conditions

If your ED is caused conditions like heart disease or diabetes or other underlying health conditions, then it has to be treated first prior to ED treatments. In some cases, treating the underlying cause may also resolve the problem of ED.

If you are taking a medication that can cause ED and there is an alternative medicine available, your GP will discuss this with you. It is important never to stop taking a prescribed medication unless you are advised to do so by your GP or another qualified healthcare professional that is responsible for your care.

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Lifestyle changes

The symptoms of ED can often be improved by making changes to your lifestyle. You can reduce your risk of ED by:
  • losing weight if you are overweight   
  • giving up smoking 
  • moderating your alcohol consumption 
  • not taking illegal drugs 
  • exercising regularly 
  • reducing stress 
As well as helping to improve your ED, these types of changes can also improve your general health.

Phosphodiesterase-5 (PDE-5) inhibitors

Phosphodiesterase-5 (PDE-5) inhibitors are one of the most widely used and effective types of medication for treating ED. They work by temporarily increasing the blood flow to your penis.

In England, three PDE-5 inhibitors are available for treating ED. They are:
  • sildenafil – sold under the brand name Viagra 
  • tadalafil – sold under the brand name Cialis
  • vardenafil – sold under the brand name Levitra

Vacuum pumps

A vacuum pump is another treatment method for ED. It consists of a clear plastic tube that is connected to a pump, which is either hand or battery operated.

You place your penis in the tube and pump out all of the air. This creates a vacuum that causes the blood to fill your penis, making it erect. You then place a rubber ring around the base of your penis in order to keep the blood in place, allowing you to maintain an erection for around 30 minutes.

It may take several attempts to learn how to use the pump correctly, but they are usually very effective. After using a vacuum pump, nine out of 10 men are able to have sex, regardless of the cause of their ED.

Alprostadil

If your ED does not respond to treatment, or you are unable or unwilling to use PDE-5 inhibitors or a vacuum pump, you may be given a medicine called alprostadil. This is a synthetic (man-made) hormone that helps to stimulate blood flow to the penis.

Alprostadil is available as:
  • an injection directly into your penis – this is called an intracavernosal injection
  • a small pellet placed inside your urethra (the tube that carries urine from your bladder to the tip of your penis) – this is called urethral application.
Hormone therapy

If a hormonal condition is causing ED, you may be referred to an endocrinologist. An endocrinologist is a healthcare professional who specialises in the treatment of hormonal conditions.

Hormones are chemicals produced by the body. Many hormonal conditions can be treated using injections of synthetic (man-made) hormones to restore normal hormone levels.


Surgery

Surgery for ED is usually only recommended if all other treatment methods have failed. It may also be considered in:
  • younger men who have experienced trauma (serious injury) to their pelvic area – for example, in a car accident
  • men with a significant anatomical problem with their penis
In the past, surgery was used if there was clear evidence of a blockage to the blood supply of the penis. The surgeon could unblock the blood vessels to restore a normal supply of blood. 

However, research now suggests that the long-term results of this type of surgery are poor, so it is unlikely to be used.

Penile implants

Penile implants are a type of surgery that may be considered. These can be:
  • semi-rigid implants – which may be suitable for older men who do not have sex regularly
  • inflatable implants – which consist of two or three parts that can be inflated to give a more natural erection
Penile implants are not usually available on the NHS and inflatable implants may be very expensive. However, around three-quarters of men report being satisfied with the results of this type of surgery.

Complications

As with all types of surgery, having penile implants carries a risk of infection. If you take preventative antibiotics (medicines to treat bacterial infections), the rate of infection is around two or three in 100. Mechanical problems with the implants may occur within five years in five per cent of cases. 

Psychological treatments

If your ED has an underlying psychological cause then you may benefit from a type of treatment called sensate focus.

If conditions such as anxiety or depression are causing your ED, you may benefit from counseling (a talking therapy).

Sensate focus

Sensate focus is a type of sex therapy that you and your partner complete together. It starts with you both agreeing not to have sex for a number of weeks or months. During this time, you can still touch each other, but not in the genital area (or a woman’s breasts).

Set aside a time when it is just the two of you. Massage, touch or stroke each other, with or without clothes on. The idea is to explore your bodies knowing that you will not have sex.

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After the agreed period of time has passed, you can begin touching each other’s genital areas. You may want to spend several weeks gradually increasing the amount of time spent touching the genital areas. You can also begin to use your mouth to touch your partner, for example, licking or kissing, them. This can build up to include penetrative sex.

Psychosexual counselling

Psychosexual counseling is a form of relationship therapy where you and your partner can discuss any sexual or emotional issues that may be contributing to your ED. By talking about the issues, you may be able to reduce any anxiety that you have and overcome your ED.

The counselor can also provide you with some practical advice about sex, such as foreplay techniques and how to make effective use of other treatments for ED in order to improve your sex life.
Psychosexual counseling may take time to work and the results achieved have been mixed.

Cognitive behavioural therapy (CBT)

Cognitive behavioral therapy (CBT) is another form of counseling that may be useful if you have ED. CBT is based on the principle that the way you feel is partly dependent on the way you think about things. CBT helps you realize that your problems are often created by your mindset. It is not the situation itself that is making you unhappy, but how you think about it and react to it.

Your CBT therapist can help you to identify any unhelpful or unrealistic thoughts that may be contributing to your ED – for example, to do with:
  • your self-esteem (the way you feel about yourself) 
  • your sexuality 
  • your personal relationships
Your CBT therapist will be able to help you to adopt more realistic and helpful thoughts about these issues.


Pelvic floor muscle exercises

Some studies have suggested that, in a few cases, it may be beneficial to exercise your pelvic floor muscles. These are a group of muscles around the underside of the bladder and rectum, as well as at the base of the penis.

Pelvic floor muscle exercise involves strengthening and training the muscles used to control the anus (back passage) and urinate. If your GP feels this type of exercise could be beneficial, then you may want to discuss it with a physiotherapist in order to learn it correctly.

By strengthening and training these muscles, you may be able to reduce the symptoms of ED.

Complementary therapies

Some complementary therapies, such as acupuncture, have claimed to treat ED. However, there is little evidence that they are useful.

In some cases, they may even include ingredients that could interact with other medications and cause side effects.

Always speak to your GP before using any complementary therapies.



Erectile Dysfunction (Impotence) - Treatment