Understanding erectile dysfunction: from diagnosis to treatment

Erectile dysfunction is a common condition that becomes more prevalent with age. Around one in 20 men have persistent erectile dysfunction by age 40, increasing to around one in seven by age 70. Occasional erectile dysfunction can occur at any age and most men will experience it at some point. 

It refers to the inability to get or maintain an erection that is firm enough to have sex, alongside a reduced desire to have sex (low libido). 

What causes erectile dysfunction?

There are both medical and psychological causes for erectile dysfunction. 

Medical causes include obesity, diabetes, heart disease, high blood pressure, hormonal conditions, low testosterone and thyroid issues. Erectile dysfunction can also be caused by a lack of sleep or exercise and as a side effect of medication. 

Erectile dysfunction is also very common after treatment for prostate cancer. However, this usually improves within one to two years of treatment. 

Getting a diagnosis

If you’re experiencing erectile dysfunction, it’s important to see your GP as there are lots of treatment options available. If you have persistent or severe symptoms, your GP may then refer you to a doctor specialising in the treatment of the male genitourinary tract (a urologist) for a specialist review and treatment.

Your urologist will ask you about your symptoms, take a thorough medical history, perform a physical examination and may also request additional tests depending on your symptoms, risk factors and any medications you’re taking. 

This may involve checking your blood pressure and referring you for blood tests to check your hormone levels, lipid profile (fatty acids) and blood sugar levels. 

They may also refer you for an ultrasound scan to measure blood flow to your penis or for overnight at-home monitoring of nocturnal penile tumescence (spontaneous erection of your penis when sleeping or waking up) using a special device.

Treating erectile dysfunction

Treatment for erectile dysfunction will depend on the underlying cause.

Lifestyle changes

Common lifestyle changes that can improve erectile dysfunction include quitting smoking, reducing how much alcohol you drink, losing any excess weight, regular exercise and stress management (eg deep breathing, yoga and mindfulness). 

Following a healthy diet, rich in fresh fruits and vegetables, whole grains and healthy fats can also help by improving your cardiovascular health and blood flow. Pelvic floor exercises can help improve blood flow to your pelvic area and penis too, which can improve your erections. 

Psychological support

Your doctor may refer you to a psychosexual counsellor or therapist for counselling, psychotherapy, cognitive behavioural therapy (CBT) and/or couples therapy. This can help address any anxiety, stress and/or relationship issues, which are contributing to your erectile dysfunction.

Medical treatments

Your urologist may prescribe oral medication to enhance the blood flow to your penis. This will help you get an erection when you’re sexually stimulated. These medications are called PDE-5 inhibitors and include sildenafil, tadalafil and vardenafil. 

Prostaglandin E1 creams, suppositories and injections to the base of the penis (eg alprostadil) can also help by increasing blood flow to your penis.

If your erectile dysfunction is caused by a hormonal imbalance, you may be prescribed hormone replacement therapy (HRT). 

If it is caused by blood vessel disease, your urologist may recommend low-intensity shockwave therapy, which is effective in reversing damage to blood vessels and consequently improves blood flow to your penis. Vacuum erection devices are also available as a non-invasive method of obtaining and maintaining an erection.

Surgery

In severe cases of erectile dysfunction where other treatments have not been effective, your urologist may recommend penile implant surgery. A penile implant can be inflatable or malleable (semi-rigid). Inflatable penile implants can be controlled using a pump implanted into your scrotum.