Erectile Dysfunction

Erectile Dysfunction (ED) also referred to as impotence, can have many causes. It is thought to affect upto 50% of men at some point in life. Read our FAQ on ED for further information. 

We offer a range of prescription on medications for the treatment of ED including leading Brands such as Viagra, Cialis and Spedra. Our service is totally confdential and is run by UK Trained and Registered Doctors.

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What is erectile dysfunction (ED)?

Simply, it is the inability to achieve or sustain an erection. It is often referred to as impotence. This section will explain the underlying biology, anatomy.

The Physiology of an erection There are many biochemical, neurological and physiological processes that are involved in achieving a normal erection. 

Tissue structure of the penis

Corpora Cavernosum: These are the ‘erectile tissue’ organised in two columns, they run along the sides of the penis, they expand when filled with additional blood supply during erection. 

Corpus Spongiosum: There is a third column of erectile tissue that runs along the front of the penis. The urethra (urine passing conduit) runs through the corpus spongiosum. 

Tunica Albuginea: A membranous sheath that surrounds the corpora providing structural support. Deep Dorsal Vein: These drains the deoxygenated blood from the glans. 

Penile Artery: Two deep-paired arteries, they provide blood to reach and expand the corpora.   Anatomy of Penile tissue structures

 

Causes of Erectile Dysfunction?

Causes and contributing factors for ED may overlap, broadly there are physical and psychological causes.  

Psychological Causes of ED

Significant stress
Relationship difficulties
Depression
Anxiety
Post-traumatic stress disorder can all contribute to ED.
Performance anxiety

Psychological ED usually occurs during partnered sex, normal erectile function is seen during masturbation.

Night-time or early morning erections are often normal.

The onset of this type of ED is often abrupt, it may coincide with new life-stresses such as job loss, financial problems or bereavement.  

Physical Causes of ED 

Neurology
The limbic system in the brain regulates emotion, it attempts to avoid pain and seek pleasure.

Sexual stimuli activate the amygdala and hypothalamus, they are connected to another part of the deep brain called the basal ganglia which functions as part of the reward system.

Nuclei in the basal ganglia (nucleus accumbens) contain a large concentration of dopaminergic neurons, it is considered the brain’s pleasure centre.

Dopamine signalling plays a central role in sexual arousal and motivation. Activation of dopamine receptors in pelvic nervous system (parasympathetic nerves of the lumbosacral plexus) facilitates erections.

Neurodegenerative
Illnesses such as such as Parkinson’s disease, multiple sclerosis, diabetes, or stroke that disrupt this neurotransmission signalling pathway can cause Erectile Dysfunction.
 

Hormonal
Testosterone is an integral hormone in the erectile physiology.  Testosterone promotes healthy nerve cells particularly of the cavernous nerve (penile). Low levels of testosterone are associated with erectile dysfunction. However, testosterone supplementation may not improve ED in all men.  

Some studies have shown though that testosterone therapy may be helpful and enable PDE-5 inhibitors to work better. Both hypothyroidism and hyperthyroidism can lead to ED and ED.  

Blood vessels
Good vascular health is essential to achieving and maintaining erections. Vascular disease causes 70–80% of non-psychogenic ED in older men.

The underlying mechanism for vascular-related ED involves endothelial dysfunction (cells lining the blood vessels). The regulation of vasodilation is a function of nitric oxide (NO) released by endothelial cells.

NO initiates production of cGMP, this causes smooth muscle relaxation and vasodilation of arteries in the corpus cavernosum.   Side-effects from other medications

Medications
Many medications can contribute to ED, the list below is not exhaustive.

 
-Antidepressants (especially SSRIs such as fluoxetine, sertraline, citalopram)
-Anxiolytics, CNS depressants, and muscle relaxants (lorazepam, cyclobenzaprine).
-Diuretics (HCTZ, spironolactone, triamterene, furosemide)
-Anti-hypertensives (clonidine, enalapril, metoprolol)  

Pornography use
Excessive use of internet pornography can influence brain neuroplasticity, like other addictive substances, pornography causes desensitization and dopamine receptor downregulation, in the severest forms this can lead to the pornography user entering a cycle of binging, craving, and the loss of willpower.

