Erectile Disorder ( ED )
Commonly known as Erectile Dysfunction, ED is the persistent or recurrent loss of or inability to achieve an erection to completion of sexual activity (DSM-V & ICD 10 & Beitia 2000).
How common is ED?
Large numbers of men have mild or occasional ED (Johannes et al 2000, Rosen et al 2004, Nicolosi et al 2003). As many as 22% of men in some parts of the world may experience it on a regular basis (Rosen et al 2004)
- Risk increases substantially with age (Johannes et al 2000).
- 5-12% of men seek help (Wylie 2007 & Hatzimouratidis et al 2010).
ED scales and measures
A number of scales exist to measure strength of erection and longevity of erection (Wincze 2004). You can find more detail on this here . If you have suffered for 3 months or more, you can consider it a problem which you may wish to seek help for (Feldman et al 1994 & NIH 1993.)
Causes and risk factors of ED
There are literally dozens of potential causes for ED, these include both biological and psychological causes. You can get more detail about these here . If you want to tell if ED is psychological or physical in nature ask yourself;
‘Do I get hard in the morning or for masturbation? ‘
If you do then it is probably primarily psychological. If you don’t then it is probably physical.
You maybe interested in treatments and there are a lot of options out there. Below you will find an over view of many of them from the common to the unusual. You can find a lot more detail here .
Medical treatments for ED
You will probably be aware of Viagra (Sildenafil), less well known are Tadalafil and Vardenafil. Each has its strengths, limitations and side effects, and as such you should consult your doctor before using them. Testosterone supplementation has also been used but there is little evidence to support it works (Aydin et al 1996). For the most serious cases there are;
- Self-administered penile injection (Wylie 2007).
- Vacuum constriction device (Hatzimouratidis et al 2010).
- Inflatable Penile prostheses (Hatzimouratidis et al 2010).
The lifestyle approach to ED
- Weight loss and exercise – Weight loss has been seen to improve sexual function in younger men, but once in midlife exercise appears to be the most important thing (Esposito Et al’s 2004, Esposito et al 2009, Derby et al’s 2000).
- Diet – levels of Low-density lipoproteins (LDL cholesterol) are directly related to ED (Feldman 1994). Some evidence exists that adopting a diet which promotes lower LDL levels and higher High-density lipoproteins (HDL cholesterol) can improve erectile performance (Aldemir 2011).
- Smoking – Although not a guaranteed cure giving up smoking has been seen to improve erectile function in as little as 24 hours (Gual et al 1998).
- Alcohol consumption – Small amounts of alcohol can aid erectile function (Bacon et al 2006). Sadly larger amounts can cause ED (Miller & Gold 1988).
- Male Kegal exercises – Also known as pelvic floor exercises (PFE). After 12+ weeks practice, about half of men with ED can maintain an erection by tensing these muscles (Dorey et al 2005, Dorey et al 2004, Claes & Baert 1993). Lots of websites show how to do Male Kegal exercises, but a physiotherapist is the best person to teach them.
For more detail
Psychological Approaches to ED – over the years lots of different approaches to ED have been employed, these include
- Couples therapies – a counsellor helps open up discussion between partners. Rarely used on its own these days couples therapy has proven benefits if used in addition to other therapies (Aubin, et al 2009).
- Systematic Desensitisation (SD) & Sensate focus, are forms of graded exposure in which the therapist guides the patient through a series of stress or anxiety producing situation in a state of distraction or . Eventually the relaxation will over ride the anxiety. This can be done either in the imagination or real life. Although not universally effective it can be very powerful with anxiety induced ED. (Kockott et al’s 1975 (Auerbach & Kilmann,1977).
- In Cognitive Behavioural Therapy (CBT) a therapist helps you to examine your beliefs and assumptions, seeking to logically adjust them and then reality test them. In one study, combining couple’s therapy and CBT the majority of participants achieved improvments (Xueqian & Heqin’s 1990).
- Hypnotherapy is an approach which combines the use of any number of psychotherapeutic approaches (including CBT & SD) with the state of hypnosis, to enhance its efficacy. One hypnotherapist treated over 400 ED patients reporting an 80% success rate (Crasilneck and Hall 1985).
For more detail