London - Though they may not want to talk about it, at any one time around one in ten British men suffers from erectile dysfunction (ED) - the inability to have and maintain an erection.
Sometimes known as impotence, the condition can be triggered by stress, depression and anxiety.
However, around 70 percent of cases are caused by the damaging effects of vascular disease such as furring of the arteries, high blood pressure and diabetes, says Roland Donat, urological surgeon at the Western General Hospital in Edinburgh.
This is because erections are caused by extra blood flow into the penis and a reduction of blood flow out of the penis.
The worry is that many men don’t realise that problems in the bedroom are often a marker for an underlying health concern.
“Being overweight, excessive drinking and smoking are linked to impotence because they can cause vascular disease,” he says.
Obesity is also associated with low testosterone levels, which can lead to difficulties. A hormone problem can be treated with testosterone gels and patches.
Because of the possibility of underlying health problems, ED should be investigated by your doctor, no matter how embarrassing this might seem, says Robert Calvert, urologist at the Royal Liverpool Hospital.
“You should be given screening tests for blood pressure, cholesterol and sugar levels,” he says.
There are a variety of treatments available for the problem, depending on the severity and cause. Here, we asked the experts to explain the options, their pros and cons...
BLOOD SUPPLY BOOSTING DRUGS
Known as phosphodiesterase-5 inhibitors, drugs such as Viagra boost the blood supply to the penis by dilating blood vessels.
Viagra needs to be taken 30 to 45 minutes before lovemaking and lasts around four hours.
Another drug, Cialis, has a longer acting effect and works for around 30 to 48 hours, allowing for greater spontaneity. Neither drug can be used by angina sufferers as they interfere with the medication.
They should be taken on a relatively empty stomach as a heavy meal can reduce absorption by the stomach and so the effectiveness of the drug.
ADVANTAGES: Tablets are the least invasive way to deal with ED. If used correctly, the success rate is around 80 percent, but the user has to be sufficiently aroused.
“You can’t sit back and wait for it to work while watching Coronation Street,” says Vijay Sangar, a urological surgeon at Wythenshawe Hospital in Manchester.
In the 20 percent of cases where the drugs don’t work there is probably more extensive damage to the blood vessels.
DISADVANTAGES: The drugs can cause hot flushes and headaches because of increased blood flow to the skin and brain.
Rarely they can interfere with nerve receptors in the eye, causing vision to have a blue tint, which can be permanent.
Cialis sometimes causes temporary backache because of dilation of blood vessels in the back.
In rare cases, drugs can cause a sustained erection because of excessive blood flow to the penis - known as priapism. Go to A&E immediately if an erection lasts more than three hours, as it can cause irreversible damage.
Here the penis is placed in a plastic cylinder from which the air is sucked out to create a vacuum. This causes blood to rush to the penis, causing an erection.
Once the penis is engorged, a ring is placed around the base of the shaft to prevent blood leaking back out; this is removed after sex.
DISADVANTAGES: Some people may find the penis does not feel sturdy. If the ring is left on for too long it can cause bruising.
To buy only from a respected medical supplier such as mediwatch.co.uk. An Erectease vacuum pump costs around £112.
A BLAST OF SOUNDWAVES
An intense form of soundwaves, similar to ultrasound, is used to trigger the regrowth of blood vessels and improve blood flow.
As with traditional ultrasound, a layer of jelly is applied to the area and then the device is pointed at five places along the shaft of the penis. The treatment is done twice a week for three weeks, followed by a break after which the treatment is repeated for another three weeks.
This is a new treatment and studies so far have only been able to show that the effects last for two years.
ADVANTAGES: Non-invasive and not painful.
DISADVANTAGES: It is used only on men who have already tried Viagra without success and whose ED is caused by vascular disease, says Mr Sangar.
Inflatable devices or bendable rods are implanted in the penis under general anaesthetic to act as a “prop”.
The simplest type consists of a pair of malleable rods, made from medical plastic or silicone, which are surgically implanted within the erection chambers (spaces within the penis that fill with blood). The penis will always then be semi-rigid and only needs to be lifted into the erect position.
The alternative is a device that consists of three connected pieces: two small, deflated balloons, a fluid-filled reservoir and a pump.
The balloons are surgically inserted in the penis and the reservoir is placed under the groin muscle. The pump sits under the loose skin of the scrotal sac.
Pressing on the pump pushes the fluid into the balloons and the penis should become erect within 30 seconds. Pushing on a deflation valve at the base of the pump drains the fluid back into the reservoir.
ADVANTAGES: More spontaneity, says urologist Chris Eden at the Royal Guildford Hospital and the Hampshire Clinic, Basingstoke.
DISADVANTAGES: Patients must avoid sex for six weeks afterwards as the body heals, and take anti-biotics for a week - there is a risk of infection in two percent of cases. It may be painful for around a week, too. Inflatable implants may require replacing after eight to ten years; the rods are permanent.
ED is often linked to psychological issues. Counselling sessions, such as psychosexual therapy, can help with underlying relationship problems or depression.
ADVANTAGES: Doesn’t use medication or invasive treatments.
DISADVANTAGES: “It will work only with the right sort of patients,” says Mr Donat. “Many men, even with psychological issues, simply want a quick fix. And even if there is a psychological component, it’s still vital to see a GP first to rule out any underlying clinical reason.”
MUSCLE RELAXING JABS
This treatment involves injecting a naturally occurring chemical called prostaglandin E1 into the penile tissues. This causes the blood vessels to widen by relaxing the thin layer of muscle in the blood vessel wall. Unlike Viagra, the medication can induce an erection without external stimuli. It has around a 60 percent success rate.
ADVANTAGES: Injections work faster than pills - it can take as little as ten minutes and last up to four hours. A GP should show you how to use it the first time.
DISADVANTAGES: Every time it is used, a small amount of scar tissue forms and over the years this can lead to pain and prevent erections, says Majid Shabbir, a urologist at Guys Hospital in London.
Sponge-like pellets, around 3mm long and 1mm in diameter, containing the drug prostaglandin E1 are pushed into the end of the penis into the ureter (the tube that carries urine and semen) using a thin rod.
Though this is self-administered, a GP would usually demonstrate the first time. The medicine works by relaxing blood vessels to improve blood flow.
ADVANTAGES: Good for those who are needle phobic.
DISADVANTAGES: A lower success rate than other treatments, at 30 to 50 percent. Some people experience a burning pain or some temporary discomfort in the ureter when they place the pellets. Needs to be applied about 40 minutes before sex.- Daily Mail