Erectile dysfunction: your treatment options

Written by: Professor Francis Chinegwundoh MBE
Edited by: Laura Burgess

Erectile dysfunction is a common condition that can be caused by a number of physical or psychological reasons. If it is happening to you more often than not, the good news is that it is treatable and a combination of lifestyle changes and, in some cases, medication can help your condition. In this article, top urologist Professor Francis Chinegwundoh MBE explains everything that you need to know about treating erectile dysfunction.



What are the most common causes of erectile dysfunction?

Erectile dysfunction (ED) is a common malady. It affects men of all ages but becomes increasingly prevalent in men over the age of 40. The definition is a persistent inability to achieve and maintain an erection sufficient for penetrative intercourse.

To achieve an erection, the brain sends chemical messages to the penis, whose blood vessels dilate such that blood rushes into the penis under pressure, causing an erection. Thus, the brain is important, the nervous system and blood vessels.

There are physical causes of erectile dysfunction as well as psychological ones. Or there is an interplay between physical and psychological.

The most common causes are related to the vascular system. Heart disease, hypertension and high cholesterol are risk factors. Diabetes contributes to ED by damaging nerves and blood vessels. Obesity and metabolic syndrome are associated with ED.

Other causes of ED include neurological disorders, such as Parkinson’s disease and multiple sclerosis. Smoking, excess alcohol and drug abuse as well as many medications increase the risk of ED. Mental health conditions including anxiety, depression and other psychiatric disorders can lead to ED.

How treatable is erectile dysfunction?

ED is a treatable condition. Firstly, if there are remediable conditions these should be addressed. Lifestyle changes are encouraged, such as desisting from smoking, stress reduction, weight loss and optimal control of conditions such as hypertension and diabetes. These may ameliorate ED, but if not, there are several treatment options.

What is the first line of treatment for men with erectile dysfunction?

The aim of treatment is to enable the man to get an erection on demand. To this end, the class of drugs called phosphodiesterase type 5 inhibitors, such as Viagra and Cialis, are used. A tablet of the necessary strength is taken up to one hour before anticipated intercourse. Sexual stimulation is required for the drug to act to stimulate an erection.

What other options are available?

Should the tablets fail or be contraindicated, there are other good options to achieve erections. These include Vitaros, which is a prostaglandin cream applied into the end of the urethra (waterpipe). There is a prostaglandin pellet called MUSE, which can also enable an erection.

Vacuum pumps applied to the penis in conjunction with a rubber ring placed at the base of the penis is also effective, whilst avoiding a pharmaceutical. Direct injections of prostaglandin, such as Caverject, into the penis, does work for most. There is psychosexual counselling available.

When would surgery/implants be necessary?

Should the tablets fail and the other methods described above of achieving an erection also be unsuccessful, then it is possible to implant inflatable rods into the penis. These rods can be activated to make the penis hard and deactivated when intercourse is over.

Are there ways of preventing erectile dysfunction from happening?

It may not be possible to prevent ED, but certainly keeping a healthy lifestyle helps. For example, avoiding smoking and recreational drug use, eating well, reducing stress, exercising, avoiding obesity. Good control of medical disorders, such as diabetes may prevent ED.

If you would like to discuss your problems with erectile dysfunction with Professor Chinegwundoh, you can book an appointment to see him via his Top Doctor’s profile here.

By Professor Francis Chinegwundoh MBE

Professor Francis Chinegwundoh MBE is a renowned consultant urologist based in London, who specialises in treating prostate cancer, benign prostate enlargement, erectile dysfunction, and a wide variety of other urological conditions. Professor Chinegwundoh also provides medicolegal services. In addition to treating patients, he is a widely published researcher, lecturer, and professor, actively involved in teaching and also involved in charity work as Chairman of the charity Cancer Black Care and a trustee of Tackle prostate cancer. He was recognised with an MBE in 2013 for services to the NHS.

Since qualifying in medicine in 1984 from the University of London, Professor Chinegwundoh has accrued a wealth of experience and expertise. He obtained a Master of Surgery degree in 1994 and more recently a Master of Medical Law in 2010. He is a Fellow of the Royal College of Surgeons of England and Edinburgh as well as a Fellow of the European Board of Urology. He established and runs the regional prostate low dose brachytherapy service at Barts Health NHS Trust. He has performed over 100 transurethral needle ablation of the prostate for benign prostate enlargement and over 1500 transperineal template prostate biopsies. He is also a medical legal expert.

Professor Chinegwundoh is currently urology lead at Newham University Hospital, Barts Health NHS Trust and past chairman of the Prostate Cancer Advisory Group. He serves as an honorary clinical senior lecturer at Queen Mary’s College, University of London and has been an honorary visiting Professor in the School of Health Sciences, City University, London since December 2014.

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