ED or erectile dysfunction is as old as humanity itself and there are few men whose equipment has not left them in the lurch at some point in their lives.
In earlier times, a failure to perform was often blamed on witchcraft or a curse, or just accepted as an inevitable result of growing older.
A scientific understanding
There were of course herbal "cures", and spells and incantations, but this was very much a hit-and-miss affair until the advent of modern medicine, which brought about a clear, scientific understanding of exactly how an erection works.
There are many physical and psychological causes of ED, and if the cause can be removed, the symptom should also be resolved.
This is however not as simple as it sounds, and in the case of more stubborn cases of erectile dysfunction medical science has a number of options:
1. Oral medications are a successful erectile dysfunction treatment for many men. They include:
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Levitra, Staxyn)
- Avanafil (Stendra)
In order to achieve an erection, the muscles in your penis need to relax. This allows blood to flow into the corpora cavernosa, causing the organ to become rigid. The above medications work by inhibiting an enzyme called Phosphodiesterase Type 5 (pde5) which normally deactivates a molecule (cGMP) that causes the blood vessels to relax.
2. Self-injections. Oral medication doesn’t work for everyone, and one or a combination of drugs can be injected directly into the penis to obtain an erection. The most common medications are alprostadil, papaverine and phentolamine, which are injected into the side or base of the penis.
3. Testosterone replacement. Before oral medications like Viagra, testosterone was routinely used to treat erectile dysfunction as it is central in the male sexual response, including the desire for sex and the process of getting an erection. Testosterone can be administered in a number of ways, for example orally, by means of an injection, skin patch, or subcutaneous (under the skin) pellet.
4. Penile implants may work for men who find ED medications ineffective. This involves the surgical implantation of devices into both sides of the penis. The implants may be either inflatable or semirigid rods.
Inflatable cylinders in the penis are filled by means of a pump from a reservoir in the abdominal area, causing an erection. This means that one can have an erection whenever and for as long as one likes.
Semirigid rods are made from braided stainless steel wires or articulating plastic disks. The rods are bent upward to have sex and pointed down to conceal the penis. The disadvantage is that the device is always firm.
5. Psychological counselling. Some examples of psychological causes of erectile dysfunction are fear, anxiety, depression, attitudes toward sex and mental blocks.
Men with severe depression tend to suffer from ED, and in most cases depression needs to be treated before ED treatment will be successful.
If psychological problems are causing tension in your relationship, your doctor might suggest that one or both of you visit a psychologist or counsellor.
6. Lifestyle changes. According to NHS Choices, ED can often be improved by making changes to your lifestyle, for example:
- Losing weight if you are overweight
- Quitting smoking
- Cutting down on alcohol
- Staying away from drugs
- Getting enough exercise
- Reducing your stress levels
7. Muse (medicated urethral system for erection) suppository is a dissolvable pellet that is inserted into the opening of the penis. It contains prostaglandin PGE-1, which causes an erection by relaxing muscles in the penis.
Muse takes about 10 minutes to work and the erection may last up to an hour. Side effects may however include aching, burning, redness and a bit of of bleeding.
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