Erectile Dysfunction get the facts
(ED) sometimes called erection problems, impotence, unable to get a hard-on may be more common than at first thought. Most men at some time in their lives have experienced periods when they were unable to get an erection (hard-on) and this is not only common, but normal. Losing erection during masturbation or sex can be a consequence of being tired, stressed, distracted or having drunk too much alcohol or taken recreational and some prescription drugs. For most men, this is a temporary situation and soon passes. If the problem persists and you find that you are unable to achieve an erection or maintain that erection, through to the cumming, then it is helpful to see your doctor. There may be some underlying medical problems or other difficulties, which may benefit from a check and maybe treatment. Some people confuse erectile dysfunction with premature ejaculation (cumming (too) quickly). The two problems are quite different, as are the treatments. It is a myth to think that using an erection drug, such as Viagra, Cialis or Levitra will help premature ejaculation. They will do nothing to slow down ejaculatory speed, however, they can help keep an erection long enough to ejaculate again, soon after. Here is a quick test to see if you have ED or premature ejaculation: question Do you lose your erection before cumming, or cum before losing your erection? answer If the problem is ED, then you probably lose erection before cumming. If the issue is premature ejaculation, then you will cum before losing the erection. Erection loss can occur at any time in life but, for many reasons, ED naturally increases with age. Between the ages of 40 and 70, it is estimated that about 50% of men will experience ED at some time. From 70 onwards, the number grows and there is a belief that 7 out of 10 men will experience this. It is estimated that ED affects 1 in 10 men worldwide and it is estimated that there are approximately 2.3 million men in the UK living with it at any one time. So if you are reading this leaflet because you are experiencing erection problems, then you are certainly not on your own. ED can be divided into two categories; psychological (or psychogenic) and physical (or organic) causes. The most common causes for psychological ED are: Stress Not getting the work-life balance right Anxiety Relationship problems Depression Poor sexual confidence One way to tell if the erection problems are psychological is if the difficulty develops suddenly. If the problem is psychological, there is a higher chance that sex drive (libido) remains as strong, however, a natural avoidance of intimacy and sex may develop as fear of failure increases. Physical reasons for ED are many. Underlying medical problems such as high blood pressure, cardiovascular problems, diabetes etc can cause difficulties with erection. Occasionally, hormonal problems, particularly with testosterone, can cause difficulties. Some commonly used medications can have ED as a side-effect. Typically, these treatments include the following types of drugs: Antidepressants Beta-blockers for anxiety or blood pressure Anticonvulsants Cholesterol lowering agents Antipsychotic drugs Diuretics (water tablets) Anti-sickness drugs Some anti-cancer drugs 2 3
A full list of medications which are known to have sexual side-effects can be found on the Sexual Advice Association website (www.sexualadviseassociation.co.uk) along with other useful information about sexual health and sexual function. If you are having erection problems, have a look at the summary table below and see if it applies to you: Psychological ED Happened suddenly Happens in a specific situation Normal night and morning erections Stress Avoidance of intimacy (due to fear of failure) Physical ED Summary of possible causes of psychological ED Happened gradually Happens in all situations Absent night and morning erections Good sex drive (libido) continues Anxiety or stress due to work, personal life, money or other matters Anxiety about sexual performance or sexual identity/sexuality issues Sexual problems with a partner Relationship/intimacy issues Depression Misconceptions/lack of sex education/poor sexual confidence Negative childhood experience Too much porn use Worries about body image or size of penis...and there are many more The problem may also be something as simple as cycling for long distances over a period of time. It is known that men who cycle over great distances put pressure on the nerves and blood supply running between the legs to the penis. If you notice that your bum, balls and legs are numb after a long cycle ride, the following information may be useful: Make sure you stop for a stretch regularly, stand up on the peddles to relieve pressure on your bum as often as you can and invest in a good gel seat and padded cycling shorts. The physical causes of erection problems are known to be, cardio-vascular and can include high cholesterol and high blood pressure, which can reduce the blood flow to the penis. If you are concerned that there may be some physical reason for the erection loss, or have a family history of heart disease, then go and see your doctor who will be familiar with treating these issues. Your doctor will be able to talk to you about the problem, do any necessary tests or investigations to find out if there is a medical reason for the erection loss and offer treatment. Seeking Help Of all men with erectile problems only 10% seek any help for this distressing condition with 90% suffering in silence. Embarrassment is the main reason for not seeking help and many men