Erectile dysfunction (or impotence) is a man’s inability to get or keep an erection that allows sexual activity with penetration.

Erectile dysfunction is not a disease, but a symptom of some other problem – physical, psychological or a mixture of both.

Don’t worry about occasional failure to get or keep an erection. This is normal. Some of the causes include drinking too much alcohol, anxiety, and tiredness. Unless it continues, there is no reason to be concerned. However, if your erectile dysfunction is ongoing, see a doctor.

Treatments for erectile dysfunction include medications given orally (usually pills), injections directly into the penis, HRT treatment, low-intensity shock waves, and some more.

Causes of Erectile Dysfunction

Doctors used to think that erectile dysfunction was mainly caused by psychological factors, such as anxiety or depression. In fact, most cases of erectile dysfunction are caused by physical illness. Psychological problems cause only one in ten cases of persistent erectile dysfunction.

Physical erectile dysfunction happens over a period of months or years, and is often a gradual loss of function. If erections still occur spontaneously overnight or in the morning, the problem may be psychological.

Erectile dysfunction can be due to:

  • physical illness – erectile dysfunction is often associated with conditions that affect blood flow in the penis, such as diabetes, high cholesterol, high blood pressure, cigarette smoking, obesity, heart disease, and multiple sclerosis;
  • psychological factors – a man’s sexual drive or performance can be affected by stress such as problems at work, relationship difficulties, or financial worries. Psychiatric conditions, and feeling depressed or anxious about poor sexual performance can also result in erectile dysfunction;
  • a combination of physical illness and psychological factors – physical problems with maintaining an erection may cause the man to feel anxious about sexual performance, which makes the problem worse;
  • medications – prescribed medicines used to treat high blood pressure, high cholesterol, depression, and psychiatric disorders, and prostate disease, may cause or worsen the symptoms of erectile dysfunction;
  • unknown – in a few cases, neither physical nor psychological causes are obvious. Vascular disease is likely to be the underlying cause in these cases.

Diagnosis of the cause of ongoing erectile dysfunction

If you have ongoing erectile dysfunction, have it investigated by a doctor. While occasional erectile dysfunction is normal, ongoing erectile dysfunction can be a symptom of a serious physical illness.

A doctor can fully investigate any ongoing problems to check for any underlying medical cause that may also need treatment. This may include heart and blood vessel diseases, diabetes, high blood pressure, or high cholesterol.

Tests can determine if the blood flow to your penis is affected. Blood tests can also help to determine if hormone problems, such as low testosterone, are causing erectile dysfunction.

Once you find out whether your erectile dysfunction has a physical or psychological cause, you can get the proper course of treatment.

Treatment for Erectile Dysfunction

There are many treatments for erectile dysfunction. These include:

  • changing your prescription medication if it is the cause;
  • psychotherapy and counseling;
  • oral medication (tablets) such as Viagra, Cialis, and Levitra;
  • external vacuum penile pump devices to create blood flow;
  • injections directly into the penis (such as Caverject Impulse);
  • penile prosthetic implants;
  • hormone therapy (rarely given);
  • vascular surgery (rarely undertaken).

The first approach is to treat the underlying cause if one is identified. If no underlying cause is found, treatments to directly restore erectile function are used.

There are many treatments aimed at restoring erectile function. These can be grouped according to their level of invasiveness, being:

  1. non-invasive treatments
  2. minimally invasive treatments
  3. surgical treatments

We provide the treatments of the first two categories.

Non-invasive treatments for erectile dysfunction

Medication: (usual pills) is effective in about 70% of men with erectile dysfunction. Brand names include Viagra, Cialis, and Levitra. These are known as PDE5 inhibitors – they inhibit a particular enzyme in the penis, improving the erectile response to normal sexual stimulation.

Pills should usually be taken at least one hour before sexual contact. With Cialis, taking a lower dose on a daily basis can allow more spontaneous sexual activity. Fatty meals and large amounts of alcohol can interfere with the body’s absorption of some of these medications.

A doctor will help you decide the best treatment for you. Oral medication may not be suitable for all men. If you are taking nitrate-containing heart medication, consult a doctor as erectile dysfunction medication may interact with these medications.

Shock Waves: The clinical term for shockwave therapy is low-intensity shockwave therapy (Li-SWT).

Shockwave therapy is administered with a wand-like device placed near different areas of the penis. A healthcare provider moves the device along parts of your penis for about 15 minutes while it emits gentle pulses. No anesthesia is needed.

The pulses trigger improved blood flow and tissue remodeling in the penis. Both of these changes can lead to erections sufficient for sex.

There’s currently no established recommendation for the treatment period or frequency.

However, a 2019 review and meta-analysis of clinical trials found that the most common treatment plan was twice weekly for 3 weeks, followed by 3 weeks without treatments, and another 3-weeks of twice-weekly treatments.

The analysis found that the effects of shockwave therapy lasted about a year.

Minimally invasive treatments for erectile dysfunction

Trimix: Some medications can increase blood flow when it is injected into the penis. A penile injection can create an erection within five to 10 minutes and last for up to one hour.

You will need to be shown how to use the penile injections properly and practice several supervised injections in the doctor’s office.

One possible side effect of penile injections is a painful erection lasting for hours, known as priapism. This occurs if the medication dose is too high. In this situation, seek immediate medical attention.

Testosterone replacement therapy (TRT) is only suitable for men whose levels of testosterone are low. Before treatment, a doctor needs to investigate the cause of your low testosterone.

For any concerns, get in touch with our qualified experts to get advice for free.