Embarrassing Illnesses

If you have erectile dysfunction (ED), the treatment that you will receive will depend on the underlying cause of the condition.

If ED is due to an underlying health condition, such as heart disease, or diabetes, that condition may need to be treated first before treatment for ED can begin. However, in some cases, treating the underlying cause will also resolve the problem of ED.

The main treatment options for ED are outlined below.

Self-help

The symptoms of ED can often be improved by using some self-help techniques, and making associated life style changes. These include:

• losing weight  (if you are overweight),
• giving up smoking (if you smoke),
• moderating your consumption of alcohol,
• not using illegal drugs, and
• taking regular exercise.

If you do a lot of cycling (more than three hours a week), and you are experiencing ED, you may want to spend a trial period without riding your bike in order to see if it improves your symptoms.

See the ‘related articles’ section for more information and advice about giving up smoking, and diet and exercise.

PDE-5 Inhibitors

PDE-5 inhibitors are one of the most widely used and effective types of medication used to treat ED. They work by temporally increasing the blood flow to your penis.

In England, three PDE-5 inhibitors are available for the treatment of ED. These are:

• sildenafil - which is sold under the brand name Viagra,
• tadalafil- which is sold under the brand name Cialis, and
• vardenafil - which is sold under the brand name Levitra.

Sildenafil, tadalafil, and vardenafil

Sildenafil and vardenafil work for about four hours and they are designed to work ‘on demand’. Tadalafil is taken once every 24 hours (but not every day) and may last for longer than 24 hours, such as over the weekend.

Sildenafil and vardenafil should be taken an hour before sexual activity, but you should be aware that it may take longer to notice their effects if they are taken with food. Tadalafil should be taken at least 30 minutes before sexual activity.

When not to take PDE-5 Inhibitors

PDE-5 inhibitors are not recommended for people who are at high risk of coronary heart disease.

PDE-5 inhibitors should never be used if you are also taking medicines that contain organic nitrates because the combination of the two substances can be extremely dangerous for your heart.

Medicines that contain organic nitrates are often used to treat angina.

You should also not use PDE-5 inhibitors if you take the recreational drug, amyl nitrate, more commonly known as ‘poppers’.

Side effects of PDE-5 inhibitors

Side effects of PDE-5 inhibitors are rare and, when they do occur, they are usually mild. Possible side effects include:

• headaches,
• hot flushes,
• indigestion,
• a blocked, or runny, nose,
• back pain, and
• disturbances to your vision.

Availability of PDE-5 inhibitors

PDE-5 inhibitors are usually only made available on a NHS prescription if you have one of the following health conditions:

• diabetes,
• multiple sclerosis,
• Parkinson’s disease,
• polio,
• prostate cancer,
• severe pelvic, or spinal injury,
• spina bifida, and
• certain genetic conditions, such as Huntington's disease.

People who have received, or are receiving, certain medical treatments may also be able to get PDE-5 inhibitors on a NHS prescription. These treatments are listed below.

• Pelvic surgery - which is often used to remove tumours, or to treat conditions such as incontinence.
• Surgical removal of the prostate gland (prostatectomy) - which is often used to treat prostate cancer.
• Dialysis for kidney failure.
• Kidney transplant

In certain circumstances, some specialist centres may offer PDE-5 inhibitors on a NHS prescription - for example, if ED is causing you severe distress.

However, you may have to pay a full prescription charge for a course of PDE-5 inhibitors. The exact price will depend on the dosage and your local pharmacy but, on average, four PDE-5 tablets cost in the region of £15-30.

Treatment for ED is not usually covered by private medical insurance.

Hormone therapy

If a hormonal condition is causing ED, you may be referred to an endocrinologist. An endocrinologist is a health professional who specialises in the treatment of hormonal conditions.

Many hormonal conditions can be treated using injections of synthetic hormones that help maintain normal hormone levels.

Penis pump

A penis pump is another method of treatment for ED. It is a simple tube that is connected to a pump. You place your penis in the tube and pump out all of the air. This creates a vacuum which causes the blood to rush to your penis. You then place a rubber ring around the base of your penis in order to keep the blood in place, allowing you to maintain an erection for around 30 minutes.

Alprostadil

If your ED does not respond to treatment, or you are unable, or unwilling, to use PDE-5 inhibitors, or a penis pump, you may be given a medicine called alprostadil. Alprostadil is a synthetic hormone that helps to stimulate blood flow to the penis. Alprostadil can be injected directly into your penis, or a small tablet can be placed inside your urethra (urine tube).

Alprostadil will usually produce an erection that lasts for between 5-30 minutes.

Surgery

Surgery for ED is usually only recommended if there is clear evidence of a blockage to the blood supply of the penis, or if all other treatment methods have failed.

If there is a blockage to your penis’s blood supply, it may be possible for the surgeon to unblock the blood vessels and restore a normal supply of blood.

An alternative surgical method involves placing inflatable implants into your penis, which you can then activate as required. Penile implants are not usually available on the NHS.

Psychosexual counselling 

If the cause of ED is thought to be primarily psychological, you may be referred for psychosexual counselling.

Psychosexual counselling is a form of relationship therapy where you and your partner can discuss any sexual, or emotional issues, or concerns, that you have that may be contributing to your ED.

The counsellor can also provide you with some practical advice about sex, such as foreplay techniques, and how to make effective use of other treatments for ED in order to improve your sex life.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is another form of counselling that may be useful if you have ED. CBT is based on the principle that the way we feel is partly dependent on the way we think about things.

Therefore, unhelpful, or unrealistic, thoughts and assumptions about issues such as self-esteem, sexuality, and your personal relationships, may be contributing to ED.

In this situation, the CBT therapist would encourage you to adopt more realistic and helpful thoughts about these types of issues and assumptions.