Erectile dysfunction, sometimes called ED or impotence, affects around one in every five men; this figure increases significantly with age. Most men will find they are unable to get or maintain an erection occasionally, perhaps because of tiredness, stress or too much alcohol; this is quite normal. ED is only diagnosed when the problem is persistent and recurrent. Unfortunately, it is very easy for a “one-off” incident to turn into a persistent problem, through fear
that the difficulty will recur. This is because, for many men, a properly functioning penis is key to their sense of ‘manhood’; thus the stakes are high, and anxiety is known to have a considerable effect on a man’s ability to become sexually aroused. It used to be thought that ED was mainly a psychological problem, but it is now known that a significant proportion of men with ED have an underlying physiological problem that is causing, or contributing to, the erectile difficulties. Contrary to popular opinion, however, low testosterone only accounts for a small minority of these cases. More common physical causes include high blood pressure, vascular disease caused for example by heart disease or diabetes mellitus, thyroid problems, neurological diseases such as multiple sclerosis, or trauma caused by spinal cord injury or pelvic surgery. In addition, a large number of prescription drugs, including those commonly prescribed for many of the disorders outlined above, can also cause ED. Smoking, alcohol and recreational drugs can also impair erectile function.
Psychological causes of ED can include depression, stress, anxiety, sexual dissatisfaction and relationship problems. Many men are ashamed or embarrassed to discuss the difficulty with their partner, and this will very often exacerbate the problem.Usually, we undertake a full psychological and psychosexual assessment to establish why a man is experiencing erectile problems, but as a rough guide, men whose erectile problems come on gradually, who notice a decline in night-time or morning erections, and who have difficulty getting or maintaining an erection even during masturbation, are most likely to have ED with a physical origin; whereas those who have no difficulty getting full erections on their own are more likely to find their ED has a psychological origin. Fortunately, there is a wide range of treatments nowadays for ED, Including oral drugs, vacuum devices, intra-urethral pellets and injection therapy, in addition to advice about lifestyle changes, relationship and sex therapy