Erectile dysfunction (ED) refers to ongoing difficulty achieving or maintaining an erection that is adequate for sexual activity.
Erection difficulties are common and can occur for many reasons. While an occasional episode may be related to tiredness, stress, alcohol or other temporary factors, recurring erectile difficulties may benefit from medical assessment.
At Kensington Family Clinic, our doctors provide confidential assessment and management of men’s health concerns, including erectile dysfunction. The aim of an ED consultation is not only to address the erection difficulty itself, but also to consider whether physical health, psychological wellbeing, medications or lifestyle factors could be contributing.
Treatment is recommended according to each patient’s medical history, symptoms and individual circumstances.
Erectile dysfunction occurs when a man regularly has difficulty getting an erection or keeping an erection sufficiently firm for sexual activity.
An erection is the result of several systems working together. These include the brain, nerves, hormones, blood vessels and psychological response.
Disruption to any of these processes can potentially affect erectile function.
Some men experience ED only occasionally, while others may notice a persistent or gradually worsening problem.
Erectile dysfunction can present differently between individuals.
You may notice:
Having difficulty getting an erection once or twice does not necessarily indicate a medical problem.
If the issue happens repeatedly or has persisted for some time, consider discussing it with a doctor.
ED can have physical, psychological and lifestyle-related causes. More than one factor may also be involved.
Certain health conditions can affect the blood vessels, nerves or hormones involved in erectile function.
Possible contributing conditions include:
Certain medications can also contribute to erectile difficulties.
If you suspect that one of your existing medications is affecting your sexual function, do not stop taking it without medical advice. Your doctor can review the medication and discuss appropriate options.
Sexual function is influenced by psychological as well as physical health.
Possible psychological contributors to erectile dysfunction include:
Sometimes a physical episode of ED can subsequently cause performance anxiety.
A man may become concerned that he will have difficulty achieving an erection again. This anxiety can itself interfere with sexual arousal and contribute to further erection difficulties.
Lifestyle can also influence erectile and cardiovascular health.
Factors that may contribute include:
Addressing these factors may form part of an overall approach to improving sexual and general health.
Although erectile dysfunction becomes more common with age, younger men can also experience ED.
In younger adults, stress and performance anxiety may sometimes play an important role. However, age alone should not be used to assume that erectile difficulties are psychological.
Physical health, medications, lifestyle factors and other possible causes may still need to be considered.
Persistent or recurring symptoms can be assessed by a doctor regardless of your age.
Erectile health is closely connected to blood circulation.
An erection depends on adequate blood flow into the penis. Conditions affecting blood vessels and cardiovascular health can therefore also affect erectile function.
This is one reason why persistent erectile dysfunction should not always be viewed simply as a sexual performance issue.
Depending on your age, medical history and other risk factors, your doctor may consider whether further assessment of your general health is appropriate.
This may include evaluating factors such as:
Further investigations may be recommended where clinically appropriate.
There is no single test that is necessary for every person with erectile dysfunction.
Assessment generally begins with a consultation.
Your doctor may ask about:
Some of these questions are personal, but the information can help distinguish between possible physical and psychological contributors.
Depending on the findings, a physical examination or further investigations may be recommended.
Treatment should be individualised according to the likely cause of ED, the patient’s general health and other relevant factors.
Possible approaches include lifestyle modification, management of underlying health conditions, psychological support and medical treatment.
Where appropriate, improving general health can form part of ED management.
This may involve:
These measures can also benefit cardiovascular and metabolic health.
When another health condition is contributing to erectile dysfunction, addressing that condition may be an important part of treatment.
For example, management may include improving control of:
A doctor may also review existing medications if a medicine could be contributing to erectile difficulties.
For some patients, oral prescription medicines belonging to a group known as PDE-5 inhibitors may be considered as part of ED management.
These medicines support the natural erectile response by helping increase blood flow to the penis during sexual stimulation.
They do not automatically produce an erection and do not directly increase sexual desire.
Prescription ED medicines are not appropriate for everyone. A doctor needs to consider your health, medical history and other medicines before determining whether such treatment may be suitable.
Where psychological factors contribute significantly to erectile difficulties, counselling or other psychological support may be helpful.
This can be particularly relevant where there is:
Physical treatment and psychological support are not mutually exclusive. Some patients may benefit from addressing both areas.
Some oral medicines used in the management of erectile dysfunction belong to a class called phosphodiesterase type 5, or PDE-5, inhibitors.
During sexual stimulation, chemical processes in the body allow the smooth muscles of blood vessels supplying the penis to relax. This enables increased blood flow.
PDE-5 inhibitors support this natural physiological response.
Sexual stimulation is still required for these medicines to work. They are not aphrodisiacs and do not cause an automatic erection.
Whether this type of treatment is suitable for an individual requires medical assessment.
Prescription ED medication may interact with other medicines or be unsuitable for people with certain medical conditions.
Before considering treatment, tell your doctor if you have:
You should also tell your doctor about all medicines and health products you are taking, including prescription medication, non-prescription products, supplements and traditional medicines.
This allows your doctor to identify possible interactions or contraindications.