9/5/2016 Erectiledysfunction(impotence)TreatmentNHSChoices

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Yourhealth,yourchoices
Erectiledysfunction(impotence)Treatment

Treatingerectiledysfunction
Ifyouhaveerectiledysfunction(ED),treatmentwilldependonwhat'scausingit.

Thevarioustreatmentsforerectiledysfunctionareoutlinedbelow.Youcanalsoreadasummaryoftheprosandconsofthetreatmentsforerectile
dysfunction,allowingyoutocompareyourtreatmentoptions.

Treatingunderlyingconditions

Ifyourerectiledysfunctioniscausedbyanunderlyinghealthcondition,suchasheartdiseaseordiabetes,thatconditionmayneedtobetreatedfirst.Insome
cases,treatingtheunderlyingcausemayalsoresolvetheproblem.

Ifyouaretakingmedicationthatcancauseerectiledysfunction,theremaybeanalternative.Itisimportantnevertostoptakingaprescribedmedication
unlessyouareadvisedtodosobyyourGPoranotherqualifiedhealthcareprofessionalresponsibleforyourcare.

Lifestylechanges

Erectiledysfunctioncanoftenbeimprovedbymakingchangestoyourlifestyle,suchas:

losingweightifyouareoverweight
givingupsmoking
cuttingbackyouralcoholconsumption
nottakingillegaldrugs
exercisingregularly
reducingstress

Aswellashelpingtoimproveyourerectiledysfunction,thesechangescanalsoimproveyourgeneralhealthandmayhelptoreduceyourriskof
cardiovasculardisease(conditionsthataffectyourheartandbloodvessels).

Readmoreaboutpreventingcardiovasculardisease.

Phosphodiesterase5(PDE5)inhibitors

Phosphodiesterase5(PDE5)inhibitorsareoneofthemostwidelyusedandeffectivetypesofmedicationfortreatingerectiledysfunction.Theyworkby
temporarilyincreasingthebloodflowtoyourpenis.

InEngland,fourPDE5inhibitorsareavailablefortreatingerectiledysfunction.Theyare:

sildenafilsoldunderthebrandnameViagra
tadalafilsoldunderthebrandnameCialis
vardenafilsoldunderthebrandnameLevitra
avanafilsoldunderthebrandnameSpedra

Sildenafil,vardenafilandavanafilworkforabouteighthoursandtheyaredesignedtowork'ondemand'.Tadalafillastsforupto36hoursandismore
suitableifyourequiretreatmentforalongerperiodoftime,forexample,overaweekend.

DependingonthetypeofPDE5inhibitoryouaretakingandthedose,itshouldtakeabout3060minutesbeforeitstartstowork.Withsildenafil,vardenafil
andavanafil,youshouldbeabletohavesexfromoneto10hoursaftertakingthemedicine.Aftertakingtadalafil,theeffectswilllastforupto36hours.

Itmaytakelongertonoticetheeffectsifthetabletistakenwithfood,soit'sbesttotakeitonanemptystomach.Youcantheneatafteranhourwithout
affectingthemedicine.

Onlytakeonetabletwithina24hourperiod.

YourGPshouldexplainthebenefitsofeachmedicationandhowitworks.Thechoicemaydependon:

howoftenyouaresexuallyactive
whetheryouhavetriedanyofthemedicationsbefore

Therehavebeenmanystudiestotesttheeffectivenessofthesemedications.Ingeneral,atleasttwothirdsofmenreporthavingimprovederectionsafter
takingoneofthesemedicines.

IfyoudonotfindthatPDE5inhibitorsareeffectiveitmaybebecause:

youhavenotwaitedlongenoughaftertakingthedose
youhavewaitedtoolongaftertakingthedose
thedoseisnothighenough
youhavenothadenoughsexualstimulation

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Thesemedicationsaretriggeredbysexualstimulation,soyoualsoneedtobearousedforittowork.

