The Causes and Treatment of Erectile Dysfunction
What is erectile dysfunction?
Erectile dysfunction (impotence) is when a man is unable to get and/or keep an erection that allows sexual activity with penetration. It is not a disease, but a symptom of some other problem, either physical, psychological or a mixture of both.
Erectile dysfunction should not be confused with low libido (little interest in sex) or the inability to reach an orgasm or ejaculate. Premature (too early) and
retrograde ejaculation (into the bladder) are also different problems that need a different approach to diagnosis and treatment.
Occasional erectile dysfunction is normal. There is no need to worry about the occasional failure to get or keep an erection. Some of the causes of occasional erectile dysfunction include excessive intake of alcohol, anxiety and tiredness. One of the most common causes of erectile dysfunction in middle-aged men is lack of sleep.
How common is erectile dysfunction?
Erectile dysfunction is very common and becomes even more common in older men. An Australian survey shows that at least one in five men over the age of 40 years, increasing to about two in three men over the age of 70 years, often experience erectile problems, and about one in ten men are completely unable to have erections.
With each decade of age, the chance of having erectile problems increases.
How does an erection happen?
At a superficial level, getting an erection is a simple process. There are two tubes of spongy tissue that run along the length of the penis, and this spongy material is surrounded by a tough fibrous, partially elastic covering.
A message is sent through nerves that leave the lower spinal cord, telling the blood vessels entering the spongy tissue of the penis to let more blood in. The flow of blood out of the penis is then blocked off so the penis fills with blood and stretches within the outer casing. This creates an erection.
Underlying this relatively simple explanation is a very complex range of chemicals in the body that also work together to get an erection. At any one time, the muscle cells in the spongy tissue and in the blood vessels are influenced by a balance of chemical factors, some which cause an erection and some which encourage a flaccid (soft) penis.
What causes erectile dysfunction?
Many factors can interfere with getting an erection and often two or three factors are present at one time. Sometimes there can appear to be no obvious cause for the erectile dysfunction; however, most cases of erectile dysfunction are physical in origin.
Apart from the physical causes of erectile dysfunction due to an event such as prostate surgery or the introduction of a medication that affects sexual function, erectile dysfunction due to physical causes often begins gradually.
Erectile dysfunction (impotence) is when a man is unable to get and/or keep an erection that allows sexual activity with penetration. It is not a disease, but a symptom of some other problem, either physical, psychological or a mixture of both.
Erectile dysfunction should not be confused with low libido (little interest in sex) or the inability to reach an orgasm or ejaculate. Premature (too early) and
retrograde ejaculation (into the bladder) are also different problems that need a different approach to diagnosis and treatment.
Occasional erectile dysfunction is normal. There is no need to worry about the occasional failure to get or keep an erection. Some of the causes of occasional erectile dysfunction include excessive intake of alcohol, anxiety and tiredness. One of the most common causes of erectile dysfunction in middle-aged men is lack of sleep.
How common is erectile dysfunction?
Erectile dysfunction is very common and becomes even more common in older men. An Australian survey shows that at least one in five men over the age of 40 years, increasing to about two in three men over the age of 70 years, often experience erectile problems, and about one in ten men are completely unable to have erections.
With each decade of age, the chance of having erectile problems increases.
How does an erection happen?
At a superficial level, getting an erection is a simple process. There are two tubes of spongy tissue that run along the length of the penis, and this spongy material is surrounded by a tough fibrous, partially elastic covering.
A message is sent through nerves that leave the lower spinal cord, telling the blood vessels entering the spongy tissue of the penis to let more blood in. The flow of blood out of the penis is then blocked off so the penis fills with blood and stretches within the outer casing. This creates an erection.
Underlying this relatively simple explanation is a very complex range of chemicals in the body that also work together to get an erection. At any one time, the muscle cells in the spongy tissue and in the blood vessels are influenced by a balance of chemical factors, some which cause an erection and some which encourage a flaccid (soft) penis.
What causes erectile dysfunction?
Many factors can interfere with getting an erection and often two or three factors are present at one time. Sometimes there can appear to be no obvious cause for the erectile dysfunction; however, most cases of erectile dysfunction are physical in origin.
Apart from the physical causes of erectile dysfunction due to an event such as prostate surgery or the introduction of a medication that affects sexual function, erectile dysfunction due to physical causes often begins gradually.