feel they will not be understood. It is common for men to wait a long time before seeking help for erection problems, in some cases up to 4 years. This is a real shame as most erection problems can be easily treated. Imagine worrying about something for all those years, now imagine what opportunities, adventures and relationships could have been enjoyed if the problem had been treated earlier. The negative effect of worrying about something that can be easily resolved impacts on emotional and mental health, relationships, work and play. What should I do if I keep losing my erection? The best advice is simple go and see your doctor. The doctor is likely to want to spend a little time discussing the problem with you, reviewing your medical history and any medications you are taking. Some doctors may want to do a very brief physical examination to see if everything looks okay. Not all doctors do this routinely. If you don t want to be examined, just say so and the doctor will respect your wishes. Also, some blood tests may be suggested. These are to check general health and male sex 4 5
hormones. No other tests will be done without your permission, and feel free to ask the doctor to explain exactly what blood tests they are planning if you have any concerns. Your doctor is one of the best people to help you identify or exclude any possible medical issues and get you the help you need. If I have ED, what options are available to me? Your doctor may refer you to a specialist psychosexual therapy (sex therapy) service for assessment and treatment. This is more common in cases where the erectile problems are thought to be psychological, however, some sexual therapy services also offer physical assessment and treatment. It is worth remembering that doctors are treating more men with erection problems than ever before, due to the drugs which are now available. One word about erection drugs; If it is suggested that you need an erection drug, such as Viagra, Cialis or Levitra, it is likely you may not be eligible for them on the NHS and may have to fund the treatment yourself. If you are paying for your treatment, make sure that you shop around for the best price and don t be afraid to ask the chemist how much the prescription will be, as prices vary. If you are using an internet based pharmacy, make sure that you only use legitimate companies such as Boots, Lloyds or Pharmacy2you.com Health warning: avoid fake erection medication There are many dangers of getting your erection drugs over the internet, the biggest is they are likely to be fake, so use known companies as discussed above. Despite the allure of low prices and a fast anonymous service, 90% of erection drugs supplied over the internet are fake or forgeries. These fake drugs often contain harmful things which are undisclosed and can be dangerous. If you are thinking of getting erection medication from the internet, have a look at the Brunswick Centre s Hard Facts leaflet on counterfeit erection drugs and judge for yourself www.thebrunswickcentre.org.uk/ resources/hard-facts-information-leaflet-on-counterfeit-erection-drugs. Getting the penile blood flowing: Pelvic floor exercises: Men are not generally good at exercising the pelvic floor (also known as Kegel s exercises). Unlike women, men have a prostate gland which is a valve and helps to hold pee. Exercising the pelvic floor really helps increase penile blood flow and hardness, makes orgasm stronger and ejaculation more forceful. Pelvic floor exercises are easy. Here is how to do them: Imagine you are in a lift with other people and want to fart. Clench you anal sphincter (bum hole) as tight as you can. Don t be clenching the bum cheeks, thighs or stomach. If you are doing it correctly, then you should feel your penis twitch and pull backwards, maybe your balls will move and there will be a general feeling of lifting in the genitals. Do the exercises twice a day for 20 repetitions. Sex therapy: If your doctor suggests sex therapy, this is a good way of helping you and maybe your partner to understand what is going on sexually and help you find ways to deal with it. If you wanted to find a sex therapist, be careful to make sure that the person you are seeing is qualified and experienced. The best advice would be to find a sex therapist who s registered with the College of Sexual and Relationship Therapists (COSRT). For more information on choosing a sex therapist, visit www.cosrt.org.uk and look at choosing a therapist where you will also find a list of qualified people in your area. Suggested reading: Men s Sexual Health by Metz and McCarthy 6 7
www.thebrunswickcentre.org.uk Committed to supporting people in our communities Also from The Brunswick Centre are other leaflets in this series: Premature Ejaculation Sex and Relationships Sexual Functioning Vaginismus Please contact The Brunswick Centre for more details. This series of leaflets have been produced by the Brunswick Centre in conjunction with Andrew Yates, Psychosexual Psychotherapist of Sex Therapy North (info@sextherapynorth.co.uk) and peer reviewed by Roz Ottery, Sexual and Relationship Therapist of Journey Counselling and Therapy (roz@journeycounselling.co.uk) The Brunswick Centre Marten House, Fern Street East, St. Andrew s Road, Huddersfield HD1 6SB Tel: 01484 469 691/01422 341 764 Fax: 01484 480 549 info@thebrunswickcentre.org.uk www.thebrunswickcentre.org.uk Registered charity no. 1015450 Company Registration no. 2764525. Satellite offices in Dewsbury, Halifax and the Upper Valley. The Brunswick Centre is member of the National Council For Voluntary Organisations (NCVO)