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Erectile Dysfunction (impotence) Page 1 of 2

What is Erectile Dysfunction? telling the blood vessels entering the What causes erectile dysfunction? Erectile dysfunction is when a spongy tissue of the penis to let more Many factors can interfere with man is unable to get and/or keep blood in. The flow of blood out of getting an and often two an erection that allows sexual the penis is then blocked off so the or three factors are present at one activity with penetration.1 It is not penis fills with blood and stretches time. Sometimes there can appear to a disease, but a symptom of some within the outer casing. This creates be no obvious cause for the erectile other problem, either physical, an erection. Underlying this relatively dysfunction; however, most cases psychological or a mixture of both. simple explanation is a very complex of erectile dysfunction are physical range of chemicals in the body that in origin. Apart from the physical Erectile dysfunction should not be also work together to get an erection. causes of erectile dysfunction due confused with low (little interest to an event such as surgery in sex) or the inability to reach an At any one time, the muscle cells in or the introduction of a medication or ejaculate. Premature the spongy tissue and in the blood that affects sexual function, (too early) and retrograde vessels are influenced by a balance erectile dysfunction due to physical (into the bladder) are also different of chemical factors, some which causes often begins gradually. problems that need a different cause an erection and some which approach to diagnosis and treatment. encourage a flaccid (soft) penis. Occasional erectile dysfunction is normal. There is no need to worry Table 1: Known causes of erectile dysfunction include: about the occasional failure to get or Psychosocial problems • Performance keep an erection. Some of the causes • Sexual attitudes and upbringing of occasional erectile dysfunction • Relationship problems include excessive intake of alcohol, • Employment and financial pressures anxiety and tiredness. One of the most • common causes of erectile dysfunction • Psychiatric disorders in middle-aged men is lack of sleep. Metabolic problems affecting blood • How common is erectile vessel function • High blood pressure dysfunction? • Erectile dysfunction is very common • Renal Failure and becomes even more common • High cholesterol in older men. An Australian survey • Sleep apnoea shows that at least one in five men Reduced blood flow • (narrowing of the arteries) over the age of 40 years, increasing to • Surgical damage to blood vessels about two in three men over the age of 70 years, often experience erectile Interference by medication, • Cigarettes problems, and about one in ten men are alcohol and other drugs • Alcohol and drug abuse completely unable to have .2 • Some medicines used to treat: With each decade of age, the chance > Blood pressure of having erectile problems increases. > Cholesterol > Depression How does an erection happen? > Psychiatric disorders At a superficial level, getting an > erection is a simple process. There are Interference with nerve function • Parkinson’s Disease two tubes of spongy tissue that run • Alzheimer’s Disease along the length of the penis, and • Spinal cord trauma this spongy material is surrounded • by a tough fibrous, partially elastic • covering. A message is sent through • Pelvic surgery (prostate, bowel) nerves that leave the lower spinal cord, Urological problems • Peyronie’s disease • Pelvic trauma Erectile Dysfunction (impotence) Page 2 of 2

There are many diseases that interfere do a physical examination of the penis, Can erectile dysfunction with how the penis functions by either testes and prostate. Blood tests are be prevented? reducing blood flow or affecting done to check glucose (sugar levels), At the present time there are no proven the nerves. Importantly, when the cholesterol and levels. ways to prevent erectile problems first signs of erectile dysfunction developing, however keeping general happen, there is often an unknown How is erectile dysfunction treated? good health may help lower the underlying cause such as diabetes, Usually there will not be a specific chance of having these problems. or high cholesterol. treatment that will lead to the cure Regular and a sensible diet About one in 10 cases of erectile of erectile dysfunction. However, there are treatments that will allow will reduce the risk of obesity, diabetes, dysfunction is caused by psychological high blood pressure and high factors. A man’s sex drive (libido) erections to happen and can enable sexual activity to take place. cholesterol, therefore making erectile can be affected by such as dysfunction less likely. For some men, problems at work or financial worries. The main types of treatment seeking treatment early can stop Feeling depressed and anxious about for erectile dysfunction are: erectile problems from getting worse. poor sexual performance can also lead Tablet medicines (Viagra®, Cialis® to erectile problems. Psychological and Levitra®) work in about 70 per Does seeing a counsellor help? causes of erectile dysfunction can cent of men with erectile dysfunction. Psychosocial problems are important happen together with physical causes. These medicines, known as PDE5 and may cause erectile dysfunction by inhibitors, block a particular enzyme themselves, or together with one of Is erectile dysfunction a part of in the penis, enhancing the erectile the other causes of erectile dysfunction getting old? response to normal . such as diabetes. Relationships are There is no doubt that the Taking a tablet for erectile dysfunction complicated and many factors cause penis has less responsive muscle cells, is non-invasive and allows a more tensions, which can affect sexual which interfere with good erections. spontaneous approach to sexual activity. relations. For some men, problems can become ongoing and it can help to Like the rest of the ageing body, Vacuum device is a pump placed over talk through the issue with a skilled ‘muscle tone’ in the penis reduces with the penis to create blood flow. It draws counsellor. Improved sexual function age, as do many other aspects of sexual blood into specific tissues of the penis, may be delayed by failing to deal function. Arousal can take longer, as would happen in a normal erection. with the psychological side. Being it may take much longer before Injection treatments increase blood open and honest with your partner a second erection happens, and flow when they are injected into the will encourage a good understanding usually the erection is not as firm. penis, causing an erection. A possible of the problem and couples can work side-effect is (a painful together to bring about a positive Where can help be found? erection lasting for hours) that if not result for their relationship. When a man experiences erectile managed can damage the penis. dysfunction he should see his local See Australia’s doctor, whether or not he wants to have Prescription medicines may need guide on Erectile Dysfunction sex. The reason for this is that erectile changing in consultation with your for more information. dysfunction may be a symptom of doctor, if they are the cause. Penile prosthetic implants are usually underlying medical conditions such as 1 Feldman HA, Goldstein I, Hatzichristou DG, Krane used as a last resort if all other those listed in table 1. It is important RJ, McKinley JB. Impotence and its medical and to talk openly to a doctor about any treatments have not worked. psychosocial correlates: Results of the Massachusetts Male Ageing Study. Journal of 1994, 151:54-61 problems with sexual functioning. It is usual to start with the least 2 Diagnosis of erectile dysfunction does invasive treatment, such as tablets, Holden CA, McLachlan RI, Pitts M, Cumming R, Wittert and be recommended more injectable G, Agius P, Handelsman DJ and de Kretser DM. Men in not need complicated tests. After Australia Telephone Survey (MATeS): A national survey treatments or surgery if the tablets fail. taking a history of sexual function and of the and concerns of middle aged general medical factors, the doctor will and older Australian men. L a n c e t 2 0 0 5 ; 3 6 6 : 2 1 8 - 2 4

About the Author

Andrology Australia is an initiative funded by the Australian Associate Professor Doug Lording Government Department of Health and Ageing. B.Med.Sci. MBBS FRACP The information in this fact sheet has been provided for educational purposes only. Cabrini Health, Melbourne 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 Date: November 2010 the services of a qualified medical practitioner for any personal health concerns. © Andrology Australia 2010