Erectile Dysfunction Only Happens To Old Men, Right?

By asking that question you are either an old guy, your partner is one or you’re a young guy who’s having problems in the downstairs department? Either that or you’re just curious about the subject and desperately need some information about the subject of erectile dysfunction. Whatever the reason to why this question is being asked, this blog will attempt to cover as much information regarding the subject as possible. So here goes…..

What is erectile dysfunction?Man with erectile dysfunction during sex with her partner looking disappointed

Before looking at whether it really does happen to old men or not we first need to understand what erectile dysfunction (or ED) is. Another posh medical but old-fashioned (and hardly ever used now) word for this term is impotence, however, nowadays medics prefer to use the term erectile dysfunction. The medical definition being …” the persistent inability to achieve and sustain an erection sufficient for satisfactory sexual intercourse or performance”.  Please note this condition is not considered normal at any age and is different from other problems which can interfere with satisfactory sexual intercourse, such as lack of sexual desire and problems with ejaculation and orgasm.

So how common is erectile dysfunction?

To put it simply, this condition is very common especially in men over 40 years old. Whether you would class 40 as being “old” or not is subjective and down to personal opinion. Being on the wrong side of 40 I would consider it to be young!

 

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Erectile Dysfunction only happens to old men, right?

Not really.  A study published in the August 2003 issue of   Annals of Internal Medicine showed that as some men get older they eventually will come face to face with erectile dysfunction.  It showed that ED is common among older men and sexual function sharply decreases after age 50. Once upon a time, doctors tended to blame ED on psychological problems or, with older men, on the normal ageing process. Today, urologists say physical factors underlie perhaps 90% of cases of persistent erectile dysfunction in men older than 50.

As part of the study, scientists surveyed more than 31,000 men, aged 53-90, about their sexual function. They asked volunteers to rate their ability in the previous three months — without treatment — to have and maintain an erection adequate for intercourse. Men with “poor” or “very poor” ability were considered to have erectile dysfunction.

Other factors such as age, physical activity, alcohol intake, and smoking were also assessed—all of which can affect erectile function.

Results showed that age does play a major role in men who say they have ED. The older the men, the higher the reported incidences of ED. The reports ranged from “good” function among younger men to a steady decline to “poor” among the older group.

The majority of younger men in the study (74%) rated sexual function as good or very good; whereas only 10% of men older than 80 rated sexual function the same. Only 12% of younger men reported big or moderate problems. But strikingly almost a third of men over the age of 50 reported this degree of severity in sexual function [7].

  • 2% reported their first ED experience was before age 40
  • 4% reported their first ED experience was between ages 40 to 49
  • 26% reported their first ED experience was between ages 50 to 59
  • 40% reported their first ED experience was between ages 60 to 69

To conclude from the results of this study in 2003-which incidentally was a long time ago, there are more reports of first experiencing ED in men aged between 60-69 than before the age of 40.  The more recent studies have shown a similar trend.  However, please do note that the volunteers were surveyed about their sexual function, so their answers were based on personal opinion rather than medical evidence. As you know personal opinion can be somewhat subjective and some results may have been exaggerated or even under-reported in some cases.

 

 

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Product Description

How does Viagra and Sildenafil work?

Viagra (Sildenafil) helps men to get and maintain an erection when sexually stimulated and/or excited. The medicine relaxes the blood vessels in the penis which results in more blood flowing to the penis when you are sexually excited.

How do I take it?

You should take Viagra (Sildenafil) approximately 1 hour before planning to have intercourse. Within a window of between 30 minutes and 4 hours after you take the medicine, it will be easier to keep and maintain an erection when you are sexually excited. If you take this medicine after a meal with a high fat content it may take a little longer to start working. This medicine will only work when you are sexually excited. You won’t get an erection just by taking Viagra (Sildenafil).

Dosage

The standard recommended dose for Viagra (Sildenafil) is 50mg and this will be suitable for most people.  If this dose is not effective, you can try 100mg and if 50mg gives you side effects you can also reduce the dose to 25mg tablets.

You must not take more than 100mg daily of Sildenafil/ Viagra. Clinical trials have been conducted in patients taking up to 200mg sildenafil and it was found that ‘doses of 200mg did not result in increased efficacy but did increase the incidence of adverse reactions (headache, flushing, dizziness, dyspepsia, nasal congestion, and altered vision).’

In addition, in patients taking more than 100mg daily, there have been reports of rhabdomyolysis (a breakdown in skeletal muscle tissue the byproducts of which can lead to kidney failure), visual perception changes, vertebral artery dissection (a tear in the artery supplying blood to the brain), heart attacks and aggressive behaviour.

