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Erectile Dysfunction

at Cadogan Clinic, London’s Leading Cosmetic Surgery Specialists. 

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Medically Reviewed January 2024, by Mr. Bryan Mayou (GMC: 1414396) - founder of the Cadogan Clinic and one of the world's leading plastic surgeons

What Is Erectile Dysfunction?

Erectile dysfunction, which is also known as impotence, is the inability to achieve and/or maintain an erection.

An erection is a direct result of increased blood flow into your penis. This blood flow is stimulated by sexual thoughts and arousal, or direct contact with your penis. When a man becomes sexually aroused, all the muscles in the penis relax, allowing the blood flow to increase into the penile arteries. The blood then fills the two chambers that are inside the penis, called the Corpora Cavernosa. When these chambers fill with blood, the penis becomes rigid and erect. The erection ends when the muscles finally contract, and the blood can flow back out the penile veins. Men who suffer from erectile dysfunction may struggle to achieve or maintain an erection due to a number of physical or mental conditions or emotional states.

Erectile dysfunction is a common condition that affects millions of men, in fact it is estimated that half of men in the UK aged between 40 and 70 have erectile dysfunction to some degree. However the condition  can affect men of all ages. Although the risk does increase with age, erectile dysfunction shouldn’t be seen as a consequence of ageing. Luckily the condition is easily treated.

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Words from our clients:

What are the symptoms of Erectile Dysfunction?

The symptoms of erectile dysfunction are:

  • Difficulty achieving an erection
  • Difficulty maintaining an erection
  • Reduced sexual desire

If you experience any of these symptoms for more than two or three months, speak to your doctor.

Sometimes erectile problems can be a symptom of a bigger or more complex health issue. You should also go to the doctor if you:

  • Are experiencing any other sexual problems such as premature or delayed ejaculation
  • Have a known health condition, such as heart disease or diabetes, which may be linked to erectile dysfunction
  • Have other symptoms along with erectile dysfunction
  • Have have any other concerns about your erections

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How is Erectile Dysfunction diagnosed?

To determine if you have erectile dysfunction, your doctor will ask you questions about your symptoms and your health history. They will carry out tests if necessary to determine whether or not those symptoms are caused by an underlying health issue. This may include a physical exam, blood pressure work, and examination of your penis and testicles. This may also include a rectal exam to check on your prostate.

If the doctor believes that you may have psychogenic erectile dysfunction, caused by psychological or interpersonal factors, then they may wish to carry out a nocturnal penile tumescence test to see whether you have erections in your sleep, the strength of these erections, how many you have and their duration.

When organic erectile dysfunction is suspected but an underlying cause is not obvious the doctor will want to try and identify any underlying conditions, particularly since erectile dysfunction may represent the first sign of cardiovascular disease. A prompt identification of any of the cardiovascular risk factors such as diabetes, high blood pressure and high cholesterol levels is paramount to set up an adequate treatment plan and prevent further progression of the cardiovascular disease.

The doppler ultrasound scan of the penis is a relatively simple investigation but it provides very important information on the blood supply to the penis.

How is Erectile Dysfunction treated?

There are a number of erectile dysfunction treatments:

The most common erectile dysfunction pills are Sildenafil, Tadalafil and Vardenafil. All these medications help to enhance erections, but do not trigger automatic erections so sexual stimulation is necessary for these medications to work. Sildenafil is sold as Viagra and can be brought from a pharmacy without the need for a prescription.

If your erectile dysfunction is caused by the narrowing of blood vessels in the penis, high blood pressure or high cholesterol, then medicine will be prescribed to lower blood pressure or statins to lower cholesterol.

Injections are self-administered into the base or the side of the penis. Each injection is dosed to create an erection lasting no longer than an hour. Sexual stimulation is not required.

Injections are recommended to patients who do not respond to oral medications.

If your erectile dysfunction is complicated by low testosterone levels, then testosterone replacement therapy may be recommended.

A vacuum pump is a tube, which is sealed around the flaccid penis. With the creation of a negative pressure, blood is rushed into the chambers of the penis. Once the desired rigidity is achieved, a constricting ring is applied to the base of the penis to prevent the blood from leaving and the vacuum pump is then removed. The vacuum pump can be a viable solution for patients who do not respond or are not suitable for oral and injectable medications.

