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