If the 100mg strength doesn’t work for you, there may be alternatives you can try and we recommend that you call us for a free consultation with our pharmacist or doctor to discuss any underlying conditions you may have. We recommend that all men taking medicine for erectile dysfunction have regular tests for blood pressure, cholesterol, diabetes and hormone imbalances. For instance, it may be that by fixing a hormone imbalance such as testosterone, your Viagra medication will be even more effective.

In addition, drug manufacturers do not advise patients to split tablets in half to get the correct dosage as they cannot guarantee that the active ingredient will be distributed evenly throughout the tablet.  For instance, if you cut a 100mg tablet in two, you may find that you get 80mg in one half of the tablet and 20mg in the other half leading to either an overdose (increased risk of side effects) or a suboptimal dose (the medication may not work).

It is important that you choose the correct dose for you. If you wish to talk to our pharmacist or doctor about this, please contact us in the pharmacy on 01625 460621 or email [email protected]

Side Effects

Viagra (Sildenafil) is normally well tolerated, however, side effects can include:

  • Headache
  • Dizziness
  • Nausea

Side effects normally subside after a few hours, however, if you experience a prolonged or painful erection (longer than 4 hours), then you must contact your doctor immediately.

Drug interactions

There are a number of medicines which interact with Sildenafil/ Viagra. For an exhaustive list please see the patient information leaflet (see section below) or call us in the pharmacy to discuss your specific situation. The main drug interactions are listed here:

Recreational drugs such as ‘poppers’ or amyl nitrate
Alpha blockers used for urinary retention or blood pressure problems (eg Flomax or Cardura)
Anti- arrhythmic drugs such as disopyramide
Antibiotics such as erythromycin
Antifungals such as itraconazole
Antivirals such as drugs used to treat HIV
Bosentan
Cobicistat
Calcium channel blockers to treat blood pressure and angina such as amlodipine
Dapoxetine (Priligy – used to treat premature ejaculation)
Grapefruit juice**
Nicorandil
Nitrates
Riociguat
Cimetidine (to treat stomach ulcers)

Please do not take Sildenafil/Viagra if you have taken any of the above drugs within the last 60 days without first consulting with either us in the Pharmacy ([email protected] / 01625 460621) or via email with our doctor [email protected]

**We advise not to take Sildenafil/Viagra with grapefruit juice as the blood concentration of Sildenafil will possibly be increased resulting in side effects.

Patient Information Leaflets

Please click here for the patient information leaflet for Viagra.

For Actavis Sildenafil please see the following leaflets: 100mg, 50mg, 25mg.

Storing Medicines Safely

Please keep your medicine out of the reach of children and store at room temperature.  Unwanted medicine can be disposed of by returning it to any local pharmacy or indeed to us here for us to dispose of it for you.

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So what are the causes of erectile dysfunction?

Remember erectile dysfunction is a symptom and not a disease. The cause of which may be organic (natural) or psychogenic (psychological rather than a physical cause). It can also be caused by certain drugs.

  • Organic causes of erectile dysfunction may be:
    • Vasculogenic (the most common cause- this basically means down to dodgy blood vessels). Conditions such as cardiovascular disease (CVD), hypertension (high blood pressure), hyperlipidaemia (raised fats in your blood), diabetes mellitus, smoking, major pelvic surgery (radical prostatectomy, radiotherapy (pelvis or retroperitoneum).
    • Neurogenic (to do with the central nervous system ie brain/spine) — degenerative disorders (such as multiple sclerosis, Parkinson’s disease, and multiple atrophy), stroke, spinal cord trauma or diseases, central nervous system tumours.
    • Neurogenic (peripheral- not to do with brain or spine) — diabetes mellitus, chronic renal failure- (kidney failure), polyneuropathy, major surgery of the pelvis or retroperitoneum), urethral surgery (for example urethral stricture and urethroplasty).
    • Anatomical or structural — Peyronie’s disease, penile cancer, a congenital curvature of the penis, micropenis, hypospadias, epispadias, phimosis.
    • Hormonal — hypogonadism, hyperprolactinaemia, hyperthyroidism, hypothyroidism, Cushing’s disease, panhypopituitarism and multiple endocrine disorders, hypopituitarism following traumatic brain injury (erectile dysfunction is estimated to occur in 15–25% of survivors of traumatic head injury and is often unrecognised)

      Worried businessman sitting at office desk full with books and papers being overloaded with work.

