What is erectile dysfunction?

Erectile dysfunction, or impotence, means not being able to obtain or keep an erection that is sufficient for sexual intercourse. Many men have erectile dysfunction at some time in their lives. It can come and go.

It is estimated erection problems affect about 1 in every 5 men over the age of 40. About 1 in 10 men cannot have erections. The problem is more common in older men.

Erectile dysfunction is also called impotence.

What causes erectile dysfunction?

Erectile dysfunction can have a range of causes, both physical and psychological. It is usually a combination of both. Sometimes there is no clear cause.

Physical factors that can cause erectile dysfunction include:

• general ageing
• health problems that affect the nerves, like spinal cord injury, Parkinson’s disease and Alzheimer’s disease
• reduced blood flow to the penis, caused by atherosclerosis (clogging of the arteries)
• conditions like high blood pressure, diabetes, high cholesterol, cardiovascular disease, obesity or sleep disorders
• underactive thyroid gland (hypothyroidism), growth hormone conditions, having too much cortisone
• alcohol, some medicines, smoking or substance abuse
• Peyronie's disease (scar tissue inside the penis)
• prostate disease, and treatments for prostate cancer or an enlarged prostate
• some medications used to treat high blood pressure, high cholesterol, depression or prostate cancer
• hypogonadism — conditions where the testicles cannot make enough testosterone or sperm

Psychological factors that can cause erectile dysfunction include:

• unresolved problems, conflicts or issues within a sexual and emotional relationship
• anxiety about sexual performance (this is most common at the start of a new relationship, especially if a man has had previous problems with sexual performance)
• stress
• problems with mental health such as depression

When should I see my doctor?

Many men experience erection problems from time to time. But if the problems continue, see your doctor. Diagnosing and treating causes like diabetes, high blood pressure or high cholesterol can prevent or delay erectile dysfunction, or stop problems from getting worse.

How is erectile dysfunction treated?

Your doctor will first treat any underlying health conditions that may be causing your erectile dysfunction. They may also recommend lifestyle changes such as eating a healthier diet and exercising regularly.

Usually more than one treatment is needed to fix the problem. You may need treatment for both the physical and psychological causes. Although erectile dysfunction usually can’t be completely cured, there are treatments that will allow you to get an erection so you can have sex.

Erection pills

Erectile dysfunction is most often treated with erection medications such as Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil) and Spedra (avanafil).

These erection pills work by helping to relax the blood vessels in the penis, allowing blood to flow into the penis, causing an erection. This can increase both the number and duration of erections. However, they are not aphrodisiacs and do not increase libido (interest in sex). They do not work in all men. You should not take these medicines if you are also taking other nitrate medicines, used to treat chest pain.

Buying medicines for erectile dysfunction

Erection pills should be obtained only from an authorised Australian prescriber, such as your doctor, specialist nurse or erectile specialist.

Medicines bought on the internet may be of poor quality and may contain ingredients that are not safe when taken in combination with other medicines you are on. They may also be unsafe due to other health problems you have.

If you are worried that you might have bought counterfeit (fake) medicines, then report it to the Therapeutic Goods Administration.

Injections

Sometimes medicines may be injected into the penis when an erection is wanted. It is possible for men to inject themselves, but they need to be shown how by a health professional.

Other physical treatments

Devices can be used to create an erection, such as penile rings, a penis implant or a penis pump. Sometimes surgery is needed to fit these.

Psychological treatments

Treating erectile dysfunction that is caused by psychological factors could involve counselling, such as cognitive behavioural therapy, or sex therapy undertaken with your partner.