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What Is Erectile Dysfunction?

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.

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.

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.

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How do I know if I have erectile dysfunction?

If you experience any of these symptoms for more than 2-3 months, speak to your doctor. 

To determine if you have erectile dysfunction, your doctor will inquire about your symptoms and your health history. They will do 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 surgery is needed, your doctor will go over the best method for you and give you your options. You may be prescribed medication as well.

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The most common oral medications prescribed in patients with erectile dysfunction are Sildenafil, Tadalafil and Vardenafil. All these medications help to enhance erections and therefore do not trigger automatic erections as injections instead do. Therefore sexual stimulation is necessary for these medications to work.

The most common side effects of these medications are headache, facial blushing, upset stomach and mild temporal visual effects (only for Sildenafil).In most cases, the side effects are minor and tend to reduce with time. Therefore only very few patients decide to discontinue the treatment due to side effects.

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

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.

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This month Cadogan Clinic consultants feature in Glamour Magazine and WhoWhatWear discussing the impact of alcohol on skin health and appearance, as well as how to look after our skin as we age and enter our 60s, and our skin loses its natural elasticity and collagen

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