  • Psychogenic causes of erectile dysfunction may be
    • Generalised — for example, due to lack of ‘arousability’ and disorders of sexual intimacy.
    • Situational — for example, due to partner-or performance-related issues, stress, and psychiatric illness (including depression, anxiety, and schizophrenia).
  • Drugs associated with erectile dysfunction include
    • Antihypertensives (to treat high blood pressure) — beta-blockers, verapamil, methyldopa, and clonidine.
    • Diuretics (“water tablets”) — spironolactone and thiazides.
    • Antidepressants — tricyclics, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors.
    • Antiarrhythmic drugs (to correct the rhythm of the heart) — digoxin, amiodarone.
    • Antipsychotics — chlorpromazine, haloperidol.
    • Hormones and hormone-modifying drugs — antiandrogens (flutamide, cyproterone acetate), luteinising hormone-releasing hormone agonists (leuprorelin, goserelin), corticosteroids, 5-alpha reductase inhibitors (for example finasteride).
    • Histamine (H2)-antagonists (“antacids”) — cimetidine, ranitidine.
    • Recreational drugs — alcohol, heroin, cocaine, marijuana, methadone, synthetic drugs, anabolic steroids [2].

Can erectile dysfunction be prevented?

An American expert in men’ s health Dr Brian Steixner (google him, he is really clever and does know what he’s talking about) – one of the world’s leading experts in erectile dysfunction states that the main reason behind ED boils down to blood loss.

“Having ED is like having a heart attack of the penis,” explains Dr Steixner. “…and preventing it involves pretty much the same advice you give to someone with a heart condition. Eat well, exercise – control those and you should be fine.”

He goes on to say “If you take care of yourself, you can avoid all that,” Dr Steixner says. “I have patients in their 90s who have perfect erections because they’ve taken care of themselves”.

The symptoms of ED, being unable to get and maintain an erection, can often be prevented by making obvious lifestyle changes, such as losing weight if  you are overweight, quitting smoking, reducing alcohol consumption to moderate levels, avoiding illegal drugs, carrying out at least 150 minutes of exercise a week and reducing stress levels.

Dr Steixner has stated because erectile dysfunction is often related to poor blood flow, steps should be taken to improve your heart health. Here are some suggestions to try:

  • Control your blood pressure to a healthy level, reduce cholesterol levels and for medical conditions like diabetes have optimum blood sugar control.
  • Avoid alcohol and recreational drugs that may reduce sexual desire or affect your ability to maintain an erection.
  • Discuss the side effects of medications with your doctor or pharmacist. Some drugs, especially those used to treat high blood pressure can contribute to erectile dysfunction. Additionally, prostate disease drugs, antidepressants and other drugs used to treat psychological conditions may cause erectile dysfunction.
  • Try to establish open and honest communication with your sexual partner as a way to ease tensions that could be affecting your performance.

However please do remember that occasional problems with erections are normal [4]. Worrying about past failures can interfere with present pleasure so try to just chill out and enjoy the experience rather than stressing about previous experiences.

Sildenafil-100-4Are there any treatment options?

Yes, plenty. However, the choice of treatment pretty much depends on the cause of the ED in the first place. This is why is so important to have a chat with your GP so that he or she can establish the cause and then by doing so discuss possible treatment options with you. The options nowadays are much better than what they used to be and chances are the problem will often go away.

So let’s have a look at some physical causes and viable treatment options [3]:

Possible physical causes Treatment
Narrowing of penis blood vessels, high blood pressure, high cholesterol Drug treatment to lower blood pressure, statins to lower cholesterol
Hormone problems Hormone replacement – for example, testosterone
Side effects of prescribed medication  Alternative medication prescribed following discussion with GP

However, if there are no known physical causes there are treatment options available the most famous one being Viagra (drug name Sildenafil). This is probably the most well-known drug in the world and works in response to sexual stimulation to increase the blood flow to the penis leading to an erection by helping the blood vessels in your penis to relax. This increases the blood flow into the penis, helping it stay hard and erect when you get sexually aroused.  Please note that these tablets do not cure the underlying causes of the erectile dysfunction although if the cause is primarily psychological, the tablets may help to break the cycle of anxiety and failure associated with being unable to achieve a satisfactory erection for satisfactory performance.

Since introduction the first PDE-5 inhibitor (this is the drug class) Viagra in the 1990s, there has been a fundamental change in the treatment of erectile dysfunction. Although there are a number of options available for non-surgical treatment, it is obvious that oral therapy has revolutionised the treatment approach to patients with erectile dysfunction. The further development of the other PDE-5 inhibitors Levitra and Cialis and much more recently Spedra begs the question of whether and how these sexual medications differ in terms of their efficacy and adverse effects.

The other similar medicines are called tadalafil (Cialis), vardenafil (Levitra) and avanafil (Spedra)  all which work in a similar manner to viagra.

What are the differences between these drugs?

