Is Erectile Dysfunction Psychological?

Erectile Dysfunction (ED) is generally something that men do not want to talk about. This condition is defined as the inability to get or maintain an erection long enough for sexual function. There is sometimes the perception that it is “all in the mind”. Some people think the man should just get over it; he’s completely in control so it must be his own fault if he can’t get an erection. However, these are common misconceptions.

The real causes of ED can be much more complicated. In many cases, the root cause is actually a physical problem and most often treated with Viagra or Sildenafil, although psychological issues do play a significant part in some men in the development of ED.

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To get an erection the man must be sexually excited and when this happens the brain sends messages down through nerves in the spinal cord to nerves in the penis. This message causes increased blood flow to the penis, allowing the tissue to expand and harden. Anything that interferes with either the nerve messages or the blood flow – the vascular system – can cause problems and result in ED.

blood flow to penisHigh blood pressure puts more effort into the heart and can, therefore, interfere with blood flow. Diabetes is another disease that can affect the blood circulation, which may not be immediately associated with being a potential cause of erectile dysfunction. A long-term complication of having the high sugar levels that diabetes can cause is damage to both the circulatory system and the nervous system. Therefore diabetes can also be a neurogenic cause of ED.

Other neurogenic conditions include Multiple Sclerosis, a disease that affects the body’s movement and balance; Parkinson’s Disease which affects the brain’s ability to coordinate movements; a stroke, where the blood supply to the brain is temporarily interrupted and so damage can occur; and any spinal injury or disorder. All of these conditions can interfere with the messages the brain will send down to the penis to allow it to become erect.

Hormonal conditions can also cause ED. Low level of testosterone, the male sex hormone, can be caused by the condition hypogonadism. Any upset in the levels of thyroid hormones, caused by hyper- or hypothyroidism, or in the levels of cortisol, caused by Cushing’s Syndrome, can lead to erectile dysfunction. There are also some anatomical conditions which can cause ED, such as Peyronie’s Disease which affects the actual tissue of the penis.

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Viagra & Generic Sildenafil

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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.

51 reviews for Viagra & Generic Sildenafil

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In all of these conditions, the cause of the ED is beyond the control of the individual. Most of these can be addressed by lifestyle changes or medication. This stresses the importance of seeing the GP about the condition, as these conditions may go undiagnosed for some time, and therefore be left untreated. High blood pressure can be otherwise asymptomatic, but if left untreated can lead on to cardiovascular disease and put the man at risk of other complications.

ED1ED can be an issue that the man may feel embarrassed about, but the short consultation with the doctor, while it may cause some short-term anxiety and embarrassment, will lead to hopefully any undiagnosed condition being brought to light and appropriately treated, and treatment of the ED itself. There are multiple effective treatments for ED available. Treating the underlying condition itself may have a beneficial effect on the ED and starting any necessary treatments sooner rather than later will prevent any further damage, and worsening of ED.

There are several psychological causes of ED, which can be harder to detect, diagnose and treat. The psychological issues, however, aren’t simply “in the mind”. They are very real and can lead to physical effects on the individual, such as ED. Anxiety, a feeling of unease, like worry or fear, is one of the main psychological causes of ED. There is a common misconception that anxiety is “just in the head”, but this is untrue. It can lead to increased heart rate and blood pressure and fatigue. These problems plus the anxiety itself can affect sexual functioning.

StressAnother common cause is stress. Often the stress the individual feels does not have to be huge for it to affect the ability to achieve and maintain an erection. Pressure from work or relationship problems can all lead to ED. Emotional problems, often linked to relationship difficulties can affect a couple’s sexual relationship. Working through any problems can help to ease the man’s symptoms and allow him to return to his normal sexual functioning. Depression can be linked to both of these problems and also causes ED.

Depression is usually caused by chemical imbalances in the brain. It can affect not only sexual function but also sexual desire. A problem is that many men do not recognise the symptoms of depression in themselves, or if they do, are reluctant to go to their GP to get checked out. This will only be compounded by having ED, also seen as an embarrassing problem, as well. However, it is important to remember that the majority of men will regain their sexual interest and performance and their normal state of mind with treatment for depression, and possibly the addition of treatment for the ED. Combinations of physical and psychological conditions are often the culprits for ED. For example, having any long-term condition, especially just after diagnosis, can lead to anxiety, stress or depression, and this plus the physical effects of the condition, if it is one of those discussed above, may lead to ED. Having one episode where you are unable to get or maintain an erection can hugely increase the stress and anxiety you feel, and lower self-esteem, and so can lead to a vicious circle.

BrainIn psychological causes of ED often treatment is not started immediately. If there is an alternative to medication it is always best to try this first. An exception is diagnosed depression. In this case, anti-depressant medication may be required to help an individual to find relief from their symptoms and they may find their ED symptoms clear up as their mind starts to return to normal. Most psychological issues are best treated with therapy and require patience and time. By consulting with the GP, the man can find the best course of action for him and if appropriate his partner.

In conclusion, ED can be caused by physical or psychological causes, or by a combination of the two. Whatever the cause, this condition can have a huge effect on the man’s life and lead to further stress and emotional problems. It is important to get this condition checked out by a GP if it lasts for more than a few weeks, as it can be a sign of a more serious underlying condition. There are many effective treatments available for erectile dysfunction and so the sooner you see the doctor, the sooner you can address the issue, and most men will get back to normal sexual performance.

 

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References

Sexual Advice Association: Erectile Dysfunction and the Heart. Accessed 24/02/15. http://www.sda.uk.net/heart

Healthline: Is Erectile Dysfunction Psychological. Kimberly Holland. Accessed 24/02/15 http://www.healthline.com/health-slideshow/erectile-dysfunction-psychological#promoSlide

NHS Choices: Erectile Dysfunction (Impotence). Accessed 24/02/15. http://www.nhs.uk/conditions/Erectile-dysfunction/Pages/Introduction.aspx

 

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].