Erectile Dysfunction Patient Information Leaflet

What is erectile dysfunction?

Erectile dysfunction (ED) means that you cannot get or maintain an erection that is firm enough for sex.

What are the symptoms of erectile dysfunction?

• difficulty getting an erection
• difficulty keeping an erection
• a reduction in sex drive

What causes erectile dysfunction?

Achieving an erection firm enough for sex involves a complex combination of factors, including mental and emotional function, hormones, nerves, muscles and blood vessels. Issues with any of these elements can contribute to or cause Erectile Dysfunction.

• Reduced blood flow to the penis
  • This is the most common cause of ED in men over 40.
  • The arteries which take blood to the penis can become narrowed over time. The blood flow may then not be enough to achieve an erection.
  • Certain risk factors can increase your risk of narrowing of the arteries, including getting older, smoking, high blood pressure, high cholesterol, diabetes and a family history of heart disease/stroke.
  • It is important to note that Erectile Dysfunction can be an early sign of underlying cardiovascular/heart disease, so it is important to have regular check-ups with your doctor, and to manage any risk factors you have, such as high blood pressure, high cholesterol, smoking, diabetes etc.
  • If your doctor is concerned about the possibility of underlying cardiovascular disease (for example, if you have a number of the above risk factors, family history etc.), they may send you to see a cardiologist (heart specialist) for further investigations.
  • Anyone who is experiencing chest pain or shortness of breath on exertion, or cramps in the legs when walking, should seek urgent medical attention, as it can be a sign of cardiovascular disease.

• Diseases or injuries which affect the nerves going to the penis
  • For example, spinal surgery/injury, multiple sclerosis (MS), stroke or other neurological (nerve-related) conditions

• Diabetes
  • Diabetes can lead to damage blood vessels and nerves, particularly if undiagnosed or undertreated.

• Side-effect of certain medicines

E.D can be an unintended side effect of other medications such as

• • some antidepressants
  • some blood pressure medications, including beta-blockers (e.g. propranolol, atenolol)
  • some ‘water tablets’ (diuretics)
  • cimetidine
  • some antihistamines
  • some painkillers & anti-inflammatories
  • some treatments used for prostate cancer

If you develop E.D, check the label of any medications you are taking regularly, in case sexual dysfunction is a listed side effect.

• Alcohol and drug abuse
• Hormonal causes.
  • For example, low testosterone levels
• Long distance cycling

What tests should I get done?

• It is extremely important to see a GP to rule out any risk factors or underlying causes of Erectile Dysfunction as mentioned above, particularly when over the age of 40, to exclude cardiovascular/heart disease, diabetes and prostate disease. This assessment may include:
  • • • • • blood pressure measurement
          • physical examination of the penis/testes
          • blood tests including cholesterol, diabetes, kidney function.
          • urine test
          • prostate check
          • mental health check
• Have a repeat check-up at least every year or so, but more often if you have risk factors like smoking, blood pressure or diabetes. And any sudden change or worsening in E.D symptoms in the meantime should be discussed promptly with a doctor.
• Stress, anxiety, depression or relationship difficulties can all contribute to or cause E.D- if you have concerns about any of these issues, you should also discuss them with your GP or other mental health professional.

Medications for ED

• You should always start with the lowest dose, and only increase if this is not effective on four occasions.
• Medications commonly used for the treatment of E.D (phosphodiesterase inhibitors such as Sildenafil/Tadalafil/Avanafil) work by increasing the blood flow to the penis.
• These medications may not work for everyone
• There is one medication that can be taken daily at a low dose for patients anticipating sex at least twice weekly.
• These medications may be unsafe for men who:
  • • are taking nitrate medications (commonly used for treatment of angina/chest pain)
    • have low blood pressure
    • have heart failure/heart disease.

What are the side effects of these medications?

• Thankfully, most people get no side effects and serious side effects are uncommon
• Side effects (usually mild) may include headache, palpitations, nasal congestion, blurred vision, indigestion, flushing.
• If you have further questions or concerns about the risks of taking these medications, read the medication information leaflet in the pack, and/or ask your doctor or pharmacist for advice if necessary.

How can Erectile Dysfunction be prevented?

Actively managing lifestyle and risk factors may help you reduce or avoid E.D:

• stop smoking
• reduce or avoid alcohol intake
• stay fit- exercise regularly (seek advice from a personal trainer or exercise physiologist if you are unfit, to help you improve your fitness level sustainably and safely)
• see your doctor for regular check-ups of heart disease risk including blood pressure, blood tests to check for high cholesterol and diabetes and other chronic health issues.
• avoid “recreational” drug use
• Pay attention to your mental health and stress levels, and consider professional help for relationship problems, stress management, anxiety, depression and other mental health concerns.
• Be mindful of side effects of medications you are taking regularly- read the label.

Are there any other treatments for ED, aside from medications?

Yes. There are other treatments including creams, injections and pellets. Consult a GP or seek referral to a urologist if you wish to discuss these lesser-used options.

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