Erectile dysfunction: frequently asked questions

What is erectile dysfunction?

Erectile dysfunction or impotence can be defined as the inability to get or sustain an erection sufficient for sexual intercourse. It is a common problem, but often not talked about. One in ten men will suffer from impotence and in diabetic men it is as common as 30%.

The ability to be able to get an erection is important to most men old and young, but because of taboos and embarrassment many men suffer in silence without seeking help or advice from their doctor or nurse.

How do erections happen?

A man needs hormones, blood supply, nerves and a desire if he is to achieve an erection. If one or more of these mechanisms fail then the erection will also fail.

When aroused nerve impulses travel from the brain to the penis, this triggers the relaxation of the smooth muscle in the penis which then allows increased blood flow into the tissues. As the penis fills with blood it will enlarge and become erect. As the penis enlarges it compresses the veins inhibiting blood flow out of the area, thus sustaining the erection. The penis will stay erect until ejaculation or when arousal stops.

What physical causes are there?

Hormone imbalance

A deficiency of male hormones can reduce desire or interest in sexual function.

Nerve damage

Damage to the nerves which cause the erection lead to reduced sensitivity thus making it increasingly difficult to achieve an erection.

Disease of the blood vessels

The blood vessels become narrowed and hardened. This reduces the blood supply to the penis which can lead to impotence.

If the penis does not fill adequately then the veins will not be closed off and the blood will leak back out of the penis. The erection will not be maintained.

Trauma

Such as injury to the spinal cord.

Pelvic surgery

Some operations on the prostate, bladder or bowel may result in some nerve damage leading to impotence.

Drugs

Some drugs for blood pressure, depression and sedatives have the side effect of causing impotence.

Smoking and alcohol

Those who smoke and drink are more likely to suffer from impotence.

In men with diabetes the most common cause of erectile dysfunction is disease of the blood vessels and / or nerve damage.

What treatment is available?

Ultimately it is your decision as to what treatment you choose; you will, of course, be given guidance as to what is most appropriate for you.

Counselling

Some men do need counselling and they will be referred to a specialist in this area. Counselling can be part or all of the treatment required.

Tablet treatment

First line treatment for most patients is now tablet treatment using either avanafil, sildenafil, tadalafil, or vardenafil. Your GP will prescribe this for you in the first instance.

Hormone treatment

This is offered to those patients who are deficient in male hormones i.e. testosterone. Medication can restore the hormone imbalance and improve potency. This treatment will not have any effect on those who do not have a hormone imbalance.

Self-injection therapy

This treatment involves self-injecting a drug into the side of the penis each time you want to have an erection. The injection causes the muscle in the penis to relax allowing increased blood flow into the area.

Injection therapy is very effective for many men but some do find the very thought of self-injection unacceptable. If you decide to choose this option then you will be trained in the clinic how to inject yourself.

Injection therapy can be used a maximum of twice a week and never more than once in 24 hours. As with all drugs there are side effects. Occasionally the erection does not go down and you may need to come to hospital to have the erection reduced. This is not common.

MUSE (medicated urethral system for erection)

This involves insertion of a pellet of prostaglandin into the urethra (water passage). Erections occur in only 35 to 40% of patients and treatment can be associated with pain or facial flushing.

Vacuum erection assistance devices

These are a non-invasive method of getting and sustaining an erection. To use this device the penis is inserted into a cylinder, using plenty of lubrication to ensure a good seal at the base of the penis. A small vacuum pump is attached to the other end of the cylinder. The pump creates a vacuum and this causes blood to be drawn into the penis thus causing an erection. A constriction ring is then placed onto the base of the penis to trap the blood in the penis and maintain an erectile state. The cylinder is then removed. The ring can be left in place for up to 30 minutes.

This is a safe and effective form of treatment. In some instances these can be supplied by the NHS. The cost of a pump is between £120 and £300. The urology sister will demonstrate how to use the device.

Penile implants

This involves surgical implantation of two rods into each side of the penis. They can be semi-rigid or inflatable and are permanent.

Specific information leaflets are available for most of these treatments from your specialist nurse or consultant urologist.

Schedule 11 allowances – NHS treatment provided for the following conditions only:

• Diabetes mellitus
• Injury (spinal cord or pelvis)
• Multiple sclerosis
• Poliomyelitis
• Prostate cancer
• Psychological distress (severe)
• Renal failure
• Single-gene neurological disorders
• Spina bifida
• Surgery (prostatectomy and radical pelvic surgery)

Other information

This leaflet contains guidelines and advice from professional bodies, together with information about the prescription of drugs. Treatment of patients will be planned with the consultant responsible for care, taking into account those drugs which are or are not available at the local hospital and what is appropriate for optimum patient care.

Who should I contact for more help or information?

Oncology nurses

Uro-oncology nurse specialist
01223 586748

Bladder cancer nurse practitioner (haematuria, chemotherapy and BCG)
01223 274608

Prostate cancer nurse practitioner
01223 274608 or 01223 216897

Surgical care practitioner
01223 348590 or 01223 256157

Non-oncology nurses

Urology nurse practitioner (incontinence, urodynamics, catheter patients)
01223 274608

Urology nurse practitioner (stoma care)
01223 349800

Urology nurse practitioner (stone disease)
07860 781828

Patient advice and liaison service (PALS)

Telephone: 01223 216756
PatientLine: *801 (from patient bedside telephones only)
Email PALS

Mail: PALS, Box No 53
Addenbrooke's Hospital
Hills Road, Cambridge, CB2 2QQ

Chaplaincy and multi faith community

Telephone: 01223 217769
Email the chaplaincy

Mail: The Chaplaincy, Box No 105
Addenbrooke's Hospital
Hills Road, Cambridge, CB2 2QQ

MINICOM System ('type' system for the hard of hearing)

Telephone: 01223 217589

Access office (travel, parking and security information)

Telephone: 01223 596060