Erectile Dysfunction: Facts and Figures

Facts & Figures

What are the facts about impotence?

• Erectile dysfunction becomes commoner with increasing age and is seen in 50 - 55% of men between 40 and 70 years old;

• It is often associated with obesity, high blood pressure, high cholesterol & diabetes which are all significant risks to health;

• Investigation is only indicated if both partners wish to pursue treatment;

• Most treatable causes can be identified by a clinical history, physical examination and routine blood tests;

• If there is no treatable cause, treatment with tablets is the first option for most men;

• Other methods of treatment are only indicated if medication proves ineffective, causes side-effects or cannot be used because of specific medical conditions.

What can cause impotence?

A psychological component, often called "performance anxiety", is common in men with impotence. However, a purely psychological problem is seen in only 10%.

Of the 90% of men who have an underlying physical cause, the main abnormalities found are:

• Cardiovascular disease in 40%;

• Diabetes in 33%;

• Hormone problems (e.g. high prolactin or low testosterone levels) & drugs (e.g. antihypertensives, antipsychotics, antidepressants, antihistamines, heroin, cocaine, methadone) in 11%.

• Neurological disorders in 10%;

• Pelvic surgery or trauma in 3-5%; and

• Anatomical abnormalities in 1-3% (e.g. tight foreskin, short penile frenulum, Peyronie's disease, inflammation, penile curvature).

What is testosterone deficiency?

Watch this video about testosterone deficiency.

Treatments: Facts and Figures

Improvements in your lifestyle, such as a eating healthy diet, reducing alcohol intake, losing weight and increasing your exercise can dramatically improve erectile dysfunction. More specific treatment usually involves:

• weight loss and increased exercise (this may reduced the risk of erectile dysfunction by up to 70%)

• treatment of any hormone abnormality (testosterone treatment is only indicated if your testosterone levels are low and may be harmful if your the levels are normal);

• lifestyle modification (e.g. reduce stress, stop smoking, reduce alcohol consumption & stop illicit drugs);

• treatment of any anatomical abnormality if present (e.g. circumcision, frenuloplasty, penile straightening);

• psychological support if necessary.
  

First line treatment will be medication with a phosphodiesterase inhibitor such as sildenafil (Viagra), tadalafil (Cialis) or avanafil (Spedra). These drugs only work when used together with sexual stimulation and will have no effect on your sex drive. There is no evidence that these drugs are dangerous if you have underlying heart disease. However, they should not be used if you are taking nitrates (e.g. GTN, isosorbide) for angina.

Your specialist will arrange a re-assessment after an initial period of drug usage. If the drugs prove ineffective, there are significant side-effects (seen in 15%) or they cannot be used, other measures may need to be considered. Please see our blog post for further details.

Visit our men's health page to find out how we can help.