What causes erectile dysfunction and what can I do about it?

Posted 21 September 2016 in Erectile Dysfunction, Men's Health, Sexual Health

Erectile dysfunction, or impotence as it’s sometimes called, is a very common condition that distresses men of all ages. It’s the inability to achieve or maintain an erection that is sufficient for satisfactory sexual activity.


Listen to our Superintendent Pharmacist, Margaret Hudson, discuss ED in a recent radio interview


In the UK erectile dysfunction, or ED, is thought to affect more than 50% of men over 40 years of age.1

Most men are unaware that ED could be a symptom of a more serious underlying medical condition, and so if you suffer from ED you should get a health check from your GP. The most common of these conditions are high blood pressure, high cholesterol and diabetes.

ED can have a range of causes but the main culprits are physical problems, psychological factors and the side-effects of certain medications.

Physical problems include narrowing of the blood vessels going to the penis; commonly associated with high blood pressure (hypertension), high cholesterol or diabetes. Hormonal problems such as an over or under active thyroid gland and surgery or injury to the penis, pelvis or surrounding area can also cause it.

Some examples of causative neurological conditions are Parkinson’s disease and multiple sclerosis while the psychological causes of ED include stress, anxiety, depression and relationship problems.

Lifestyle can also cause ED and so if you’re overweight, smoke, drink excessively or take recreational drugs, you are more likely to suffer from these symptoms.

In younger men, it may be caused by anxiety, nervousness about having sex, inexperience in using a condom or even fear of causing an unwanted pregnancy.

The most common health conditions causing ED are cardiovascular disease and diabetes but the medications for high blood pressure, prostate problems, high cholesterol, depression and anxiety can also cause ED and therefore compound the situation. For example, you might have high blood pressure which causes ED, then you take a medication for your blood pressure which also causes ED making your symptoms even worse! 2

In fact, there is a long list of medications that may cause ED, including:

  • Diuretics - “Water tablets”
  • Beta-blockers - used to treat high blood pressure
  • H2-antagonists - used to treat stomach ulcers
  • Antihistamines - used to treat allergic health conditions, such as hay fever
  • Antipsychotics - used to treat some mental health conditions, such as schizophrenia
  • Anticonvulsants - used to treat epilepsy
  • Corticosteroids - medication that contains steroids, which are a type of hormone

Speak to your GP if you are concerned that a prescribed medicine is causing erectile dysfunction as alternative medication may be available. However, it is important never to stop taking a prescribed medicine unless you are advised to do so by a qualified healthcare professional who is responsible for your care.

Most men blame themselves for having ED as they think it’s a reflection of their masculinity and don’t realise that it’s caused by a health problem that they may or may not be aware of.

It is believed that if more men were aware of this fact then they would be much more willing to go to their GP for a health check. Not only would the individual find out if they have an important health condition but they would also be more confident about seeking a solution to their ED.

Most men don’t talk about ED when they meet up with their friends for a drink or for any other social activity. It’s a topic that they would rather avoid at all costs!

In fact, most men even find it difficult to speak to their partner about it and it’s thought that ED causes the breakdown of about 20% of all relationships. 3 It seriously impacts on all aspects of a man’s quality of life and his self esteem. It can also affect how a man interacts with his friends and co-workers as it may cause him to lose confidence, reduce his morale and enjoyment of life generally. Furthermore, since ED is not openly discussed, a man may feel isolated and alone as he struggles with these symptoms.

Some men find counselling helpful as a means of exploring psychological causes for ED. Some sexual health clinics (also known as GUM clinics) offer this service or your GP may be able to direct you to someone who can help. 4

If someone was too embarrassed to go to their GP about ED, there are other options. The first line treatment for ED is a group of drugs called phosphodiesterase -5 inhibitors (PDE-5 inhibitors) that dilate the blood vessels leading to the penis and, with sexual stimulation, give a much firmer and longer lasting erection.

In the UK there are four PDE-5 inhibitors available for treating erectile dysfunction.

They are:

  • Sildenafil – sold under the brand name Viagra or generic name sildenafil
  • Tadalafil – sold under the brand name Cialis
  • Vardenafil – sold under the brand name Levitra
  • Avanafil – sold under the brand name Spedra

There are differences between the various products available. They differ in the time it takes for them to act and how long they act for. This is due to the different pharmacokinetics* of the active ingredient. The pharmacokinetics, which include the half-life** of a medication, dictates how long it stays in the blood.

* Pharmacokinetics – How the drug moves through the body

**Half-life – The time taken for the levels of medicine in your blood to fall by half. This directly relates to how long the medicine acts for.

Sildenafil (Viagra) has a half-life of 4 hours and vardenafil (Levitra) has a half-life of 4-6 hours while tadalafil (Cialis) has a half-life of 17.5 hours and is active for up to 36 hours.

This means that vardenafil (Levitra) should act longer than sildenafil (Viagra) but the clinical significance is not known although some studies have shown that vardenafil (Levitra) is more suitable for diabetics. Tadalafil (Cialis) has the longest half-life and duration of action and so allows you to take the medication and not relate the sexual activity to its immediate use. It’s been called the “week-end pill” because of its long duration of action and in lower doses can be taken continuously each day, for those who are more sexually active and struggle to plan ahead.

The most recently introduced Avanafil (Spedra) has the quickest onset of action and only takes about 15 minutes but its effects last about the same time as vardenafil and sildenafil.  

ED drugs: How soon they start working and how long they last

MedicationOnsetDuration
avanafil (Spedra)15-30 minutes4-6 hours
sildenafil (Viagra)30-60 minutes4-6 hours
tadalafil (Cialis)30-45 minutesUp to 36 hours
tadalafil (Cialis) dailyContinuous after 4- 5 dayscontinuous
vardenafil (Levitra)30-60 minutes4-6 hours

It’s very important that men realise that they don’t have to suffer in silence as ED is a very common condition that’s easily treated, in most cases, with oral medication that can dramatically improve their performance and general well-being.  Swingometer

References

1 NHS. Choices. Department of Health. Erectile dysfunction (impotence); 2016 Jun 21 [cited 2016 Sep 21]. Available from: http://www.nhs.uk/Conditions/Erectile-dysfunction/Pages/Introduction.aspx

2 Miller S. Medline Plus. Drugs that may cause impotence: MedlinePlus medical encyclopedia; 2015 Jan 21 [cited 2016 Sep 21].
Available from: https://medlineplus.gov/ency/article/004024.htm

3 Health Centre. Access to health & medical information on Internet; 2016 [cited 2016 Sep 21]. Available from: http://www.healthcentre.org.uk

4 Charitable Company. Sexual Advice Association. Sexual Advice Association. Factsheets [cited 2016 Sep 21].
Available from: http://sexualadviceassociation.co.uk/factsheets/

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