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Erectile Dysfunction Explained

Erectile Dysfunction Explained | Jo Divine

Erectile dysfunction is a common problem affecting 1 in 3 men but according to the Sexual Advice Association (SAA) only around 10% of sufferers receive treatment.

“The umbrella term of erectile dysfunction can be a range of health problems including: issues with sustaining an erection, orgasm, ejaculation, a low libido and an inability to have long erections and may require erectile dysfunction treatment,” says Dr Hilary Jones, medical advisor to Health Express.

“The good news is that it is usually temporary and there are many effective treatment options for this condition, including oral treatment and non-prescription solutions, such as counselling or therapy. Although impotence is a common issue, and is usually related to stress, it can sometimes relate to a more serious underlying health issue such as diabetes or heart disease so it is really important you speak to a medical professional about any concerns you have.”

How an Erection Happens

It’s quite a complex process involving brain function, the nervous system, blood vessels and emotions. Erections are caused by physical stimulation – direct touch, squeezing the PC muscles, oral sex, or the psychological excitement of fantasy or flirting.

When a man is aroused the nervous system triggers a release of nitric oxide, which relaxes the muscles in the twin chambers of the penis (corpora cavernosa) allowing them to fill with blood. A biological molecule called cGMP is released enabling this process.

Blood circulation quickens and the connective tissue (tunica albuginea) that surrounds the corpora cavernosa prevents the blood flowing back out causing a temporary hardness. An enzyme called PDE-5 breaks down cGMP enabling this process to run smoothly.

However, if there’s a chemical imbalance, i.e. the body isn’t producing sufficient cGMP or is making too much PDE-5, then it can be disrupted. Reasons for this can be physical/hormonal and/or psychological/emotional.

Causes of Erectile Dysfunction

There are plenty of myths around ED or impotence, as it’s sometimes called. This goes some way to explain why many men are reluctant to talk about it.

It’s not age-specific and often affects younger men who are anxious about sexual performance and body image. It is also not a sign that a man is no longer interested in sex or his partner. However it could be an underlying medical condition, so seek medical advice.

Recent research published in the Journal Of Adolescent Health (2016) found that many young men aged 16-24 experience erectile dysfunction and premature ejaculation.

He may want to have an erection but for various physical or emotional reasons is unable to. He may be able to get an erection but lose it before or after penetration.

Often it is a short-term condition caused by stress, anxiety or worries at work/home. Ongoing ED is more likely to have a physical cause – present in around 75% of cases according to the SAA. Seeing a GP is the first step to finding out what the problem is.

A doctor will check blood pressure, heart and lung function, genital health and may do a fasting blood test to check cholesterol levels (narrowing of the arteries can inhibit blood flow). They will also do a blood sugar check for diabetes, which is a common cause of ED, and a testosterone check – low testosterone can be a problem and levels naturally decline as men age. He will also be asked questions about lifestyle and health, such as stress levels, depression, sleep, diet, exercise, alcohol and medications, as these all have an impact on sexual health.


Making some lifestyle changes may resolve the problem – avoid too much saturated fat which can clog the arteries, stop smoking, lose weight, do regular exercise and make an effort to reduce stress.

Communicate with partners as they may be feeling part of the problem. This isn’t a sign of lack of arousal or interest in a partner and it’s something that may not be under a man’s conscious control. He may want to have sex but for various reasons can’t get or maintain an erection.

“Like any sexual problem, good communication is a major part of addressing the issue. If approached with an open mind, issues with erectile ability can be an opportunity to start a sexual dialogue and bring a couple closer together by talking about fears and concerns, getting healthy and expanding an often intercourse-focused sexual repertoire to include a wider range of pleasurable activities,” says sex therapist Dr Ian Kerner.

Most men have nocturnal erections and a good way to monitor this is by securing a piece of tissue around his penis at bedtime. If it is torn by the morning then he has had an erection during the night indicating the problem isn’t physical. Similarly, if he is able to get an erection when masturbating then there isn’t a physical issue.

Men also need to be aware that some medication can cause ED so if you start to experience ED problems when taking a new medication, speak to your GP about the side effects.


Oral medications are the most popular because they’re convenient and work quickly, slowing down the PDE-5 enzyme and enabling more blood to flow into the genitals. They can be taken short-term or long-term and have a good success rate – between 57-80% in trials. They are available from a GP, online from certified medical websites like Health Express and over the counter (OTC) at pharmacies.

  • Viagra – taken 30 minutes before sex and lasts for up to four hours. Viagra has enabled around 20m men to enjoy sex again. However, doctors stress that oral medication will only be effective if a man feels sexual desire and has some form of foreplay. He won’t get an automatic erection half an hour after popping a pill.

Now Viagra ia available (OTC) you will be asked a couple of general health questions and advised to see your GP within 6 months of your first Viagra purchase to ensure there is no underlying serious health condition causing your ED, such as heart disease, diabetes or prostate health issues. This is extremely important as these ehalth conditions need to be diagnosed and treated as soon as possible.

  • Cialis (the weekend pill) – taken 30 minutes before sex and lasts for up to 36 hours. You can also take a ‘one-a-day’ pill, which releases the medication in small doses.
  • Levitra – aimed at older men who may have other medical conditions such as high cholesterol. Works within 20 minutes and lasts up to five hours.
  • Another option is to self-inject medications directly into the base of penis, which sounds more painful than it is! This has a 90% success rate and works within 15 minutes. The medications are Caverject or Viridal and they work by increasing blood flow to the penis to make it erect.

Sex Toys can help

Finally, sex toys can be helpful and bring a little fun back into the proceedings. There are many new products whch can be beneficial to men’s sexual health which also avoid unwanted side effects of taking medication.

Constriction rings can help temporarily by increasing blood circulation and trapping blood in the penis for a period of time. They should not be worn for more than 30 minutes and are not recommended for men who have circulatory problems. Avoid metal constriction rings as these are dangerous and may be difficult to remove once you have an erection.

A 2006 study showed that vibrators could help men who have spinal injuries to have erections. The Pulse III Solo by Hot Octopuss has been designed with this in mind to help men enjoy sexual stimulation and pleasure even when they are unable to have an erection.

Using a penis pump, such as the Bathmate Hydromax can help prevent ED when used on a regular basis, in addition to helping symptoms of ED.

Male Pelvic Floor exercises

Men have a pelvic floor too, just like women but very few men are aware that doing pelvic floor exercises can increase penile hardness and rigidity, improving the quality of your erections. It is recommended that you seek advice from a physiotherapist, trained in men’s health to instruct you how to do these exercises correctly.

If you think you have ED, seek advice from your doctor.