Erectile dysfunction or impotence is defined as the continuing inability to attain and sustain an erection in order to permit satisfactory sexual performance. It is important to see your GP if symptoms of erectile dysfunction last longer than a few weeks as erectile dysfunction could be a sign or indicator of cardiovascular disease. Recently clinicians have strongly recommended that for men presenting with erectile dysfunction further cardiovascular disease screening tests should be completed to ascertain whether an individual has established cardiovascular disease or has a greater risk of developing it. To attain a normal erection a man requires the following:
Sufficient levels of circulating hormones (testosterone),
Adequate levels of blood supply to the penis,
Nerves supplying the penis to be intact,
An appropriate level of sexual desire (4).
If there is a problem in one or more of these areas then erectile dysfunction may occur. To sum up, anything which may interfere with the nervous system or the circulation of blood can eventually lead to the occurrence of erectile dysfunction in men.
Erectile dysfunction is usually seen more commonly in men aged 40 years old or older. Although the prevalence rates in younger men under the age of 40 have been rising. In 1995 research estimated that over 100 million men worldwide experienced erectile dysfunction. It is predicted that figures could significantly increase to 322 million by 2025.
Studies show that up to 50% of men aged between 40 to 70 years old suffer from erectile dysfunction to a certain degree. Research completed highlights that globally erectile dysfunction affects approximately between 30% to half of all men who have diabetes, which is further compounded and exacerbated by a sedentary lifestyle and smoking. There are a multitude of causal factors and in some cases there could be a number of underlying reasons present in an individual who presents with erectile dysfunction, which influences the type of treatment a prescriber may recommend. Some of these causes are explored in greater depth below and they may include:
Alcohol-related or due to side effects from drugs (prescribed or recreational). Examples of prescribed drugs where erectile dysfunction may emerge as a side effect include:
Certain antidepressants, (medicines which are used to treat depression and some antidepressants may be used to treat other conditions such as neuropathic pain for example Amitriptyline of which erectile dysfunction is listed as a common side effect).
Some antipsychotic drugs (used in the treatment of schizophrenia or bipolar disorder).
Some anti-epileptic drugs (used in epilepsy treatment).
Certain medicines used to treat hypertension (otherwise known as high blood pressure).
Anti-androgen drugs such as Cyproterone acetate may be associated with developing impotence.
This list is not exhaustive and if you think one of the drugs you are taking may be causing erectile dysfunction, consult your GP, pharmacist or health care professional for further advice. Also, more information on the side effects of the medicine you are taking can be found in the patient information leaflet supplied with your medicine. Note do not adjust the dose or stop taking your medication unless your GP has advised you to do so. Additionally taking recreational drugs such as heroin, Methadone, anabolic steroids, the amphetamines or cocaine may result in erectile dysfunction/ impotence.
Apart from medication-induced other risk factors for impotence/ erectile dysfunction include:
Smoking, fatigue and increased stress levels. These can all be risk factors for developing erectile dysfunction.
Certain physical or psychological conditions may lead to erectile dysfunction occurring as a complication. The most common cause of erectile dysfunction is related to medical conditions which can lead to a restriction of blood supply to the penis such as in diabetes, having high cholesterol levels or having cardiovascular disease. For instance in diabetes elevated blood glucose levels over prolonged periods of time can result in damage to the blood vessels and nerves supplying the extremities leading to the development of erectile dysfunction as a consequence. Atherosclerosis is a condition where plaque accumulation in the arteries causes the blood vessels to narrow, which is another causal factor for erectile dysfunction occurring in men. Erectile dysfunction could be attributable to psychological conditions such as anxiety and depression as well.
Neurological causes include stroke, multiple sclerosis, spinal cord injuries and Parkinson’s disease. The latter is a medical condition which impacts on the way the brain co-ordinates movements.
Furthermore, it is estimated that erectile dysfunction may occur in approximately 15-25% of men who have experienced a significant head injury/ trauma. A lack of testosterone production due to a head trauma/ injury could affect the function of the pituitary gland (this gland is vital in stimulating the testes to manufacture testosterone) and it can result in impotence.
Other medical conditions which could result in erectile dysfunction include thyroid function disorders such as hypothyroidism (a condition characterised with low levels of thyroid hormones) or hyperthyroidism (a hormonal condition characterised with high levels of thyroid hormones). Also, Cushing’s syndrome which interferes with cortisol levels and causes a surge in cortisol could lead to erectile dysfunction in men. This can occur as an adverse effect from glucocorticoid therapy such as Prednisolone. Cortisol is a hormone produced by the adrenal glands which have many important functions in the body.
Careful assessment of the individuals’ medical history, psychosexual history, cardiovascular risk factors and lifestyle is undertaken by the prescriber to determine the ideal treatment. First line treatment according to the British Society for Sexual medicine are drugs known as the Phosphodiesterase type 5 inhibitors.
A drug from the phosphodiesterase-5 inhibitor class on its’ own or alongside other treatments such as treating the underlying cause, counselling, drug misuse services, alcohol and smoking cessation treatments, can be used to treat erectile dysfunction. The treatment recommended is based on a careful assessment by a healthcare professional. Examples of drugs within the phosphodiesterase- 5 inhibitor class include Tadalafil, Vardenafil, Avanafil and Sildenafil. You may have heard of the commonly known brand name of Sildenafil, Viagra, which has recently become available without a prescription. The wider availability of Viagra Connect will assist greater numbers of men accessing treatment. Viagra Connect can be sold in pharmacies after a consultation with a pharmacist. The other drugs within this class are only available on prescription after a consultation from a prescriber such as a doctor. The phosphodiesterase-5 inhibitors work by causing the blood vessels supplying the penis to relax thus increasing blood flow during sexual excitement and this causes an erection. In order for them to work sexual stimulation is required as these drugs work to facilitate an erection. If you are taking other medication it is vital that you consult a GP or pharmacist for advice on whether phosphodiesterase-5 inhibitors can be taken safely with your medication.
Cognitive behavioural therapy may be recommended in particular for individuals who have anxiety and depression. It is important to follow lifestyle advice in conjunction with treatment as this will improve outcomes and to take medication in line with prescriber instructions to help prevent adverse effects. Lifestyle changes could include stopping smoking, reducing stress levels (through employing relaxation techniques or yoga), losing weight if overweight, eating a healthy diet (could lower high cholesterol levels), better management of diabetes and exercising more. Alongside this, it is important to attend regular appointments to review your treatment.
As the number of men experiencing erectile dysfunction is increasing it is important to seek advice on available treatments from registered healthcare professionals such as Pharmacists or your local GP. By doing so individuals can access the treatment which is appropriate for them.
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