If your erectile dysfunction is caused by psychological or interpersonal factors, then psychosexual counselling may be recommended. Any depression and anxiety can be treated with cognitive behavioural therapy (CBT).

Sometimes making healthy lifestyle changes can help with erectile dysfunction. This includes quitting smoking, cutting excessive alcohol intake to under 14 units a week, exercising daily, eating a healthy diet and reducing stress levels.

This surgical treatment involves placing bendable rods into both sides of the penis. These rods keep the penis firm but flexible while an inflatable device allows you to control your erection.  Surgery is not usually recommended until other erectile dysfunction treatments have been tried first.

Who is suitable for treatment?

You are considered suitable for erectile dysfunction treatment if one or more of the following is true:

  • You have difficulty achieving an erection
  • You have difficulty maintaining an erection
  • You are experiencing reduced sexual desire
  • You are experiencing depression, anxiety or stress due to erectile dysfunction
  • The condition is impacting on your romantic relationships#
  • You are experiencing erectile dysfunction and have an underlying health condition, such as diabetes or high blood pressure
  • You are experiencing erectile dysfunction and suspect you have an underlying condition.

It is important that you have a realistic expectation of what your erectile dysfunction treatment can achieve.

The Patient Journey. A breakdown of what you can expect on your journey with us

We are deeply invested in ensuring that every step of your surgical journey with us is as informative and reassuring to you as it can be. This article outlines what you can expect at each stage of the journey

The Patient Journey

Frequently Asked Questions

There are several different things that may cause erectile dysfunction, including:

  • Underlying health conditions (high blood pressure, diabetes and high cholesterol)
  • Hormonal problems
  • Previous surgery (prostate gland removal, urinary bladder removal, surgery to the rectum, spinal surgery)
  • Injury to the brain, spinal cord, peripheral nerves or arteries
  • Substance abuse (tobacco, drugs, alcohol and some medications)
  • Psychological problems such as anxiety, depression and relationship issues
  • Performance anxiety (psychogenic erectile dysfunction)

It is important to get an accurate diagnosis and identify the cause in order for the appropriate treatment or procedure to be recommended.

It is possible to get erectile dysfunction treatment on the NHS, but some NHS Trusts do not  fund certain ED treatments, such as vacuum pumps. If you are referred for psychosexual counselling, there is a long-waiting list if you are seeking this treatment on the NHS.

The NHS has been, and continues to be, hit hard by the Covid-19 pandemic. High levels of staff sickness have had an impact on waiting times across the board. These waiting times vary from hospital to hospital. And any new waves of Covid-19 infections may result in this wait getting even longer. Because of this, many people choose to go to a private clinic for their erectile dysfunction treatment. At the Cadogan Clinic, there is no waiting list, so you can have the procedure promptly.

There is no one test that can comprehensively diagnose erectile dysfunction and its root cause. But the most common test which is performed is an ultrasound. A device is held over the blood vessels to check the flow of blood to the penis.

Sometimes the doctor carrying out the scan will inject medication into the penis to stimulate blood flow, resulting in an erection.

Sometimes making simple lifestyle changes can help with erectile dysfunction. This includes quitting smoking, cutting excessive alcohol intake to under 14 units a week, exercising daily, eating a healthy diet and reducing stress levels.

Do not use herbal medicines to try and cure your erectile dysfunction. They do not work and are a waste of money. Sometimes the people who sell them are not honest about what the so-called treatments contain, so they may even pose a risk to your health.

What are the risks?

The most common side effects from hydrocortisone injections is pain or swelling in the joint where the injection was given. This is temporary and usually resolves in one to two days. There may also be some mild bruising at the injection site.

As hydrocortisone shots are injected straight into the joint, the medicine does not travel around your body. However sometimes hydrocortisone may get into your blood and as a result there is a very slim chance you may experience a serious side effect. Potential side effects include: depression, mood changes, infection, deep vein thrombosis (DVT), eyesight changes, diabetes or complications of diabetes, and Cushing’s syndrome. Some of these side effects may happen after a few days while others may not present until months after treatment. These are all very rare side effects.

It is extremely rare to have an allergic reaction (anaphylaxis) to a hydrocortisone shot.


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My Face My Body

Best Clinic Winner

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My Face My Body


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