Warnings

PDE5inhibitorsshouldbeusedwithcautioninmenwhohavecardiovasculardisease,suchascoronaryheartdisease.However,sexualactivityisalsolikely
tobebeneficialforyourcardiovascularhealth.YoushoulddiscusstherisksandbenefitswithyourGP.

PDE5inhibitorsshouldalsobeusedwithcautioninmenwhohaveanatomicalproblemswiththeirpenis,suchasPeyronie'sdisease(aconditionthat
affectsthetissueofthepenis).

PDE5inhibitorsshouldalsobeusedwithcautioninmenwho:

areatriskofpriapismapainfulerectionthatlastsforseveralhours
arealsotakinglonglastingalphablockersamedicationusedtotreatanumberofconditions,suchashighbloodpressure(hypertension)

DonottakePDE5inhibitorsifyouarealsotakingmedicinesorrecreationaldrugsthatcontainnitrates.Thecombinationofthetwo
substancescanhaveadangerouseffectonyourheart.

Organicnitratesareoftenusedtotreatangina,andbutylnitrateisarecreationaldrugthatismorecommonlyknownas'poppers'.

YouarealsowarnednottotakePDE5inhibitorsifyou:

havebeenadvisednottotakepartinsexualactivityorinactivitiesthatwidenyourbloodvessels
havelowbloodpressure(hypotension)
haverecentlyhadastrokeamedicalemergencythatoccurswhenthebloodsupplytothebrainisinterrupted
haveunstableanginaanunderlyingheartconditionthatcausessymptomssuchaschestpain
havehadaheartattackamedicalemergencywherethebloodsupplytotheheartissuddenlyblocked
haveahistoryofnonarteriticanteriorischaemicopticneuropathyaneyeconditionthatcausesasuddenlossofvision

Sideeffects

PDE5inhibitorscancausesomesideeffects,including:

headachesandmigraines
flushing(redness)
indigestion
nausea(feelingsick)
vomiting(beingsick)
ablockedorrunnynose
backpain
visiondisturbances
musclepain

NHSprescriptions

YourGPcanprescribesildenafiltoanyonewitherectiledysfunctionaslongasitissafetodoso(seewarningsabove).OtherPDE5inhibitorsmayonlybe
prescribedbasedonyourindividualcircumstances.

Insomecasesyoumayneedtopaythefullcostofthemedication.TheexactpricewilldependonthedosageandyourlocalpharmacybutfourPDE5tablets
usuallycostbetween17and30.

Readmoreabouthelpwithprescriptioncosts.

MenwiththefollowingmedicalconditionsareentitledtoNHSprescriptionsforPDE5inhibitors:

diabetes
multiplesclerosis
Parkinsonsdisease
polio
prostatecancer
spinabifida
certaingeneticconditions,suchasHuntington'sdisease

MenwhoarereceivingorhavereceivedcertainmedicaltreatmentsmayalsobeentitledtoNHSprescriptionsforPDE5inhibitors.Thesetreatments
include:

pelvicsurgerywhichisoftenusedtoremovetumours(growths)ortotreatconditionssuchasincontinence
surgicalremovaloftheprostategland(prostatectomy)whichisoftenusedtotreatprostatecancer
dialysisforkidneyfailure
kidneytransplant

Incertaincircumstances,somespecialistcentresmayprovideanNHSprescriptionforPDE5inhibitors.Forexample,ifEDiscausingyouseveredistress.

Vacuumpumps

Avacuumpumpconsistsofaclearplastictubethatisconnectedtoapump,whichiseitherhandorbatteryoperated.

Youplaceyourpenisinthetubeandpumpoutalloftheair.Thiscreatesavacuumthatcausesthebloodtofillyourpenis,makingiterect.Youthenplacea
rubberringaroundthebaseofyourpenistokeepthebloodinplace,allowingyoutomaintainanerectionforaround30minutes.

Itmaytakeseveralattemptstolearnhowtousethepumpcorrectly,buttheyareusuallyeffective.Afterusingavacuumpump,nineoutof10menareableto
havesex,regardlessofthecauseoftheirED.

