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Urology 2020

Why erectile dysfunction is more common than you think

photo credit: Getty images / bernardbodo

Mr Giulio Garaffa MD PhD FECSM FRCS (Eng)

Consultant Uro-Andrologist, Honorary Senior Lecturer in Urology, The Institute of Urology, University College London Hospitals, and Associate Editor of the Sexual Medicine Journal Open Access

While men might find themselves embarrassed to talk about erectile dysfunction, the reality is that it’s incredibly common and can be easily treated in virtually all cases.

“The topic of erectile dysfunction is taboo and not much talked about. But it’s important for men to know that the problem is very common and that the risk of developing erectile dysfunction increases with age,” says Mr Giulio Garaffa, Consultant Uro-Andrologist at the University College London Hospitals.

Current statistics show that more than 60% of men aged 50 may suffer from erectile dysfunction and, importantly, it could also be a warning sign that things aren’t right in your cardiovascular system and in your health in general. As the arteries carry blood to the penis, a problem with maintaining an erection warrants a check of your whole cardiovascular health. Since erectile dysfunction often indicates that your cardiovascular system is not healthy, it is not surprising that both heart attacks and strokes are more common in men suffering from erectile dysfunction.

Erectile dysfunction-solving pills might not always be appropriate – check with your GP

Mr Garaffa says men should talk to their GP as soon as they realise that they might suffer from the condition. He says: “There is definitely a need to find the cause of erectile dysfunction and identify any cardiovascular risk factors, such as high blood pressure, raised cholesterol and triglycerides, raised blood sugar, obesity, lack of physical activity, tobacco smoke and excessive alcohol intake. Men with erectile dysfunction are twice as likely to develop heart attacks and strokes as men who do not have erectile dysfunction, so the aim is to slow down cardiovascular disease in general.”

In terms of treating erectile dysfunction there are a variety of options, with PDE5-inhibitor pills being the first line treatment in most men. These medications help to relax the arteries in the penis, which produces an increased blood flow to the organ and ultimately a better erection. Although they are available over the counter, and are effective in a large number of patients, it is still worth seeing your GP to make sure further health checks are carried out – and to make sure that this treatment is appropriate; some health conditions are not compatible with these medications.

There is also a range of injections and topical creams that work by increasing the blood flow to the penis. If the above treatments are ineffective, poorly tolerated or contraindicated, a vacuum pump can be offered to the patient.

Another promising, non-surgical option is low intensity shockwave therapy, which rejuvenates the tissue inside the penis, improving blood flow and ultimately the quality of the erections. Various studies have shown that this treatment is safe and well tolerated. Encouraging results in terms of long-term improvement of erections are common in carefully selected patients.

Surgical solutions after non-invasive options have failed to work

Surgical treatments for erectile dysfunction are recommended for men if the treatments mentioned fail to work or are contraindicated.

Mr Garaffa explains: “In experienced hands, penile prosthesis implantation has a very high success rate and will allow the patient to have the rigidity necessary to resume sexual activity in full confidence preserving completely sensation and climax.  Many men find that the implant is very discreet and from the outside the penis will look perfectly normal. In general, best results are achieved with inflatable penile prostheses, which are designed to create both flaccidity and erect state.”

While surgery is only recommended after other treatments fail, are contraindicated or poorly tolerated, there is often embarrassment from patients who may not be aware that it is still a safe and effective treatment.

“I would suggest that any man interested to know more about the cause and treatments of erectile dysfunction visits the British Society of Urological Surgeons and downloads the free patients’ information leaflets there.”

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