Erectile dysfunction, which is also known as impotence, is the inability to achieve and / or maintain an erection. It is a common condition that affects millions of men; it is estimated that half of men in the UK aged between 40 and 70 have erectile dysfunction to some degree, but it can affect men of all ages. Although the risk does increase with age, erectile dysfunction shouldn’t be seen as a consequence of ageing.

There are many causes for erectile dysfunction ranging from underlining health conditions (high blood pressure, diabetes and high cholesterol), hormonal problems, previous surgery and injury through to psychological problems such as anxiety, depression and relationship issues. It is important to get an accurate diagnosis and identify the cause in order for the appropriate treatment or procedure to be recommended.

Our Uro-Andrology department is led by Mr. Giulio Garaffa, an award-winning Consultant Uro-Andrologist with over 20 years’ international medical experience in this field. Mr Garaffa has a global reputation for his excellence in urology and andrology, and is one of the leading experts in the fields of erectile dysfunction, congenital penile curvature, complex penile reconstruction, phalloplasty, Peyronie’s disease, male infertility and microsurgery.

 

Frequently Asked Questions

Approximately 40% of men at the age of 50 suffer from erectile dysfunction and this prevalence increases of around 10% each decade.

Although prevalence of erectile dysfunction increases with age, erectile dysfunction should not be seen as an inevitable consequence of ageing.

Erectile dysfunction can be subdivided in psychogenic and organic. Psychogenic erectile dysfunction, which is more common in younger men, cannot trace his origin to a physical problem or disease and is due to performance anxiety.

Organic erectile dysfunction is much more common than psychogenic erectile dysfunction and in most cases the causes can be easily identified. Once identified, proper treatment can be recommended to help patients return to a satisfying sexual life.

Organic erectile dysfunction is usually caused by an injury (to the brain, spinal cord, peripheral nerves or arteries), by a disease (diabetes, high blood pressure or high cholesterol), by an operation (prostate gland removal, urinary bladder removal, surgery to the rectum, spinal surgery) and by substance abuse (tobacco, drugs, alcohol and some medications).

A thorough examination and history taking is necessary to understand the nature of erectile dysfunction. Patients with psychogenic erectile dysfunction may be further investigated with a nocturnal penile tumescence test to confirm that the nocturnal erections are preserved. The confirmation of the presence of normal nocturnal erections excludes the presence of an organic cause of erectile dysfunction and the patients should be therefore reassured and offered psychosexual counselling.

When organic erectile dysfunction is suspected and an underlying cause is not obvious from the examination and history, efforts should be made towards the identification of any underlying condition, since erectile dysfunction may represent the first sign of diffuse 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.

The management of the patient with erectile dysfunction is tailored to the underlying cause of erectile dysfunction and to patients’ preferences.

Various drugs are now available for the treatment of erectile dysfunction. Some medications are administered orally, some are injected directly into the penis while other are inserted into the urethra at the tip of the penis. When medical treatment is ineffective and contraindicated, the vacuum constriction device or penile prosthesis implantation guarantee the rigidity necessary for sexual intercourse.

A penile prosthesis is an artificial stiffener, which is inserted under general anaesthetic into the chambers of the penis to guarantee the rigidity necessary for sexual intercourse. A penile prosthesis reproduces a normal erection and preserves all the normal feeling and sensation during intercourse. The quality of the erection obtained with a penile prosthesis is excellent and most patients and partners are very happy with the outcome post surgery.

The procedure usually takes just under an hour and the patient is discharged the same day. The prosthesis is usually inserted through a 3cm long incision via the scrotal sac. Sexual activity can be resumed 6 weeks post-surgery.

There are 2 kinds of penile prostheses: semirigid and inflatable. The semirigid or malleable prosthesis is made of two semirigid cylinders, which are inserted into the chambers of the penis. They produce a constant erection and the penis is usually bent laterally to be concealed in the underwear. The inflatable prosthesis is made of two cylinders, which sit in the chambers of the penis along with a scrotal pump and an intra-abdominal reservoir - a system filled with sterile water, and requires the patient to press a pump to transfer the fluid from the reservoir to the cylinders. This produces good level of rigidity and a natural looking erection. When the sexual intercourse is completed, the patient presses the deactivation button of the pump to transfer the fluid back into the reservoir and to render the penis flaccid.

Inflatable penile prosthesis by far produces the best results in terms of rigidity and concealing of the penis in flaccidity. Malleable penile prosthesis are only used in selected groups of patients.

Injections are indicated in these patients who do not respond to oral medications or when oral medications are contraindicated.Injection therapy induces an erection even without the need of sexual stimulation. The main advantage of injections is that it can be easily self-administered while the main risk is to induce a prolonged erection and may occur if an excessive dose of the medication has been injected.

The main reasons why patients quit injections are inadequate response, fear of needles, desire for a permanent treatment alternative and concerns over side effects.

The 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 rushing out of the penis 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 and are not keen on penile prosthesis implantation.

We advise you to book a consultation with Mr Garaffa, one of the world leading experts in the diagnosis and management of erectile dysfunction and one of the largest penile prosthesis implanters in the world. Your condition will be treated discretely and you will be offered the treatment that best suits you and that will allow you to regain sexual activity with confidence.

What to expect

Free Consultation with one of our Patient Advisors

We offer a free, no-obligation 30-60 minute consultation with one of our Patient Advisors. They will work with you to understand your objectives and the results you want to achieve, talk you through the procedure and answer any questions you may have. If you decide that you would like to proceed to the next step and see a surgeon, your Patient Advisor will be happy to arrange this for you. At this point, you will be required to pay a consultation fee. 

Surgical Consultation

The next step is for you to meet your chosen surgeon at the Cadogan Clinic. Your surgeon will use this time to make a comprehensive medical assessment of you, your condition, and your expectations before making a recommendation and personalised treatment plan for you. You will then discuss the outcomes you can expect to see and ask any questions.

The Procedure

On the day of your procedure you will be welcomed at the Cadogan Clinic by your Patient Advisor and dedicated nursing staff. Following a brief medical check, you will meet with both your surgeon and anaesthetist to run through the details of your procedure one final time and answer any last questions you may have.  

Recovery

After the procedure, you will recover in the capable hands of our aftercare team. As we are a day-case facility you can expect your recovery to be complete within 2 to 3 hours. If your surgeon is happy with your results, you will be able to be discharged from the Clinic the very same day. In some cases patients may wish to stay locally in our exclusive partner hotel the day before or after your procedure in order to be close to their surgeon. Talk to us about these options if this is for you. 

After Care & Support

Our care and support continues in the days and weeks following your procedure with our complimentary aftercare programme. This comprised of a series of appointments made with your surgeon and nursing team to monitor your progress and recovery. They will also introduce you to several scar minimization techniques and bespoke products to aid your progress. Our team are also on call to answer any questions you have around your surgery at any time you are concerned.

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Mr. Giulio Garaffa
Mr. Giulio Garaffa

Uro-Andrologist

Considered one of the world leading experts in his fields of interest and is invited world wide to give lectures and perform live surgery