What are the treatment options for impotence (erectile dysfunction)
A referral to a specialist is sometimes needed for assessment and treatment. However, GPs are now treating more cases of ED than previously as the treatment options have improved in recent years. The following gives a brief summary of treatment options. There is a good chance of success with treatment. There are pros and cons of each treatment, and your doctor will advise further.
Have you considered your other medication?
As mentioned, some medicines can cause ED. Check the leaflet that comes with any medication that you take to see if ED is a possible side-effect. Do not stop any prescribed medication, but see your doctor if you suspect this as the cause. A switch to a different medicine may be possible, depending on what the medicine is for.
Medication (tablets taken by mouth)
In 1998, the first tablet to treat ED was launched. This made a huge impact on the treatment of ED. There are now four different tablets licensed in the UK to treat ED.
- Three of the tablets work by increasing the blood flow to your penis. They do this by affecting the chemicals involved in dilating (widening) the blood vessels when you are sexually aroused (described above). They are sildenafil (trade name Viagra), tadalafil (trade name Cialis), and vardenafil (trade name Levitra). You take a dose before you plan to have sex. Because of the way they work, these medicines are called phosphodiesterase type 5 inhibitors (PDE5 inhibitors).
- Apomorphine (trade name Uprima) works by increasing the level of certain chemicals in the brain which are involved in sending messages down nerves to the penis when you are sexually aroused. You take a tablet which dissolves under the tongue 20 minutes before you plan to have sex.
So, even if the nerves or blood vessels going to your penis are not working so well, a tablet can cause the blood flow to increase in your penis, and cause an erection. Tablets can treat ED caused by various underlying conditions.??None of these tablets will cause an erection unless you are sexually aroused. There is a good chance that a medicine will work (about an 8 in 10 chance of it working well). However, they do not work in every case. There are pros and cons for each of the above, and your doctor will advise. For example, you may not be able to take certain tablets for ED if you have certain other medical conditions, or take certain other medicines. For example, you should not take a PDE5 inhibitor if you take nitrate medicines (including GTN) which are often used to treat angina.
Pelvic floor muscle exercises
The pelvic floor muscles are a group of muscles that wrap around the underside of the bladder and rectum. One of these muscles (the bulbocavernosus muscle) also partly wraps around the base of the penis. This is involved with preventing blood escaping during an erection, (as well as being active during ejaculation, and when emptying the urethra of urine when finishing at the toilet). A common treatment for incontinence in women is to strengthen the pelvic floor exercises. Studies suggest that strengthening the pelvic floor muscles in men can cure ED in some cases. ?
For example, one study found that after a course of pelvic floor exercises, about 4 in 10 men with ED had regained normal erectile function, just over 3 in 10 had improved, but there was no improvement in just under 3 in 10 men. The exercises were done for a time every day for three months. Those found least likely to improve were those with other significant problems such as heart disease, diabetes, or those who drank a lot of alcohol. The conclusion of this study was that pelvic floor muscle exercises should be considered a treatment option for many people with ED. ??To identify your pelvic floor muscles: firstly, contract the muscles that you would use to stop passing wind from your anus; secondly contract the muscles that you would use to stop the flow of urine. These are the muscles that can be trained and strengthened. Ideally, discuss this option with your GP. If this option is considered appropriate to try, then ideally you should see a physiotherapist for advice on exactly how to do the correct exercises. Also, see the references at the end of this article.
Injection treatment
This was the most common treatment before tablets became available. It usually works very well. You are taught how to inject a medicine into the base of the penis. This causes increased blood flow, and an erection usually develops within 15 minutes. (Unlike with tablets, the erection occurs whether of not you are sexually aroused.)
Urethral medication
You can place a small pellet into the end of the urethra (the tube which passes urine and opens at the end of the penis). The pellet contains a similar medicine to that used for the injection treatment. The medicine is quickly absorbed into the penis to cause an erection, usually within 10-15 minutes.
Vacuum devices
There are several different devices. Basically, you put your penis into a plastic container. A pump then sucks out the air from the container to create a vacuum. This causes blood to be drawn into the penis and cause an erection. When erect, a rubber band is placed at the base of the penis to maintain the erection. The plastic container is then taken off the penis and the penis remains erect until the rubber band is removed (which must be removed within 30 minutes).
Penile prosthesis
A surgeon can insert a 'rod' permanently into the penis. The most sophisticated (expensive) type can be inflated with an inbuilt pump to cause an erection. The more basic type keeps the penis rigid all the time.
Other treatments
Treating an underlying cause
For example, treating depression, anxiety, changing medication, cutting back on drinking lots of alcohol, or treating certain rare hormone conditions may cure the associated ED.
Lifestyle and other advice
As mentioned above, ED is often a marker that heart disease or other cardiovascular diseases may soon develop. Therefore, you should review your lifestyle to see if any changes can be made to minimise the risk of developing these problems. For example, stop smoking if you are a smoker, take regular exercise, eat a healthy diet, etc. ??For details, see separate leaflet called 'Preventing Cardiovascular Diseases'. Also, your doctor may prescribe a statin drug if your risk of developing cardiovascular disease is high.
Counselling
Sometimes 'couple counselling', or sex therapy is useful. These are most useful if certain psychological problems are the cause of, or the result of, ED.??In some cases, sex therapy is used in addition to another treatment option.
Treatment for erectile dysfunction on the NHS
The Department of Health states........."From 1 July 1999 only those patients suffering from one of the specified medical conditions are eligible to receive drug treatments for impotence on the NHS. Other men can receive a private prescription from their own GP." ??The specified medical conditions are: diabetes; multiple sclerosis; Parkinson's disease; poliomyelitis; prostate cancer; prostatectomy (an operation to remove the prostate gland); radical pelvic surgery; renal failure treated by dialysis or transplant; severe pelvic injury; single gene neurological disease; spinal cord injury and spina bifida.
?Therefore, unless you have one of the above conditions, you have to pay the full cost of any tablets prescribed to treat ED. This policy may be reviewed by the Department of Health in the future.
Further help and information
Sexual Dysfunction Association
Windmill Place Business Centre, 2-4 Windmill Lane, Southall, Middlesex, UB2 4NJ?Helpline: 0870 7743571 Web: www.sda.uk.net?Offers information and support for those who suffer from erectile dysfunction. They also provide information on female sexual dysfunction, Peyronie's disease, and premature and delayed ejaculation.
References
- Guidelines on erectile dysfunction, European Association of Urology (2005)
- Jackson G, Rosen RC, Kloner RA, et al; The second Princeton consensus on sexual dysfunction and cardiac risk: new guidelines for sexual medicine. J Sex Med. 2006 Jan;3(1):28-36; discussion 36. [abstract]
- Grace Dorey et al. Pelvic floor exercises for erectile dysfunction BJU International 2005;96(4):595597; [The author of this study has written several books on erectile dysfunction and treatment with pelvic floor exercises. The books give detailed accounts of how to do the exercises. They can be found on websites such as Amazon. Search for 'Grace Dorey'.]
- British Heart Foundation Factfile Drugs for Erectile Dysfunction, June 2005
- Erectile dysfunction is common with long distance cycling. BMJ 2004;329 (9 October); [BMJ POEM]
Comprehensive patient resources are available at www.patient.co.uk
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS and PiP have used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
© EMIS and PiP 2007 Updated: 9 May 2007 DocID: 4648 Version: 38
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