What is erectile dysfunction?

Erectile dysfunction means not being able to obtain or keep an erection sufficient for sexual intercourse. Many people have erectile dysfunction at some time in their lives. It can come and go.

Erection problems affect abround 2 in every 3 males over the age of 45 years. More than 1 in every 10 males cannot have erections. The problem is more common if you are older.

Erectile dysfunction is also known as ED or impotence.

What are the symptoms of erectile dysfunction?

Symptoms of erectile dysfunction include:

• difficulty getting an erection
• difficulty keeping an erection
• difficulty engaging in sexual intercourse, due to your penis not being hard enough

What causes erectile dysfunction?

Erectile dysfunction can have a range of causes, both physical and psychological. It is usually a combination of both. Sometimes the cause is not clear.

Problems with the male reproductive system that can cause erectile dysfunction include:

• Peyronie's disease (scar tissue inside the penis)
• prostate disease, and treatments for prostate cancer or an enlarged prostate
• hypogonadism — conditions where the testicles cannot make enough testosterone

Physical factors that can cause erectile dysfunction include:

• general ageing
• health problems that affect the nerves, like spinal cord injury, Parkinson’s disease and Alzheimer’s disease
• reduced blood flow to the penis, caused by atherosclerosis (clogging of the arteries)
• hormonal problems, including underactive thyroid gland (hypothyroidism), growth hormone conditions, having too much cortisone
• alcohol, smoking or substance abuse
• some medicines used to treat high blood pressure, high cholesterol, depression or prostate cancer

Chronic health conditions that can contribute to erectile dysfunction include:

• high blood pressure
• diabetes
• high cholesterol
• cardiovascular disease
• obesity
• sleep disorders

Psychological factors that can cause erectile dysfunction include:

• unresolved problems, conflicts or issues within a sexual and emotional relationship
• anxiety about sexual performance (this is most common at the start of a new relationship, especially if you have had previous problems with sexual performance)
• stress
• mental health conditions such as depression or anxiety

When should I see my doctor?

Many people experience erection problems from time to time, and if you only have occasional erection problems, you might not need to get medical help. But if the problems continue, see your doctor.

Often, erectile dysfunction is the first sign of certain medical problems such as:

• cardiovascular disease
• diabetes
• high blood pressure
• high cholesterol

How is erectile dysfunction diagnosed?

Your doctor will ask about your symptoms and do a physical examination. Depending on their findings, they may refer you for blood tests or imaging scans, such as ultrasound.

If needed, your doctor may refer you to a specialist, such as a urologist, for further assessment or treatment.

Diagnosing and treating these problems early can help treat your symptoms. It can also reduce your chance of complications from the conditions themselves.

How is erectile dysfunction treated?

Your doctor will first treat any underlying health conditions that may be causing your erectile dysfunction. They may also recommend lifestyle changes such as eating a healthier diet and exercising regularly.

More than one treatment may be needed to fix the problem. You may need treatment for both the physical and psychological causes. Although erectile dysfunction usually can’t be completely cured, there are treatments that will allow you to get an erection so you can have sexual intercourse.

Medicines

Erectile dysfunction is most often treated with erection medications such as:

• sildenafil (for example, Viagra)
• tadalafil (for example, Cialis)
• avanafil (Spedra)

These medicines work by helping to relax the blood vessels in the penis. This allows blood to flow into the penis, making it easier to get an erection.

Medicines can increase both the number and duration of erections, but they do not increase libido (interest in sex). They do not work for everyone.

Do not take these medicines if you are also taking other nitrate medicines, used to treat chest pain.

Buying medicines for erectile dysfunction

You need a prescription from your doctor to buy medicines for erectile dysfunction. You can buy these medicines from a store-based pharmacy or reputable online pharmacy with a prescription.

Medicines bought on the internet without a prescription may be of poor quality or not contain the ingredients they claim to. They may contain ingredients that are not safe when taken in combination with other medicines you take, or because of certain medical conditions.

If you're concerned about a counterfeit medicine, report it to the Therapeutic Goods Administration.

Injections

Your doctor might suggest a medicine that you can inject into your penis when you want an erection. Once you learn how to do this from a health professional, you will be able to inject this yourself.

Other physical treatments

There are devices that you can use to create an erection, such as penile rings, a penis implant or a penis pump. Some of these involve surgery to fit the device.

Psychological treatments

If your erectile dysfunction is caused or triggered by psychological factors, you doctor may recommend counselling. Examples include cognitive behavioural therapy, or sex therapy, and may also include your partner.

Resources and support

• The Healthy Male website has more information about erectile dysfunction and other sexual health issues for males.
• Mensline is a free telephone and online counselling service. Call 1300 78 99 78 for help 24 hours a day, 7 days a week, or chat online.
• Relationships Australia has resources for couples and individuals to help support healthy relationships.