Erectile Dysfunction/Impotence

Bay Cluster Network

This month we focus on erectile dysfunction. This is the inability to attain and maintain an erection sufficient for sexual performance. It is a very common problem encountered in general practice particularly in men over 40 and can have significant impact on the quality of life of sufferers and their partners.


Erectile dysfunction symptoms might include:-

  • Trouble getting an erection
  • Trouble maintaining an erection
  • Reduced sexual desire


Male sexual arousal is a complex process involving lots of pathways involving the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can occur from a problem with any of these.  Furthermore, stress and mental health problems can also cause or worsen erectile dysfunction.

Physical causes

  • Approximately 8 in 10 cases of ED in over 40s are caused by physical conditions. Examples of which include:-
  • Reduced blood flow to penis caused by narrowing of arteries which carry blood to the penis. Conditions which increase
  • your chance of narrowing of blood vessels include high blood pressure, high
  • cholesterol and smoking
  • Nerve damage conditions such as Parkinson’s disease and multiple sclerosis can affect the nerve supply to the penis.
  • Diabetes this can affect blood vessels and nerves to the penis.
  • Hormonal causes include a lack of testosterone.
  • Side effects of certain medication including antidepressants and beta blockers.
  • Alcohol and drug abuse
  • Long distance cycling
  • ED due to physical causes tends to develop slowly over time.

 Psychological causes

Mental health conditions are common causes leading to the development of ED. Examples include:-

  • Stress
  • Anxiety
  • Depression

ED due to psychological causes tend to develop suddenly. Symptoms may resolve as mental state improves.

A psychological cause for ED is more likely if you can get an erection at certain times.


The best way to prevent ED is to make healthy lifestyle choices and to manage exisiting health conditions. These may include:-

  • Smoking cessation, limiting or abstaining from alcohol and avoiding drug use
  • Regular exercise
  • Stress reduction
  • Seeking help for underlying mental health conditions
  • Couples counselling or sex therapy can also be useful


The most commonly used treatment include:- oral tablets. The most well-known example is Sildenafil (Viagra).  Other tablets within the same drug group are also available. These act to increase the blood flow to the penis.  They are taken prior to sexual intercourse. These tablets are successful in approximately 8 out of 10 cases.

Alternative treatment options include topical cream applied to the penis, injection treatment to the base of the penis, urethral medication (the tube which passes urine and opens at the end of the penis), vacuum devices and penile implants.

If you develop symptoms ED it is best to see your GP or GP pharmacist. They will discuss the problem, review any medication you may be taking, perform a physical examination and may organise some tests in order to identify the underlying cause to provide the optimal treatment.





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