Birmingham Urology Clinic

Erectile Dysfunction is inability to get erections sufficient for penetrative sexual intercourse. Many studies have shown that Erectile dysfunction increases with age starting with one third of men aged over 40 to almost half the men aged over 70. 

Problem with erection could be due to simple reasons like stress, anxiety and tiredness. More commonly erection problems could results from either blockage of arteries supplying blood to the penis or damage or disease to the nerves supplying the penis. Blockage of arteries  could be due to Diabetes or atherosclerosis (blockage of arteries due to fat or calcium). Damage to nerves could be again due to diabetes or operations in the lower part of tummy such as Radical Prostatectomy for cancer, Bowel resection for cancer and radiation treatment. Any structural problems in the penis such as bend in the penis (Peyronies disease) or scar tissue from previous operations or injury can also cause Erectile dysfunction. As Testosterone (male sex hormone) is required for libido (sex drive) and erection, deficiency of this hormone can also result in erectile dysfunction.

Diagnosis is made mostly based on symptoms of inability to get erections and have sexual intercourse. Examination is carried out to check if there are any physical disabilities in the penis and to look for blood flow and pulsations in the groin and arteries of leg. Some basic blood tests including blood count and male sex hormone (Testosterone) is also carried out. Usually, no special scans are necessary for making the diagnosis. Occasionally a doppler scan of the penis is required to check the blood supply of the penis.

Initial treatment involves a trial of a medicine that belongs to a group called PDE-5 Inhibitors. These need to be taken half an hour before sex. These medications work by enhancing certain chemicals released during erection. However, for these drugs to work, the chemicals need to be released by sexual stimulation and foreplay. Examples of medications include:

Sildenafil (Viagra): 50mgs and 100mgs

Tadalafil (Cialis): 5 mg Daily, 10mgs and 20mgs when required 

A vacuum constriction device is an external pump with a band that is used to create and maintain erection. This device consists of a cylinder with a pump that is attached directly to the end of the penis. A constriction ring or rubber band is placed at the other end of the cylinder. The cylinder and pump are used to create a vacuum to help the penis become erect and the band  is applied to maintain the erection.

Vacuum Suctions pumps from iMedicare is commonly used. They provide services from a representative of the company who visits the patient and advises on it's usage

For details: visit https://www.mypelvichealth.co.uk/en/men/erectile-penile-health/erectile-dysfunction-management-penile-rehabilitation/

These injections which are made of a chemical called Prostaglandin are injected directly into the side of the penis and produces erection. These drugs cause dilatation of the arteries of the penis and allows blood to flow in. Erection occurs within a matter of minutes. Patients will be taught to do the injection themselves  before engaging in sexual activity. 

This is used as a last resort after trying all other options. A prosthetic device is inserted into the penis and operated by pressing a button that is implanted in the scrotum. Due the prosthetic nature, there are risks of infection, erosion and device failure. Once the implant surgery is carried out, there is no going back to the previous options as they don't work anymore.

For information about Penile Prosthesis surgery please refer to https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Penile%20prostheses.pdf

When there are no physical causes are found for the erectile dysfunction (as is often the case), psychosexual counselling may provide a major benefit. Couples with stress, anxiety and relationship issues would certainly benefit from this method.