Erectile Dysfunction

Erectile Dysfunction also known as impotence is the inability to obtain or maintain an erection firm enough to allow penetration or sexual intercourse. Many men suffer from this particular concern but few admit it or seek assistance for it. This can lead to complications in relationships and marriages and should not be a matter to ignore.

It is important to understand that erectile dysfunction is not a disease, but a secondary condition brought on by other, primary causes.

It is a side effect, a symptom of something else. Thirty years ago, when men went to their doctors asking for help for erectile problems, they were told that there was no treatment because it was caused by aging, or it was all in their heads (psychological). A generation of research has been conducted in the intervening years. With more knowledge now, doctors divide this very common disorder into four general causes:

Psychological

Physical (Organic impotence)

Mixed origin (both psychological and physical)

Unknown origin

About 85% of this problem is due to a physical (organic) cause. Slightly more than 10% is totally psychological, or "all in your head." The other 5% is unknown. The 85% figure includes a mixture of physical impotence with psychological involvement. Once a man fails to become erect a few times, he places more stress on himself to have an erection by sheer will power. When this too fails, he often begins to have a psychological problem.

The main point here is this: 85% of all impotent men are that way because something within the body, other than the penis, is malfunctioning.

A) Some of the physical causes of erectile dysfunction:

1) Circulation Problems:

a) Arterial Insufficiency. This is most commonly due to diabetes, heart or other circulation disease, high blood pressure, high cholesterol, smoking, drinking or ageing. Progressive hardening and blocking of the penile arteries reduces the arterial diameter available for blood flow.

b) Venous Leakage. This ranges from minor or moderate to severe. Often the erection is achieved relatively quickly but subsides soon after. In this case the valve-like mechanism that traps blood in the penis in order to maintain an erection fails, thus allowing blood to escape back into the body. This can be due to anatomical abnormality, penile injury from an accident or during intercourse, damage to the intricate vascular network in the penis or generalised inelasticity of erectile tissue.

c) Mixed arterial and venous insufficiency. This is common in many patients.

2) Neurological: Spinal injury of other medical conditions.

3) Traumatic: After prostate or other pelvic or abdominal surgery.

4) Hormonal Imbalance: This is a condition, manifesting in "male menopause". Low testosterone usually affects desire rather than erections but will have an indirect on the ability to get and maintain and erection.

5) Peyronies Disease: A not uncommon condition in men usually older than 35. The man becomes suddenly aware of a change in the shape of his penis. He may feel pain, a palpable lump or lumps or new curvature when erect. It can be progressive and extensive. It may last 2 or 3 years and resolve or be permanent. The cause is unknown but it is associated with other conditions that promote scar tissue.

6) Drug Induced: Some drugs implicated include blood pressure medication, diabetes medication, some cholesterol medications and anti-depressant drugs. (If not treated with medication, these conditions can cause ED anyway.)

7) Disuse: Abstaining or celibacy. Prolonged lack of use of any body part including the penis will result in deterioration of that part: use it or lose it.

B) Psychological causes of erectile dysfunction: Psychological causes can include depression, stress, performance anxiety and misinformation. A combination of physical and psychological causes is not uncommon. Anxiety is often how a variety of cultural, psychological and relationship stresses converge to produce erectile failures in men with normal genitalia.
The psychological consequence of anxiety is a surge of adrenaline into the blood stream and reaching the penis almost instantly, causing the penile arteries and the smooth muscles to constrict.

For one reason or another, an initial failure to perform can set off a vicious cycle of failure and loss of confidence. This can be a devastating experience for both partners if left unresolved. There are therapists who can help with this problem: this Clinic can provide an effective medical solution.



Treatment Options
The aim of the treatment is to cure or alleviate the problem and reduce risk factors that aggravate it. You can speak with our Doctors to discuss treatments suitable for you by enquiring now.

Quadraject self-application therapy
The current formulation is considered the most effective in the world. The treatment combines a range of vaso-dilating agents

Papaverine, Regitine, Atropine and Prostaglandin E1 in various combinations.

This has been the most popular and effective medical treatment for many years now, and helps more than 95% of patients achieve erections through a virtually painless procedure thanks to the automatic applicator: it administers the medicine instantly at the press of a button, making sex spontaneous and enjoyable.

Direct application into either rod (the "corpus cavernosa") of the shaft of the penis causes relaxation of the penile arteries and of the erectile tissue, allowing a rigid erection to occur almost immediately. Self-injection therapy can be very successful with all causes of erectile dysfunction or premature ejaculation.

This type of treatment represents the gold standard against which other treatments must be compared. International experience shows this type of treatment has the highest cure rate, improving erections and confidence for many patients.

Lozenges
These types of treatments are applied 20 to 30 minutes before intercourse under the tongue while holding saliva in the mouth as long as possible. By releasing the medication directly into the blood stream of the mouth, the lozenges mean:

a smaller dose is required

a quicker response is usual

they bypass the digestive tract, so aren't affected by a heavy meal.

The lozenge will take approximately 3-5 minutes to dissolve, and does require sexual stimulation to result in an erection. Lozenges should be kept below 22 degrees Celcius, as they are made to melt in the mouth.

Your Medical Professional will have carefully screened you and your medical history because it can be dangerous to use this medicine without medical supervision if you have heart disease or very low or high blood pressure.

Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra) note: It is absolutely forbidden to consume this medicine if you take nitrate medication for angina or use recreational amyl nitrate, as the drop in blood pressure can be fatal.

Hormonal Therapy
Testosterone treatment: This involves supplementing hormone imbalance with testosterone either by oral, implant or injection methods for symptoms of "male menopause"

Fatigue

Low libido

Increased sweating.

Arterial Insufficiency
To treat this, your therapy involves intensive treatment of six to eighteen months duration, once or twice per week by self application to help open and stretch muscles of penile arteries and erectile tissue. This is not just to give you an erection but also to improve the elasticity needed for future erections: it can not only prevent deterioration but also improve spontaneous erectile function. Reducing risk by quitting smoking, losing weight and increasing exercise can also be important.

Venous Leakage
Self application of medication helps improve the elasticity or expandability of the erectile tissue allowing trapping and hence maintaining an erection. Having a good erection up to twice per week for six to eighteen months as an intensive treatment can improve this flexibility significantly. In severe cases a penile ring can be useful as well.

Psychological Impotence
The vicious cycle can be broken once you are sure that you will perform: a positive reinforcement will occur and your level of confidence and self-esteem will improve, meaning a lesser chance that adrenaline will be released, reducing blood-flow to your penis.

Vascular Surgery
This is not often done because of a high failure rate after one or two years.

Vacuum Erection Device
This involves applying a rubber ring around the base of the penis and placing the penis in a tube which then has a vacuum force applied - usually by hand. The resulting erection is usually firm rather than hard, and can be floppy at the base.

Penile Implant Surgery
If other treatments are not successful this is a potential option. This treatment involves inserting prosthetic rods or saline implant tubes: these have a reservoir, allowing emptying and filling of the penis with a salt and water mix, replacing blood in the cavernosum (erection tube). Possible side effects include infection, rejection, failure of apparatus, scarring and loss of sensation. The success rate for the operation is 90% and above. The Medical Professional can refer you to a urological surgeon if required.