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Considerations

Youshouldnotuseavacuumpumpifyouhaveableedingdisorderorifyouaretakinganticoagulantmedicines,whichreducetheabilityofyourbloodtoclot.

Sideeffectsofvacuumpumpsincludepainorbruising,althoughtheseoccurinlessthanathirdofmen.

MenwhoqualifyforNHSprescriptionsforerectiledysfunctiontreatmentsmaybeabletogetavacuumpumpontheNHS(seeaboveformoredetails).
However,somemenwillneedtobuyone.

TheSexualAdviceAssociationproducesanumberoffactsheets,includingoneonvacuumpumpsthatprovidesdetailsofcompaniesthatsupplythem.

Alprostadil

Ifyourerectiledysfunctiondoesn'trespondtotreatment,oryouareunableorunwillingtousePDE5inhibitorsoravacuumpump,youmaybegivena
medicinecalledalprostadil.Thisisasynthetic(manmade)hormonethathelpstostimulatebloodflowtothepenis.

Alprostadilisavailableas:

aninjectiondirectlyintoyourpenisthisiscalledanintracavernosalinjection
asmallpelletplacedinsideyoururethra(thetubethatcarriesurinefromyourbladdertothetipofyourpenis)thisiscalledurethralapplication

Youmaybetrainedtocorrectlyinjectorinsertalprostadil.Ifyourpartnerispregnant,useacondomduringsexifyouareinsertingalprostadilintoyoururethra.

Alprostadilwillusuallyproduceanerectionafterfiveto15minutes.Howlongtheerectionlastswilldependonthedose.

InmenwhodidnotrespondtoPDE5inhibitors,alprostadilinjectionsweresuccessfulin85outof100men.Alprostadilinsertedintotheurethraissuccessful
foruptotwothirdsofmen.

Warnings

Alprostadilshouldnotbeused:

inmenatriskofpriapism(apainfulerectionthatlastsforseveralhours)forexample,thosewithsicklecellanaemia
alongsideothererectiledysfunctionmedications
ifyouhaveapenileimplantorifyouhavebeenadvisedtoavoidsexualactivity

Urethralapplicationmayalsonotbeusedin:

somemenwhohaveanatomicalproblemswiththeirpenis(conditionsthataffectthephysicalstructureofthepenis)
menwhohaveinfectionsoftheirpenis,suchasbalanitis(inflammationoftheheadofthepenis)

Sideeffects

Alprostadilcancausesomesideeffectsincluding:

changesinyourbloodpressure
dizziness
headache
paininyourpenis
urethralburningorbleeding
reactionsatthesiteoftheinjection,suchasswelling

NHSprescriptions

AswithPDE5inhibitors,NHSprescriptionsforalprostadilmayonlybeavailableformenwithparticularhealthconditionsorthosereceivingsometypesof
medicaltreatments.Ifyouneedtopaythefullprescriptioncost,asingleinjectionofalprostadilcostsaround8to22,dependingonthedose.Asingledose
ofalprostadilforurethralapplicationisaround10.

Hormonetherapy

Ifahormonalconditioniscausingerectiledysfunction,youmaybereferredtoanendocrinologist(whospecialisesinthetreatmentofhormonalconditions).

Hormonesarechemicalsproducedbythebody.Manyhormonalconditionscanbetreatedusinginjectionsofsynthetic(manmade)hormonestorestore
normalhormonelevels.

Surgery

Surgeryforerectiledysfunctionisusuallyonlyrecommendedifallothertreatmentmethodshavefailed.Itmayalsobeconsideredin:

youngermenwhohaveexperiencedseriousinjurytotheirpelvicareaforexample,inacaraccident
menwithasignificantanatomicalproblemwiththeirpenis

Inthepast,surgerywasusediftherewasclearevidenceofablockagetothebloodsupplyofthepenis.Thesurgeoncouldunblockthebloodvesselsto
restoreanormalsupplyofblood.However,researchnowsuggeststhatthelongtermresultsofthistypeofsurgeryarepoor,soit'sunlikelytobeused.