Treating ED

Treating ED doesn't only benefit you during sexual intercourse, it has been shown to has have wide-ranging beneficial effects on other parts of your life too. The resolution of ED can boost your overall self-confidence and self-esteem. This confidence may also help kick start other health beneficial changes in your life such as quitting smoking, increasing exercise and losing weight.

Vacuum Constriction Device
The vacuum constriction device (VCD), colloquially referred to as a “penis pump” was designed by Geddings Osbon in 1974.  Osbon referred to it as a “youth equivalent device” he claims to have personally used it for 20 years without failure  

VCDs works by increasing blood flow to the penis through generating 110–225 mmHg negative pressure and preventing blood from escaping with a constriction ring.  

Although it has shown to benefit some men, there have been reports of VCDs causing an unsatisfactory erection that tends to be purplish, cold, or numb.  

Side effects include bruising of the penile shaft and trapping of ejaculate during orgasm from the constriction band.  

Physical Therapy
Pelvic floor muscles important for maintaining an erection weaken with age. Initiating physical exercise therapy to strengthen the bulbocavernosus and ischiocavernosus muscles can help alleviate ED symptoms in some men.    

Diet, Exercise and weight loss  
Diet Certain foods improve vascular health, this in effect may enhance erectile function. Foods high in nitrates such as beets and leafy greens raise nitric oxide levels, promote normal endothelial function, and reduce blood pressure.  

Pomegranate seeds and juice also improve endothelial function and lower blood pressure while decreasing oxidized and glycated LDL, this keeps the vessel walls healthy and maintains adequate blood flow to the penis.  

Evidence from four clinical trials suggests that the Mediterranean diet (copious intake of vegetables, fruits, extra virgin olive oil, whole grains, nuts, and fish and moderate intake of wine) positively influence sexual function.  

Exercise reduces inflammation, improves vascular function and promotes insulin sensitivity. A recent large study confirms that moderate to vigorous exercise for a minimum of 8 weeks can improve ED.  

Obesity, particularly central obesity is associated with metabolic syndrome, vascular disease and low testosterone levels.  All of these contribute to the development of ED.   Weight loss can significantly improve erectile function.  

Reconditioning from Pornography use 
Reversing ED attributed to frequent pornography use requires the patient to eliminate all pornography, pornography substitutes, pornography recall, and essentially all artificial sexual stimulation.

This allows for reconditioning sexual arousal and erectile ability with real-life partners. Although the time to “reboot” the brain with pornography avoidance is unknown it is suggested upto 5months is required. Further help with regards to counselling should be sought from your own G.P.  

Counselling
Cognitive behavioural therapy, stress management, or couple’s therapy may be appropriate for some men with ED.

Pharmacological therapies
Phosphodiesterase type 5 inhibitors (PDE-5) are the mainstay and proven medical treatment for ED.  

The first and still the most popular medication in this group is Viagra (sildenafil). Alternatives with selective advantages include Tadalafil, Vardenafil and Avanafil, all these are treatment options provided by AccessDoctor.

We understand that this condition may be embarrassing for some men to discuss. This is why we offer our highly confidential service to ensure you receive the most suitable treatment, safely and discretely.

What do I do if my ED symptoms persist?

The first thing to do is discuss this with your own doctor, this will help you to identify any underlying cause. It is also advisable to speak to your partner.  

If this is too difficult, you can discuss this confidentially with one of our doctors. Simply choose a medication you think is suitable and fill in the online consultation service. If need be one of our doctors can speak to you over the phone.  

Our service avoids the need for you to have an awkward face-to-face consultation but still enabling you  to get your treatment delivered to you the next day.