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Erectile dysfunction (ED) is when you’re unable to get and keep an erection that’s strong enough for sex. Most men experience it, and often it’s just a one-time thing. But when it keeps happening, it’s something you may need treatment for.
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Sometimes known as impotence, erectile dysfunction is when a man has persistent problems getting and sustaining an erection. Sometimes, this may be:
How long it needs to be happening for it to be medically defined as ED is a subject pretty open to discussion. There’s actually a scale called The International Index of Erectile Function (IIEF) which gives men an ED ‘score’, based on their erection habits over the previous month.
Normally, a clinician will be able to tell if you need treatment by asking you a few questions about your symptoms and general health.
You’ve probably seen the TV commercials for ED medication. Older men strolling with their partners across a sunset beach. These ads target men in this age group, and it figures. Because as men get older, they’re more likely to develop health problems like high blood pressure or poor circulation. And these conditions can make it harder to get an erection.
But ED affects young men too. As well as the physical side of it, there’s the psychological side. In a new relationship, you may feel pressure to satisfy your partner for example, and this can lead to ED. Or you may be stressed at work, which may also trigger it.
So in fact, the answer to the question ‘Who gets ED?’ is anyone (and in some way or another, at some time, probably everyone).
It depends who you ask. Some health bodies have suggested that about 50% of men over 40 will experience erectile dysfunction. And a study of the condition in men under 40 estimates that a quarter in this group will get it at some point.
Unfortunately, the nature of ED means that many men won’t seek help for it. So it could well be more common than we think. But experts reckon that most men will get some form of ED at least once, even if it’s only short-term.
Erectile dysfunction. [online] www.nhsinform.scot.
One Patient Out of Four with Newly Diagnosed Erectile Dysfunction Is a Young Man—Worrisome Picture from the Everyday Clinical Practice. The Journal of Sexual Medicine, 10(7), pp.1833–1841.
Lots of things can lead to ED. It can be down to physical problems (being overweight or having high blood pressure), psychological problems (anxiety or depression) or a combination of the two. Even tiredness can trigger ED.
ED can also be triggered by an underlying health condition, like diabetes, or it can be an early sign of heart disease. So if you keep getting erection problems, you should see a clinician, as these conditions need to be treated too.
In the body, ED is caused by loss of circulation to the penis, where the arteries at the base of the penis contract and don’t let blood through. An enzyme called PDE5 plays a part in this, and makes the arteries tighter.
Treatment for ED works by countering the effects of PDE5, so blood can flow into the penis, and help it to become erect when you’re aroused.
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No. Sometimes making lifestyle adjustments can make it go away. If you drink a lot of alcohol, smoke cigarettes, or take recreational drugs, curbing these habits can help with erections.
Being overweight can be a factor in ED too, so eating a healthy diet and exercising more is a good solution as well.
You might get erectile dysfunction if you’re anxious about sex. And talking to someone about it, whether it’s your partner, a friend or a therapist, can make all the difference. If you find that having conversations about it doesn’t help though, medication may be recommended.
It’s down to personal choice on your part really, and your health background.
Viagra is a household name and has been around the longest, and some would argue it’s the most successful treatment for ED.
The generic, Sildenafil, is less expensive, but has the same active ingredient in it, and functions in the same way in the body.
The benefit of Cialis is that you only have to take one and it stays active for up to 36 hours (other ED drugs average about 4 or 5 hours).
There’s also a smaller dose version of this designed to be taken every day, called Cialis Daily. With the everyday version, you’re ‘ready to go’ all the time, and you don’t have to wait around for the drug to take effect (it takes half an hour to an hour for most others). Tadalafil (generic Cialis), is cheaper and works in exactly the same way.
As well as being a licensed treatment for ED, Tadalafil is an approved option for BPH (or benign prostatic hyperplasia) which is when you have an enlarged prostate. So if you experience BPH and ED, Tadalafil can treat both conditions.
Spedra is an on-demand treatment that starts to work from 15 minutes after you take it. It’s a good option for men who want a quick-acting drug, but don’t want to take something every day.
And then there’s Levitra, which is said to be better for older men or men with pre-existing conditions, like high blood pressure or diabetes.
If you can’t take ED tablets because of their side effects or due to an existing health condition, or if you’d just prefer not to use them, there is a prescription cream available too called Vitaros.
You apply this cream to the opening of your urethra (the opening at the tip of your penis) and the active ingredient in it, alprostadil, helps to widen the blood vessels in your penis. Once the blood vessels are more dilated, more blood can flow into your penis, and this allows you to get an erection.
So using ED creams is a bit different to taking ED tablets. But Vitaros is faster acting than ED tablets (effective within 5-10 minutes of use, rather than between quarter of an hour and an hour). From a spontaneity point of view then, it’s a pretty strong option.
MUSE is a ‘urethral suppository’ – basically a very small pellet you insert into the opening at the end. You can use MUSE up to seven times in seven days, so there’s quite a lot of flexibility with it.
On that basis, if you’re looking to have sex frequently, MUSE might be one of the better options for you.
Applying the pellet takes a bit of getting used to. But because it’s a locally acting treatment, it works faster than pills – usually within 10 minutes of application.
Another prescription medication for ED is injections. You may find that tablets or creams aren’t the right treatments for you, or that your body doesn’t tolerate them. Like Vitaros and MUSE, ED injections such as Caverject and Viridal Duo kick in very quickly (within five minutes) and they contain the same active ingredient (alprostadil) so if you’re looking for fast results, injections can give you that.
You inject these medications into the penis directly, and you don’t need to be aroused in the first place for them to take effect. If you’ve not used them before though, you should see your clinician or a pharmacist prescriber in the first instance, as they will need to show you how to do it.
You shouldn’t use injections any more than three times a week (and not more than once over any 24 hour period). If you find that the dose you’re on isn’t working the way you want it to, drop our clinician a message, and they can look into adjusting your dose with you.
Most are prescription only. The only licensed prescription-free ED treatments are Viagra Connect, Aronix and Liberize – all of which contain 50mg of sildenafil (then drug found in Viagra). As pharmacy medicines though, you’ll still need to have a consultation with a pharmacist before they can be given to you.
Hatzimouratidis, K. (2014). A review of the use of tadalafil in the treatment of benign prostatic hyperplasia in men with and without erectile dysfunction. NCBI, Ther Adv Urol. 2014 Aug; 6(4): 135–147.
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