Almost all men will have some problems with erections at some time in their lives, but a persistent inability to get or keep an erection is never normal, and we can almost always help.
Erectile dysfunction is the term now used for the consistent inability to get or maintain an erection of sufficient rigidity for satisfactory sexual intercourse. The lay term for this problem, now regarded by some as of suspect political correctness, is impotence. Indeed this term any give a better idea as to how a man with ED feels, as the loss of manhood, power and status make a man feel generally impotent.
Despite ill-advised comments in the media, it is a serious condition and one that affects both partners in a relationship. There are measurable adverse events which occur as a result of ED and measurable benefits associated with its successful treatment.
It is often not realised that many men presenting with ED have potentially serious underlying medical conditions, leading to the prospect of early intervention for such conditions as diabetes, cardiovascular disease and depressive illnesses. The attention of the patient to his erection is also a powerful aid to reinforcing advice on general lifestyle changes.
Erectile dysfunction is common in all age groups, with the incidence increasing as men get older.
Over five per cent of men in their forties will report complete impotence. It is of course important to realise what is meant when men report erection difficulties: almost all men will have transient failures associated with life events, but if the problem is persistent reassurance alone will not do as treatment.
In contrast to the commonly held belief that ED is more common in older men due to decreasing androgen levels, impotent aged men do not seem to have significantly lower serum androgens than potent age matched controls.
Men with impotence have a significantly increased risk of suffering form heart and other arterial disease, diabetes, depression and smoking. It is therefore impossible to propose that these patients, who represent a poorly attending group in primary care, should not at least be seen for examination and screening of underlying disease.
Most men with erectile dysfunction will present a mixed picture of physical and psychogenic origin. We do not refuse to treat patients with chronic pain syndromes for which no physical cause is obvious! The important thing for a man and his partner is to work out the problem and get things going again.
Most men can be helped by simple medication taken by mouth – lifestyle changes such as improving fitness and stopping smoking are also important.
For men who need more, treatments ranging from drugs applied to the penis, vacuum devices and even surgical treatment mean that no man needs to suffer this problem forever.
A little known but common problem, this is scar tissue inside the penis which makes one side of the penis less elastic, causing a bend.
We do not know what causes Peyronie’s disease: in many men an injury to the penis when erect (which may pass unnoticed) causes an exaggerated inflammatory response causing the scar tissue. It probably affects about 10% of men to some degree.
If the problem causes a minor bend, no treatment may be needed.
For man who are bothered by the bend, a number of options starting with self-stretching through to surgery are commonly used if needed. While a conservative approach is usually recommended, nearly all men can expect a straight working penis.