The table below summarises some of the main differences between the 4 drugs in this class. Sildenafil or Viagra is probably the most popular of the 4 however as you can see, food with a high-fat content can affect the onset of action. This basically means it may take longer to work. Whereas Tadalafil or Cialis which has a similar onset of action time to Viagra is not affected by the presence of fatty food. But the half-life of Tadalafil is 17.5 hours- this essentially means that it takes 17.5 hours for half of the absorbed drug to be eliminated from the body [5][6]. So it stays in the body longer. This may be beneficial to some but not to others. All four have a maximum daily dose to be taken no more than once a day. The onset of action for vardenafil is only 10 minutes whereas for avanafil is between 35-40 minutes. Therefore the use of vardenafil may be more beneficial to some than others.  However, these factors may or may not be of importance to you or your partner and the choice may ultimately come down to cost.

 

Generic drug name Brand name Onset of action Affected by fatty food Half life Dosing Max daily dose
Sildenafil Viagra 14 mins yes 4 hours 25-100mg 1 hour before sexual activity Once daily
Tadalafil Cialis 16 mins no 17.5 hours 5-20 mg just before sexual activity Once daily
Vardenafil Levitra 10 mins yes 4 hours 5-20mg 1 hours before sexual activity Once daily
Avanafil Spedra 35-45 minutes Yes 6-17 hours 50-200mg 15-30 minutes before sexual activity Once daily

 

Are there any other treatment options?

The simple answer is yes. Again your GP will discuss these options with you further. In brief:

  • Injection Treatment: These options work very well but most men hate the sticking a needle into the base of the penis. I’ve been told it’s not very painful (ouch). The injected drug increases blood flow to the penis and an erection happens within 15 minutes. Unlike tablets, the erection occurs whether or not you are sexually aroused.
  • Urethral Medication ED Treatments: A small pellet is placed into the end of the urethra which contains a similar medicine to injection treatments. The medicine is rapidly absorbed into the penis, giving an erection within 10-15 minutes.
  • Vacuum Devices: The penis is placed into a plastic container. Then a pump is used to suck out the air from the container to create a vacuum. This vacuum causes blood to be drawn into the penis, leading to an erection. A rubber band is placed at the base of the penis to stop the blood flowing out to maintain the erection. The plastic container is removed off the penis which should remain erect until the rubber band is removed.

What about counselling?
If anxiety or stress is causing your (or your partner’s) ED problems, it may help to talk to a professional counsellor.

Remember life-changing problems or even everyday stress can trigger erectile dysfunction. Talking about these things with a qualified counsellor can ease sexual anxiety and help make you feel more confident in your relationship.

Your GP or Pharmacist can you talk you through all the treatment options available and provide you with sufficient information thus enabling you to make an informed choice as to the most appropriate type of treatment. Ultimately, as explained earlier the choice may ultimately be down to cost.

 

To summarise…

Going back to the title (scroll upwards if you’ve forgotten) lets separate fact from fiction knowing what we now know about ED.

Fiction: ED is a normal part of growing older and men have to learn to live with it.Happy man showing medicine pill

Fact: Although ED is probably more common amongst older men, that doesn’t mean it’s something you have to live with.

It’s not unusual (or weird for that matter) for older men to need more stimulation to help get them aroused than they did when they were younger. But there’s no reason older guys are not able to enjoy sex as they get older. Lots of men are able to get erections well into their later years, and there’s likely no reason that you can’t be one of them (if you are one of them!).

Fiction: Erectile dysfunction doesn’t affect younger men.

Fact: Although ED is probably more common in men over 75, guys of any age can suffer from it-remember, not every guy will admit to it.

So whether you posed the question as you’re an older guy or younger guy or your partner is suffering just to reiterate ED is not an older bloke only condition, virtually any man of any age can suffer from it. However, it’s not something which you (or your partner) have to live with and there are lots of treatment options available.

So if you think you have or might have erectile dysfunction, a good first step would be to go and have a chat with your doctor or pharmacist who will be happy to help and discuss the next possible steps with you.

 

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References

  1. https://www.webmd.boots.com/erectile-dysfunction/guide/erectile-dysfunction-basic
  2. https://cks.nice.org.uk/erectile-dysfunction#!topicsummary
  3. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/
  4. https://www.webmd.boots.com/erectile-dysfunction/guide/ed-prevention
  5. https://www.ncbi.nlm.nih.gov/pubmed/16780568
  6. https://www.pbm.va.gov/clinicalguidance/drugclassreviews/PDE5InhibitorsErectileDysfunctionDrugClassReview.pdf
  7. https://www.medicines.org.uk/emc/files/pil.5331.pdf
  8. https://www.webmd.com/erectile-dysfunction/news/20030804/erectile-dysfunction-common-with-age

 

Assured Pharmacy is not liable for the currency or accuracy of the information contained in this blog post. For specific information about your personal medical condition, please contact our doctors or pharmacists for advice on [email protected]