Erectile Dysfunction (ED)

This is sometimes called “Impotence”.  It can affect a man at any age but becomes more common with age.  40% of men over 40 years of age report some dysfunction.  An erection is produced by blood being pumped into the penis.  This is controlled by many factors.  Although not strictly a part of “sub-fertility” as the man may produce copious sperm, it is obviously a problem for conception if he is unable to place the sperm in the vagina.
ED is a serious condition as it can cause much tension between partners, particularly if it is poorly understood.  Fortunately, it can usually be treated.  Sometimes, ED is the only manifestation of an underlying disease or one of the effects of a disease which is already diagnosed.

Do you suffer any of the following conditions?

  • •Diabetes
  • •Heart Disease
  • •High Blood Pressure
  • •Kidney Failure
  • •Prostate Cancer or surgery
  • •Spinal Cord Injury
  • •Nerve problems such as Multiple Sclerosis
  • •Depression or anxiety

  • How is ED Investigated?
    We want to exclude those conditions.  The doctor will enquire about them and perform a general examination.  You will be asked about any drugs (prescription and otherwise) that you are taking as some have this side effect.

    Some are discovered on testing and so you will have:

  • •a blood pressure test
  • •a urine test to see if there is sugar in the urine. Or possibly a “Random Blood Glucose”.  If these suggest a poor ability to handle sugar, you may be asked to attend the hospital for a full Glucose Tolerance Test (GTT)
  • •a blood test for cholesterol as ED can have a vascular cause
  • •a blood test for the hormone testosterone

  • How can I improve things myself?
    Simply understanding that this is a common condition that affects most men at some time can enable some to relax.  You should reduce or avoid alcohol.  We have talked of “Brewers’ Droop” for years.  Exercising, losing weight and stopping smoking may be beneficial in helping treat your condition, but you should speak to your doctor to find out what will be suitable for you.

    How is ED Treated?

  • Counselling:  This is always a part of the therapy as we appreciate how stressful and embarrassing the problem can be.
  • Oral Tablets: There are currently three different products on the market.  They are called PDE-5 inhibitors.  Depending on the treatment, they need to be taken between 25 minutes and 1 hour before sexual intercourse. The period of time over which they work can vary from 4–5 hours up to 36 hours. i.e. during these time periods, providing you have sexual stimulation, an erection may be achieved. 
  • •Sildanafil,  ( Viagra, Revatio)
  • •Tadalafil,    (Cialis)
  • •Vardenafil,  (Levitra)
  • Are there any side effects?  The drugs were developed during research into possible treatments for high blood pressure by opening up blood vessels.  They were found to affect the vessels in the penis better than elsewhere in the body.  So some side effects are to do with lowered blood pressure.
    The most common side effects include:

  • •headache
  • •indigestion
  • •flushing
  • •pounding heartbeat
  • •nausea
  • •nasal congestion
  • •effects on vision
  • •dizziness
  • •back pain
  • •muscle aches
  • •abdominal pain

  • Injections and Insertions:   There are three products which contain alprostadil.  They are either injected into the penis or inserted down the urethra using a special applicator.  They work in about 5 – 15 minutes.  If your penis is scarred, not straight, or abnormally formed, you should NOT use these products.
  • Vacuum Pumps:  These work by sucking blood into the penis. A constriction ring   is then placed around the base of the penis to trap the blood and maintain the erection.  This ring should NOT be in place for any more than 30 minutes. 
  • Hormone Treatment: This is rare but occasionally used.  Testosterone (Andropatch, Intrinsa, Nebido, Restandol Testocaps, Striant SR, Sustanon, Testim, Testogel, testosterone, Tostran, Virormone)
  • Surgery: The most common surgical procedure is insertion of prosthetic implants.  Surgery may occasionally be needed to repair damaged blood vessels.
  • Retrograde Ejaculation / Dry Orgasm

    What is a dry orgasm?
    Even though plenty of sperm are being produced, semen is being made at the prostate and orgasm is experienced, some release little or no semen into the vagina.  This is called a dry orgasm and is usually caused by retrograde ejaculation. This is of no worry unless you are trying to father a child. 

    How is it caused?
    Normally, the sphincter (circular muscle) which hold your bladder outflow closed until you are ready to void will tighten at orgasm.  This means that the semen has only one way to go; along the penis to the vagina.  However, in this condition, the muscle may relax slightly and allow the semen to flow into the bladder. 

    How do I recognise this?
    The first thing is the dry orgasm.  Secondly, when you void urine after orgasm, it may look cloudy due to the semen in it.  It may come to light when infertility is investigated.

    What makes it more likely?
    You are at increased risk or retrograde ejaculation if

  • •You have diabetes or multiple sclerosis
  • •You have had prostate or bladder surgery
  • •You take certain drugs for high blood pressure or mood disorder
  • •You have had a spinal cord injury
  • •Pelvic irradiation (cancer treatment)

  • Can it be treated?
    Retrograde ejaculation does not need treatment unless you are suffering infertility.  If treatment is required, the choice depends upon the cause.
    Drugs are unlikely to work if it has been caused by surgery or scarring due to radio-therapy. 
    Drugs known as alpha-blockers are used to treat high blood pressure.  A change of therapy may be of benefit.  Careful management of diabetes is essential. 
    Drugs used to treat retrograde ejaculation are generally used for other purposes but seem to have a useful side effect.  Imipramine (a tri-cyclic anti depressant) ,chlorpheniraamine (an anti histamine), ephedrine (and related decongestants).  Some drugs used to treat this have serious side effects.

    Is there anything else?
    If the problem is simply subfertility, sperm may be recovered from your urine and used for assisted reproduction techniques such as intrauterine insemination, IVF, or if only a few,sperm are found, ICSI.

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