Known causes of erectile dysfunction
Psychosocial problems
• Performance anxiety • Employment and financial pressures
• Sexual attitudes and upbringing • Depression
• Relationship problems • Psychiatric disorders
Metabolic problems affecting blood vessel function
• Diabetes • Renal failure
• High blood pressure • High cholesterol
• Obesity • Sleep apnoea
Reduced blood flow
• Atherosclerosis (narrowing of the arteries)
• Surgical damage to blood vessels
Interference by medication, alcohol and other drugs
• Cigarettes
• Alcohol and drug abuse
• Some medicines used to treat
> Blood pressure > Depression
> Cholesterol > Prostate cancer
> Psychiatric disorders
Interference with nerve function
• Parkinson’s disease • Multiple sclerosis
• Alzheimer’s disease • Diabetic neuropathy
• Spinal cord trauma • Pelvic surgery (prostate, bowel)
Urological problems
• Peyronie’s disease
• Pelvic trauma
There are many diseases that interfere with how the penis functions by either reducing blood flow or affecting the nerves. Importantly, when the first signs of erectile dysfunction happen, there is often an unknown underlying cause such as diabetes, hypertension or high cholesterol.
About one in 10 cases of erectile dysfunction is caused by psychological factors. A man’s sex drive (libido) can be affected by stress such as problems at work or financial worries. Feeling depressed and anxious about poor sexual performance can also lead to erectile problems.
Psychological causes of erectile dysfunction can happen together with physical causes.
Is erectile dysfunction a part of getting old?
There is no doubt that the ageing penis has less responsive muscle cells, which interfere with good erections. Like the rest of the ageing body, ‘muscle tone’ in the penis reduces with age, as do many other aspects of sexual function. Arousal can take longer, it may take much longer before a second erection happens, and usually the erection is not as firm.
Where can help be found?
When a man experiences erectile dysfunction he should see his local doctor, whether or not he wants to have sex. The reason for this is that erectile dysfunction may be a symptom of underlying medical conditions such as those listed in the table in Symptoms & causes.
It is important to talk openly to a doctor about any problems with sexual functioning.
Diagnosis of erectile dysfunction does not need complicated tests. After taking a history of sexual function and general medical factors, the doctor will do a physical examination of the penis, testes and prostate. Blood tests are done to check glucose (sugar), cholesterol and male hormone levels.
Treatment
Usually there will not be a specific treatment that will lead to the cure of erectile dysfunction. However, there are treatments that will allow erections to happen and can enable sexual activity to take place.
The main types of treatment for erectile dysfunction are:
1) Tablet Medicines
Such as Sildenafil or Tadalafil which work in about 70 per cent of men with erectile dysfunction. These medicines, known as PDE5 inhibitors, block a particular enzyme in the penis, enhancing the erectile response to normal sexual stimulation. Taking a tablet for erectile dysfunction is non-invasive and allows a more spontaneous approach to sexual activity.
2) Vacuum Device is a pump placed over the penis to create blood flow. It draws blood into specific tissues of the penis, as would happen in a normal erection.
3) Injection Treatments increase blood flow when they are injected into the penis, causing an erection. A possible side-effect is priapism (a painful erection lasting for hours) that if not managed can damage the penis.
4) Prescription Medicines may need changing in consultation with your doctor, if they are the cause.
5) 5) The Priapus Shot®. (Also known as the PShot®) uses Platelet-Rich Plasma (PRP) activated as a Platelet Rich Fibrin Matrix (PRFM) to stimulate the patients own platelet growth factors to generate new connective and neurovascular tissue with applications in ED. Learn More About The P-Shot®. Review P-Shot® Data Information.
6) Penile Prosthetic Implants are usually used as a last resort if all other treatments have not worked.
It is usual to start with the least invasive treatment, such as tablets, and be recommended more injectable treatments or surgery if the tablets fail.
Can erectile dysfunction be prevented?
At the present time there are no proven ways to prevent erectile problems developing, however keeping general good health may help lower the chance of having these problems. Regular exercise and a sensible diet will reduce the risk of obesity, diabetes, high blood pressure and high cholesterol, therefore making erectile dysfunction less likely. For some men, seeking treatment early can stop erectile problems from getting worse.
Does seeing a counsellor help?
Psychosocial problems are important and may cause erectile dysfunction by themselves, or together with one of the other causes of erectile dysfunction such as diabetes. Relationships are complicated and many factors cause tensions, which can affect sexual relations.
