Impotence - causes and treatments

What causes erectile dysfunction and how is it treated?


What is impotence?

The definition of impotence or erectile dysfunction is the inability to achieve or maintain an erection long enough to have sexual intercourse.

Erectile dysfunction is referred to as primary if the man has never achieved or sustained an erection. The erectile dysfunction is termed as secondary when it is acquired by a man who has previously experienced healthy erections

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What happens when a male has an erection?

When sexually aroused, nerves release chemicals that in turn caused an increase in blood flow to the penis. There are two chambers in the penis called corpus cavernosum; they are made of spongy tissue which during an erection relax and trap blood. This then makes the penis hard and an erection happens. When the male has ejaculated, another set of nerve signals go to the penis which causes the muscular tissue in the penis to contract to force blood back into the male’s circulation


Causes of erectile dysfunction

Erectile dysfunction may be a result of health problems or emotional issues or both. Risk factors for erectile dysfunction include:

  • Being over 50 years old
  • Being diabetic
  • Having hypertension (high blood pressure)
  • Having high cholesterol
  • Having cardiovascular disease
  • Smoking
  • Using recreational drugs
  • Drinking excessive quantities of alcohol
  • Being obese
  • Having a sedentary lifestyle

Erectile dysfunction can be an early warning of a more serious underlying health issue. For this reason, it is vitally important that if you suffer from erectile dysfunction you seek help to find the cause and get treatment.



In order to achieve an erection there needs to be:

  • adequate blood supply to the area - there are a number of health problems that can cause a reduced flow of blood to the penis.  These include:
    1. Hardening of the arteries
    2. Cardiovascular disease
    3. High blood sugar (diabetes)
    4. Hypertension (high blood pressure)
    5. Smoking
  • slowing of the blood supply out of the penis - if blood does not stay in the penis an erection cannot happen
  • healthy nerve function in the nerves leading to and from the penis are - some diseases, injury or surgery to the pelvic area can cause damage to the nerves in the area
  • diabetes can cause small vessel disease or nerve damage to the penis
  • Neurogenic conditions which include Parkinson's disease and multiple sclerosis
  •  adequate amounts of testosterone
  • sufficient libido (sex drive)
  • cancer treatment in the pelvic area can affect how the penis functions. Surgery and/or radiation in the area can result in erectile dysfunction. Cancer survivors who have been damaged in this way can consult a urologist for advice
  • prescription medication that is being taken for other issues can also have a negative impact on the ability to achieve erections.  If this has been the case then your GP may be able to offer an alternative
  • Peyronie’s disease - this causes a ‘bend’ in the penis which may make erection painful and/or sexual intercourse difficult



If our psychological or emotional world is out of balance it can have a serious effect on aspects of our physical well-being. There are a number of emotional factors which may cause or contribute to erectile dysfunction:

  • Relationship issues either within the relationship or outside it; for example, issues with colleagues at work
  • Stress at work or home
  • Depression
  • Anxiety
  • Issues around social, cultural, or religious areas of life
  • Performance anxiety, that is, concern about sexual performance
  • You have a history of sexual abuse


When to consult your doctor

If you are suffering from erectile dysfunction on a regular basis (occasional ED is normal) and it has continued for several weeks it would be advisable to seek advice from your doctor; the reason for this is that Erectile dysfunction can sometimes be an early warning about a more serious underlying condition. Whilst this may be embarrassing for some men it is worth remembering that doctors are perfectly comfortable when discussing these kinds of problems and they will have heard it all before!


Diagnosis of ED

During the consultation, your doctor will ask questions about your lifestyle, sexual history, and diet. They will carry out a physical assessment including :

  • Weight
  • Height
  • Waist size
  • Heart and lungs check
  • Blood pressure check
  • Examination of the genitals in order to rule out any obvious abnormalities
  • Check for diabetes
  • Check cholesterol levels
  • Check testosterone levels

If there are symptoms of an enlarged prostate such as the poor flow of urine, urgent urination, or frequent urination your doctor may also want to carry out a rectal examination of your prostate gland


Treatment for erectile dysfunction


When the causes of ED are physical there are several approaches that can be taken when solving the problems - 



For most men who are experiencing erectile dysfunction, the first stop is Viagra - or something similar. It is one of the medications known as phosphodiesterase inhibitors (PDE’S) and the group includes Viagra (sildenafil), Cialis (tadalafil), and Levitra (vardenafil). The main difference between these medications is how long they last. Viagra lasts between 30 minutes and 4 hours to work, Levitra between 30 minutes to two hours and Cialis lasts up to 36 hours. Viagra is slightly less effective if taken with food and has side effects where it can also cause temporary abnormalities of vision.

Other side effects of phosphodiesterase inhibitors include headaches, flushing, nasal congestion, nasopharyngitis, and dyspepsia

If an ED sufferer also has heart disease it may be that these types of drugs are not suitable. In rare cases, the pills may cause a condition called ‘priapism’ which is a long and painful erection

Topical treatments for ED such as Nitroglycerine and Vitaros are another option. They act as vasodilators and when applied to the penis they increase blood flow to the tissue. In the case of nitroglycerine cream, it can cause the partner to have headaches and so it will be necessary to use condoms
Penile injection medication. This treatment is administered by self-injection at home. The medication is Alprostadil (the active ingredient in Vitaros cream) and it relaxes some muscles and increases the blood flow to the penis and restricts blood outflow from the penis. Repeatedly injecting the penis comes with its own risks such as infection, scarring (fibrosis), and pain. An alternative way to administer the alprostadil is to place a small pellet of the medication directly into the urethra.


External mechanical devices

Vacuum devices which go around the penis and enable an increase of blood flow into the penis as well as restricting blood flow out are between 50% and 80% effective

The disadvantages of using a penile vacuum pump device are that foreplay must be interrupted in order to use them and use may cause some soreness



When emotional or psychological issues are the root cause of your erectile dysfunction there are many forms of counseling available. Your GP should be able to refer you to a psychosexual therapist who will be able to work with you, either alone or as a couple.



Sex is a large part of most people’s life at any age and erectile dysfunction can be an extremely distressing condition both for the sufferer and his partner.

It is important that men understand that the condition is far more common than they may think. It is something that most men will not discuss with their friends but they do need to understand that help is out there - all you need to do is ask!

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