Erection problems — a doctor’s guide to getting help
Erectile dysfunction is common and it can be embarrassing at times, but there are plenty of solutions available. Dr Rhianna McClymont, Livi Lead GP, has advice
- Over half of men between 40 and 70 will experience erectile dysfunction (ED)
- 90% of men have at least 1 underlying physical cause
- These can include cardiovascular disease, diabetes and hormone problems
Most men experience trouble getting or maintaining an erection at some point in their lives. This is often referred to as erectile dysfunction or ED. According to the British Association of Urological Surgeons, ED affects more than half of men between the ages of 40 and 70.
But awareness of ED is low in men and women aged 20 to 70, a recent survey commissioned by the European Association of Urology (EAU) has found. The majority of the respondents did not know what ED was, and 1 in 4 had never heard of any of the most common treatments for ED.
Why you should talk to a doctor about erectile issues
It’s not helpful that our culture often refers to men as having to ‘perform’ in bed. This can lead to undue pressure and anxiety, which can compound the problem.
But while many will suffer in silence, too embarrassed or ashamed to broach the subject with their doctors, it's essential they do.
That's because ED isn't just a problem that affects your sex life. It can also be one of the first signs of underlying health problems that may have no other symptoms, including heart disease or type 2 diabetes.
What’s more, ED can affect self-esteem and lead to frustration, anger and mental health issues.
The good news is, simple lifestyle changes can sometimes reverse ED. Where they don’t, a variety of medical and psychological help is available through a Livi doctor.
We’ve called on the expertise of Dr Rhianna McClymont, Lead GP at Livi, to help raise awareness of ED and answer some commonly asked questions.
What’s the best way to talk about erectile dysfunction (ED) with a partner?
Whether you’re the person affected, or you have a partner who is experiencing ED, it can be a tricky thing to talk about. Of course, it’s worrying when ED happens but don’t panic and assume your sex life is over.
‘Any man can struggle to get or maintain an erection at times, and there can be a number of reasons — in particular, psychological factors — why this might occur,’ says Dr McClymont.
‘So, give your partner time, gently encourage him to get help but don’t pressure him, listen in a non-judgemental way if he’s experiencing stress or struggling with mental health, and try not to take your partner’s erection difficulties personally.’
And remember, penetration doesn’t have to be the endgame of sex. ‘You can adjust your sexual activity as a couple to find other ways to please each other and remain intimate.’
What causes erection problems?
There are many factors that can contribute to erectile dysfunction and 90% of men have at least 1 underlying physical cause for their problem.
These can commonly include underlying or undiagnosed cardiovascular disease or diabetes — which is why it’s so important to talk to your doctor about it.
ED can also be caused by hormone problems, neurological disorders, pelvic surgery or physical trauma.
Around 10% of men’s erection problems are caused by psychological factors like stress, anxiety, depression or ‘performance anxiety’.
Although it’s rare, around 1-3% of men may have an anatomical abnormality like a tight foreskin or penile inflammation or curvature.
Who commonly gets ED?
‘Occasional episodes of erectile dysfunction can happen to a man at any age,’ says Dr McClymont.
‘Persistent difficulties in erections, however, are more common in men over the age of 40, when conditions that may contribute to it, such as diabetes, high blood pressure, heart disease or neurological conditions more frequently occur,’ Dr McClymont points out.
Getting and maintaining an erection requires a healthy supply of blood flow to the penis. But common circulatory problems that restrict blood flow such as atherosclerosis (a narrowing of the arteries due to fatty deposits of substances like cholesterol) can impede this process, resulting in erection problems.
‘Various medications can also cause ED as a side effect,’ Dr McClymont adds. These include widely prescribed medicines for conditions such as depression, high blood pressure and prostate enlargement.
Can lifestyle changes help?
Simply becoming more active may reduce your risk of erectile dysfunction by up to 70%.
In fact, a review of studies found that doing 40 minutes of moderate to intense cardiovascular activity (the type that gets you sweaty), 4 times a week could decrease ED within six months.
Stopping smoking, losing weight, reducing alcohol intake, lowering stress levels and avoiding illicit drugs can also play a big part in alleviating erectile problems.
‘Things like stress and excess alcohol are common triggers for ED,’ says Dr McClymont. ‘So, if occasionally a man struggles to get or maintain an erection when perhaps he’s had a bit too much to drink or is under exceptional pressure at work, then he should not worry,’ says Dr McClymont.
If you ride a bike for more than 3 hours a week, your doctor might recommend you try a period without cycling to see whether that helps improve things. If you do cycle, it’s vital you have a properly fitted, comfortable seat — some saddles are specifically designed to relieve pressure on the blood vessels and nerves supplying the penis.
When should you see a GP?
Many men find this issue so embarrassing they wait for more than 2 years before seeing a medical professional, research has found — but doctors are trained to deal with ED.
If you’ve been having erection problems for a few weeks, book an appointment with a Livi doctor.
‘If it’s your partner that’s affected, and he is reluctant, encourage him to seek further help as his doctor may need to run further tests to exclude a physical cause,’ says Dr McClymont.
How can a GP treat erectile dysfunction?
Thankfully, the majority of cases of ED can be treated. A doctor will first ask you for your full medical history and may also perform blood and urine tests to help detect any underlying medical conditions.
Your doctor may then recommend lifestyle changes. If these don’t help, other treatments are available for ED:
There are currently four tablets available: sildenafil (brand name Viagra), tadalafil (Cialis), vardenafil (Levitra) and avanafil (Spedra). These belong to a group of medicines called phosphodiesterase inhibitors (PDE5i).
Viagra is now available in the UK to buy without a prescription and at least two-thirds of men have improved erections after taking it.
But you should always talk to a doctor or pharmacist before taking such drugs — and never buy them online as they may be fake.
Drugs used to treat ED can produce side effects which commonly include headache, stuffy nose, flushing or upset stomach. If that happens to you — or they don’t work for you — a GP may prescribe other treatments to support erectile function. These may include penile injections or, if physical trauma is the cause, surgery.
Occasionally, Viagra-type drugs can produce serious side effects such as chest pains, seizures, painful erections and a sudden loss of vision. Always call a doctor straight away if you suffer from any of these.
If atherosclerosis is the cause of your ED, a doctor may also prescribe statins to control your cholesterol levels and drugs to lower your blood pressure.
You’ve probably read reports online about treatment options like vacuum pumps. These cause an erection by encouraging blood to flow to the penis. They can be used if drugs are not suitable and work for most men. Speak to your doctor about the best way to get a pump.
Your doctor may find your hormone levels are contributing to your ED . They may be able to prescribe Testosterone Replacement Therapy (TRT) or refer you to an appropriate specialist to consider this. TFT comes in the form of a gel rubbed into the skin every day or as a long-acting injection given every 6-12 weeks.
Does depression play a part in ED?
This can work in two ways. ‘Depression can cause erectile dysfunction,’ says Dr McClymont, ‘and some of the medications that are used to treat depression can also contribute to erection issues.
‘Conversely, many men who suffer with persistent erectile dysfunction from another cause such as heart disease or diabetes find that having ED adversely affects their mental health — with men suffering feelings of anger, sadness and frustration.’
In both instances, counselling or Cognitive Behavioural Therapy (CBT) may help. A Livi doctor can help refer you for a course of psychological therapies to help with dealing with ED.
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