Erectile Dysfunction (ED) is the medical term for problems achieving or sustaining an erection which is sufficient to have penetrative sex. This can be a very difficult topic for a man to seek medical advice about and it can often be very helpful to know what to expect from a consultation with your doctor.
by Dr Karen Osborne BSC (Hons) MBBS DRCOG DFSRH MRCGP FRACGP
History
Your doctor should start by taking a thorough medical history. It is important that the doctor asks in detail about the circumstances of the Erectile Dysfunction as different features of the history may point to a specific likely cause. For example, a man who continues to have spontaneous night-time erections whilst sleeping is less likely to have a physical cause of his ED. They will also ask about symptoms related to your general and urological health.
Erectile Dysfunction can have a number of causes.
- Physical Causes which cause problems with the blood flow to the penis e.g. Diabetes, High Blood Pressure, Obesity, Arthrosclerosis (narrowed arteries)
- Psychological Causes e.g. Anxiety, Depression, Performance Anxiety, Stress, Work Pressures, Relationship Issues
- Smoking, alcohol, drugs
- Some Prescribed Medications such as Antidepressants, Blood Pressure medication
- Neurological / Spinal Cord Conditions e.g. Multiple Sclerosis
- Some Urological Conditions
Erectile Dysfunction is also more common in older men.
Examination
Clinical examination of the male genital system involves
- Examination of the penis – looking for scar tissue etc. Your doctor will not ask you to try and produce an erection.
- Examination of the testicles. This involves your doctor assessing the size of the testicles with a gloved hand, in addition to checking for any lumps or other abnormalities.
- Examination of the Prostate Gland if appropriate. This involves the doctor feeling for the size, shape and consistency of the prostate gland (including any lumps). This is done with a gloved, lubricated finger inserted into the rectum as the prostate gland at the base of the penis can be felt through the wall of the rectum.
- Observations such as Blood Pressure, Peripheral Pulses, Height/weight/BMI and Waist Circumference may also be recorded and your urine may be “dipped”.
Investigations
Tests may be requested by your doctor depending on the history and examination findings. Common tests to be performed may be:
- Diabetes Testing – this may be a simple Fasting Glucose or a Glucose Tolerance Test
- Cholesterol Testing
- Early Morning Testosterone Levels
- Prostate Specific Antigen (PSA) – may be tested in men over the age of 45Y if there is a higher risk of prostate cancer. It is important to note that it is not a validated screening test for cancer of the prostate.
- Other tests such as Thyroid Function, Liver and Kidney tests may also be done. Your doctor may also want you to have an ECG if he or she is concerned about your blood pressure or circulation.
Treatment of Erectile Dysfunction
There are several treatments available for Erectile Dysfunction. The success for the treatment may depend on the likely cause of the ED and also the severity of other medical problems such as diabetes. Sometimes the doctor may alter any existing medications which may be a cause if it is safe to do so. Depending on the likely cause of the ED, your doctor may recommend a psychological approach or usually a tablet first-line. Your doctor may also refer you onto a specialist to try a different approach.
Oral Medications such as Viagra, Cialis and Levitra will work in approximately 70% of cases. They work by blocking an enzyme allowing the erectile tissue of the penis to be more responsive to stimulation. They cannot be used by patients who take Nitrate medications or those with some heart conditions.
Penile injections are available to men who may prefer this method; they work by causing blood flow into the penis. One brand called Caverject will work approximately 80% of the time. This method may produce an uncomfortable side-effect of a painful erection lasting for hours.
Vacuum pump devices can be used which, when placed over the penis, can encourage blood flow into the erectile tissues.
As a last resort, a surgical procedure to insert a penile implant can be performed. These have a high success rate but are obviously invasive as they require surgery. Once fitted, the man is able to inflate the implant as desired to produce an erection.
About The Writer:
Dr Karen Osborne graduated from Guy’s & St Thomas’s, University of London in 2000 and trained as a GP in the UK, completing her GP training in 2005. Since then she has worked in a range of Sexual Health and Family Planning Clinics both in the UK and Australia. Karen has a particular interest in pre-conception counselling, subfertility and Antenatal / Postnatal Care and is accredited for Antenatal Shared Care. She is an Implanon Trainer and inserts and removes IUDs.