For some men, problems can become on-going and it can help to talk through the issue with a skilled counsellor. Improved sexual function may be delayed by failing to deal with the psychological side. Being open and honest with your partner will encourage a good understanding of the problem and couples can work together to bring about a positive result for their relationship.
c/o Monash Institute of Medical Research Victoria Australia
Andrology Australia is an initiative funded by the Australian Government Department of Health and Ageing.
This information has been provided for educational purposes only. It is not intended to take the place of a clinical diagnosis or proper medical advice from a fully qualified health professional. Andrology Australia urges readers to seek the services of a qualified medical practitioner for any personal health concerns.
Psychosocial problems
• Performance anxiety • Employment and financial pressures
• Sexual attitudes and upbringing • Depression
• Relationship problems • Psychiatric disorders
Metabolic problems affecting blood vessel function
• Diabetes • Renal failure
• High blood pressure • High cholesterol
• Obesity • Sleep apnoea
Reduced blood flow
• Atherosclerosis (narrowing of the arteries)
• Surgical damage to blood vessels
Interference by medication, alcohol and other drugs
• Cigarettes
• Alcohol and drug abuse
• Some medicines used to treat
> Blood pressure > Depression
> Cholesterol > Prostate cancer
> Psychiatric disorders
Interference with nerve function
• Parkinson’s disease • Multiple sclerosis
• Alzheimer’s disease • Diabetic neuropathy
• Spinal cord trauma • Pelvic surgery (prostate, bowel)
Urological problems
• Peyronie’s disease
• Pelvic trauma
There are many diseases that interfere with how the penis functions by either reducing blood flow or affecting the nerves. Importantly, when the first signs of erectile dysfunction happen, there is often an unknown underlying cause such as diabetes, hypertension or high cholesterol.
About one in 10 cases of erectile dysfunction is caused by psychological factors. A man’s sex drive (libido) can be affected by stress such as problems at work or financial worries. Feeling depressed and anxious about poor sexual performance can also lead to erectile problems.
Psychological causes of erectile dysfunction can happen together with physical causes.
Is erectile dysfunction a part of getting old?
There is no doubt that the ageing penis has less responsive muscle cells, which interfere with good erections. Like the rest of the ageing body, ‘muscle tone’ in the penis reduces with age, as do many other aspects of sexual function. Arousal can take longer, it may take much longer before a second erection happens, and usually the erection is not as firm.
Where can help be found?
When a man experiences erectile dysfunction he should see his local doctor, whether or not he wants to have sex. The reason for this is that erectile dysfunction may be a symptom of underlying medical conditions such as those listed in the table in Symptoms & causes.
It is important to talk openly to a doctor about any problems with sexual functioning.
Diagnosis of erectile dysfunction does not need complicated tests. After taking a history of sexual function and general medical factors, the doctor will do a physical examination of the penis, testes and prostate. Blood tests are done to check glucose (sugar), cholesterol and male hormone levels.
Treatment
Usually there will not be a specific treatment that will lead to the cure of erectile dysfunction. However, there are treatments that will allow erections to happen and can enable sexual activity to take place.
The main types of treatment for erectile dysfunction are:
1) Tablet Medicines
Such as Sildenafil or Tadalafil which work in about 70 per cent of men with erectile dysfunction. These medicines, known as PDE5 inhibitors, block a particular enzyme in the penis, enhancing the erectile response to normal sexual stimulation. Taking a tablet for erectile dysfunction is non-invasive and allows a more spontaneous approach to sexual activity.
2) Vacuum Device is a pump placed over the penis to create blood flow. It draws blood into specific tissues of the penis, as would happen in a normal erection.
3) Injection Treatments increase blood flow when they are injected into the penis, causing an erection. A possible side-effect is priapism (a painful erection lasting for hours) that if not managed can damage the penis.
4) Prescription Medicines may need changing in consultation with your doctor, if they are the cause.
5) 5) The Priapus Shot®. (Also known as the PShot®) uses Platelet-Rich Plasma (PRP) activated as a Platelet Rich Fibrin Matrix (PRFM) to stimulate the patients own platelet growth factors to generate new connective and neurovascular tissue with applications in ED. Learn More About The P-Shot®. Review P-Shot® Data Information.
