Erectile Dysfunction


Patient Information
About Erectile Dysfunction
IMPORTANT. All men with Erectile Dysfunction MUST inform their GPs about it and about their treatment. Erectile Dysfunction (ED) is very common. About half of men between 40 and 70 get ED at least once. ED can be distressing. It is often simple to treat. Anything that interferes with the circulation or with the nervous system can lead to ED. Most men with ED are in reasonable health. ED can have physical and psychological causes, including:

Heart disease and high blood pressure (hypertension),
Diabetes and high cholesterol,
Hormonal problems including under active thyroid,
Some medications (GPs or Pharmacists can advise if regular medication is the cause),
Stress, anxiety, depression and relationship problems,
Abdominal and prostate surgery and spinal and head injury,
Lifestyle, obesity, smoking, alcohol and tiredness and recreational drugs. Sometimes, ED occurs only in certain situations. This suggests the underlying cause is likely to be psychological. If erections do not occur under any circumstances, the underlying cause is likely to be physical.

Anxiety usually makes ED symptoms worse.

When to see a GP
Men must inform their GPs if ED lasts more than a few weeks. GPs will assess the general state of health. ED can be a sign of problems such as heart disease or poor circulation.

GPs will ask about symptoms, overall physical and mental health, sex life, alcohol consumption, drugs, and any medication.

Physical examination may be needed to look for a deformityof penisknow as Peyronie's diseases where the penis is markedly bent to one side.

Glucose, cholesterol and thyroid tests may be needed. More extensive tests are not usually required in men over 40 in whom ED is common.

Treatment of erectile dysfunction
Where there are underlying conditions these should be treated. This does not always help the symptoms of ED. The following may also help:

Changes in lifestyle can sometimes reduce ED
Losing weight (if overweight),
Giving up smoking,
Moderating consumption of alcohol,
Not using illegal drugs, and
Taking regular exercise.

How to take ED tablets
Viagra, Cialis and Levitra work by temporarily increasing the blood flow to the penis. They work only when sexual arousal is also present. If there is no arousal there will be no erection.

Usual starting doses are Viagra 50mg, Cialis 10mg or Levitra 10mg. Your Pharmacist may recommend half doses to start with.

It may be necessary to increase doses to obtain the best results. The maximum single dose for Viagra is 100mg, and for Cialis and Levitra, 20mg as a single dose.

Tablets should be taken about 60 minutes before their action is needed. Levitra starts to work a little more quickly than the others and can take as little as 20 minutes to become active. Taking ED medication with food can delay the onset of action to 2 hours.

Viagra works for about four hours, Cialis for 36 hours and Levitra for 12 hours. Tablets should not be taken more than once in 24 hours.

The dose instruction for low dose daily Cialis 2.5mg or 5mg is: "One tablet daily taken around the same time each day".

Men who need regular ED medication twice or more a week have the option to take low dose Cialis either 2.5mg or 5mg tablets once daily on a continuous basis. The daily dose is low; however Cialis stays in the body for 36 hours and builds up to effective levels when taken daily.

Combinations of Viagra, Levitra and Cialis should not be taken in combination without a break of 36 hours between one medication and another.

Cautions and warnings and side effects
You MUST read the ‘Patient Information Leaflet’ supplied with tablets.

Serious side effects are rare. Possible side effects include: headaches, hot flushes, indigestion, a blocked, or runny, nose, back pain, and temporary disturbances of colour vision.

There are a few serious side effects requiring immediate medical help: Loss of vision or hearing (Rare)
Chest pain with nausea and discomfort (Possible heart pain, rare)
Continuous painful erection lasting 4 or more hours (Priapism, rare)

Alternatives to ED medication
ED sometimes improves without the need for treatment. Briefly, other treatments include:

Hormone therapy (Occasionally used in men with measured hormone deficiency),
Penis pumps and penile implants (Mechanical devices which stiffen the penis),
Alprostadil (A medication injected directly into the penis, or a small tablet placed inside the penis usually producing an erection that lasts for between 5-30 minutes),
Surgery (usually reserved for special cases),
Psychosexual counselling (A form of relationship therapy where sexual, or emotional issues are discussed),
Cognitive behavioural therapy (CBT is based on the principle that the way we feel is partly dependent on the way we think about things).

ED treatment on the NHS
Most men with ED are not eligible for treatment on the NHS. Where men are eligible for NHS treatment a few tablets a month only are allowed.

Men with the following are sometimes eligible; diabetes, multiple sclerosis, Parkinson’s disease, poliomyelitis, prostate cancer, severe pelvic injury, single gene neurological disease, spina bifida, or spinal cord injury or men receiving dialysis for renal failure or where there is a history of radical pelvic surgery, prostatectomy (including transurethral resection of the prostate), or kidney transplant were receiving Caverject®, Erecnos®, MUSE®, Viagra®, or Viridal® for erectile dysfunction, at the expense of the NHS, on 14 September 1998 or in men suffering severe distress as a result of impotence (prescribed in specialist centres only)

Treatment for ED is not usually covered by private medical insurance