6) Penile Prosthetic Implants are usually used as a last resort if all other treatments have not worked.
It is usual to start with the least invasive treatment, such as tablets, and be recommended more injectable treatments or surgery if the tablets fail.
Can erectile dysfunction be prevented?
At the present time there are no proven ways to prevent erectile problems developing, however keeping general good health may help lower the chance of having these problems. Regular exercise and a sensible diet will reduce the risk of obesity, diabetes, high blood pressure and high cholesterol, therefore making erectile dysfunction less likely. For some men, seeking treatment early can stop erectile problems from getting worse.
Does seeing a counsellor help?
Psychosocial problems are important and may cause erectile dysfunction by themselves, or together with one of the other causes of erectile dysfunction such as diabetes. Relationships are complicated and many factors cause tensions, which can affect sexual relations.
For some men, problems can become on-going and it can help to talk through the issue with a skilled counsellor. Improved sexual function may be delayed by failing to deal with the psychological side. Being open and honest with your partner will encourage a good understanding of the problem and couples can work together to bring about a positive result for their relationship.
c/o Monash Institute of Medical Research Victoria Australia
Andrology Australia is an initiative funded by the Australian Government Department of Health and Ageing.
This information has been provided for educational purposes only. It is not intended to take the place of a clinical diagnosis or proper medical advice from a fully qualified health professional. Andrology Australia urges readers to seek the services of a qualified medical practitioner for any personal health concerns.
P-Shot® Data Information
Mechanism
The P-Shot® uses Platelet-Rich Plasma (PRP) activated as a Platelet-Rich Fibrin Matrix (PRFM), that harnesses the power of the patients own platelet growth factors to regenerate new connective, vascular and neural tissue. It is a minimally invasive autologous medical treatment used across multiple medical specialties - including cosmetic rejuvenation.
Safety
There have been no serious long term effects found with PRP when administered appropriately with an FDA approved kit. A recent retrospective study in the Investigative Clinical Urology, Ethan 2018, concluded that PRFM injections for Erectile Dysfunction (ED) and Peyronie’s Disease (PD) are feasible and safe (1)
Providers
The P-Shot® is a trademarked procedure created by Dr Charles Runels. All global providers are registered members of the Cellular Medicine Association which includes urologists, surgeons, cosmetic physicians and general practitioners (2).
Patient Satisfaction Rates
A retrospective study of 1220 patients by Kumar CS; “Combined Treatment of Injecting Platelet Rich Plasma With Vacuum Pump For Penile Enlargement”; J Sex Med 2016, 11, 174, concluded that penile length and girth enhancement using PRP and Vacuum Device for patients suffering from small penis, severe ED, significant shortening with or without Peyronies disease is a safe cheap effective procedure that can be performed in an outpatient department. With erection satisfaction rates of 70% reported (3). Important variables such as patient medical history, presence chronic illness, medications-anti platelet therapy, lifestyle-smoking, type of PRP kits, harvesting technique, quality of PRP, doctor skill and patient expectations are contributing factors towards patient satisfaction and dissatisfaction rates (2a).
Demographics
In New Zealand there are more than 1 in 3 men who suffer from erectile dysfunction in their lifetime (4,5) the majority of whom present with mild-to-moderate erectile symptoms, which worsen with age (4). We recommend that any complicated cases that have not previously been investigated be referred to the appropriate clinicians such as an urologist before proceeding with any treatment.
References:
1) Ethan L Matz, Amy M Pearlman, Ryan P Terlecki; Investig Clin Urol 2018 Jan; 59 (1): 61-65
2) Website www.priapusshot.com/members/directory
and 2a) Website www.priapusshot.com
3) Kumar CS; “Combined Treatment of Injecting Platelet Rich Plasma With Vacuum Pump For Penile Enlargement”; J Sex Med 2016, 11, 174
4) Quilter M, Hodges L, von Hurst, P, et al; “Male Sexual Function In New Zealand: A Population-Based Cross-Sectional Survey Of The Prevalence Of Erectile Dysfunction In Men Aged 40-70 Years”; J Sex Med 2017; 14:928-936
5) Berrada S, Kadri N, Mechackra-Tahiri S, Nejjari C; “Prevalence Of Erectile Dysfunction And Its Correlates; A Population-Based Study In Morocco”; Int J of Impotence Res 2003; 15:S3-S7
6) Virag R; “A New Treatment Of Lapeyronie’s Disease By Local Injections Of Plasma Rich Platelets (PRP) and Hyaluronic Acid . Preliminary Results.” E-Memoires de l’Academie Nationale de Chirurgie 2014; 13(3):96-100
7) Virag R; “Evaluation Of The Benefit Of Using A Combination Of Autologous Platelet-Rich Plasma and Hyaluronic Acid For The Treatment Of Peyronie’s Disease”; Sex Health Issues 2017 1(1):1-8
8) Platelet Rich Plasma (PRP) is an accredited procedure within the New Zealand Society of Cosmetic Medicines Training Program.’ 18th January 2018 Dr Joanna Romanowska NZSCM Censor. www.nzscm.co.nz
The P-Shot® uses Platelet-Rich Plasma (PRP) activated as a Platelet-Rich Fibrin Matrix (PRFM), that harnesses the power of the patients own platelet growth factors to regenerate new connective, vascular and neural tissue. It is a minimally invasive autologous medical treatment used across multiple medical specialties - including cosmetic rejuvenation.
Safety
There have been no serious long term effects found with PRP when administered appropriately with an FDA approved kit. A recent retrospective study in the Investigative Clinical Urology, Ethan 2018, concluded that PRFM injections for Erectile Dysfunction (ED) and Peyronie’s Disease (PD) are feasible and safe (1)
Providers
The P-Shot® is a trademarked procedure created by Dr Charles Runels. All global providers are registered members of the Cellular Medicine Association which includes urologists, surgeons, cosmetic physicians and general practitioners (2).
Patient Satisfaction Rates
A retrospective study of 1220 patients by Kumar CS; “Combined Treatment of Injecting Platelet Rich Plasma With Vacuum Pump For Penile Enlargement”; J Sex Med 2016, 11, 174, concluded that penile length and girth enhancement using PRP and Vacuum Device for patients suffering from small penis, severe ED, significant shortening with or without Peyronies disease is a safe cheap effective procedure that can be performed in an outpatient department. With erection satisfaction rates of 70% reported (3). Important variables such as patient medical history, presence chronic illness, medications-anti platelet therapy, lifestyle-smoking, type of PRP kits, harvesting technique, quality of PRP, doctor skill and patient expectations are contributing factors towards patient satisfaction and dissatisfaction rates (2a).
Demographics
In New Zealand there are more than 1 in 3 men who suffer from erectile dysfunction in their lifetime (4,5) the majority of whom present with mild-to-moderate erectile symptoms, which worsen with age (4). We recommend that any complicated cases that have not previously been investigated be referred to the appropriate clinicians such as an urologist before proceeding with any treatment.
References:
1) Ethan L Matz, Amy M Pearlman, Ryan P Terlecki; Investig Clin Urol 2018 Jan; 59 (1): 61-65
2) Website www.priapusshot.com/members/directory
and 2a) Website www.priapusshot.com
3) Kumar CS; “Combined Treatment of Injecting Platelet Rich Plasma With Vacuum Pump For Penile Enlargement”; J Sex Med 2016, 11, 174
4) Quilter M, Hodges L, von Hurst, P, et al; “Male Sexual Function In New Zealand: A Population-Based Cross-Sectional Survey Of The Prevalence Of Erectile Dysfunction In Men Aged 40-70 Years”; J Sex Med 2017; 14:928-936
5) Berrada S, Kadri N, Mechackra-Tahiri S, Nejjari C; “Prevalence Of Erectile Dysfunction And Its Correlates; A Population-Based Study In Morocco”; Int J of Impotence Res 2003; 15:S3-S7
6) Virag R; “A New Treatment Of Lapeyronie’s Disease By Local Injections Of Plasma Rich Platelets (PRP) and Hyaluronic Acid . Preliminary Results.” E-Memoires de l’Academie Nationale de Chirurgie 2014; 13(3):96-100
7) Virag R; “Evaluation Of The Benefit Of Using A Combination Of Autologous Platelet-Rich Plasma and Hyaluronic Acid For The Treatment Of Peyronie’s Disease”; Sex Health Issues 2017 1(1):1-8
8) Platelet Rich Plasma (PRP) is an accredited procedure within the New Zealand Society of Cosmetic Medicines Training Program.’ 18th January 2018 Dr Joanna Romanowska NZSCM Censor. www.nzscm.co.nz