Penileimplants

Penileimplantsareatypeofsurgerythatmaybeconsidered.Thesecanbe:

semirigidimplantswhichmaybesuitableforoldermenwhodonothavesexregularly
inflatableimplantswhichconsistoftwoorthreepartsthatcanbeinflatedtogiveamorenaturalerection

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PenileimplantsarenotusuallyavailableontheNHSandinflatableimplantsmaybeveryexpensive.However,aroundthreequartersofmenreportbeing
satisfiedwiththeresultsofthistypeofsurgery.

Complications

Aswithalltypesofsurgery,havingpenileimplantsinsertedcarriesariskofinfection.Ifyoutakepreventativeantibiotics,therateofinfectionisaroundtwoor
threein100.Mechanicalproblemswiththeimplantsmayoccurwithinfiveyearsinfivepercentofcases.

Psychologicaltreatments

Ifyourerectiledysfunctionhasanunderlyingpsychologicalcausethenyoumaybenefitfromatypeoftreatmentcalledsensatefocus.

Ifconditionssuchasanxietyordepressionarecausingyourerectiledysfunction,youmaybenefitfromcounselling(atalkingtherapy).

Sensatefocus

Sensatefocusisatypeofsextherapythatyouandyourpartnercompletetogether.Itstartswithyoubothagreeingnottohavesexforanumberofweeksor
months.Duringthistime,youcanstilltoucheachother,butnotinthegenitalarea(orawomansbreasts).Theideaistoexploreyourbodiesknowingthatyou
willnothavesex.

Aftertheagreedperiodoftimehaspassed,youcangraduallybegintouchingeachothersgenitalareas.Youcanalsobegintouseyourmouthtotouchyour
partner,forexample,lickingorkissing,them.Thiscanbuilduptoincludepenetrativesex.

YoucanfindoutmoreaboutsensatefocusfromtheCollegeofSexualandRelationshipTherapists(COSRT).

Psychosexualcounselling

Psychosexualcounsellingisaformofrelationshiptherapywhereyouandyourpartnercandiscussanysexualoremotionalissuesthatmaybecontributingto
yourerectiledysfunction.Bytalkingabouttheissues,youmaybeabletoreduceanyanxietythatyouhaveandovercomeyourerectiledysfunction.

Thecounsellorcanalsoprovideyouwithsomepracticaladviceaboutsex,suchashowtomakeeffectiveuseofothertreatmentsforerectiledysfunctionto
improveyoursexlife.

Forinformationandadviceaboutsexualarousal,readaboutgoodsex.

Psychosexualcounsellingmaytaketimetoworkandtheresultsachievedhavebeenmixed.

Cognitivebehaviouraltherapy(CBT)

Cognitivebehaviouraltherapy(CBT)isanotherformofcounsellingthatmaybeusefulifyouhaveerectiledysfunction.CBTisbasedontheprinciplethatthe
wayyoufeelispartlydependentonthewayyouthinkaboutthings.CBThelpsyourealisethatyourproblemsareoftencreatedbyyourmindset.Itisnotthe
situationitselfthatismakingyouunhappy,buthowyouthinkaboutitandreacttoit.

YourCBTtherapistcanhelpyoutoidentifyanyunhelpfulorunrealisticthoughtsthatmaybecontributingtoyourerectiledysfunctionforexample,todowith:

yourselfesteem(thewayyoufeelaboutyourself)
yoursexuality
yourpersonalrelationships

YourCBTtherapistwillbeabletohelpyoutoadoptmorerealisticandhelpfulthoughtsabouttheseissues.

Readmoreaboutcognitivebehaviouraltherapy.

Pelvicfloormuscleexercises

Somestudieshavesuggestedthat,inafewcases,itmaybebeneficialtoexerciseyourpelvicfloormuscles.Theseareagroupofmusclesaroundthe
undersideofthebladderandrectum,aswellasatthebaseofthepenis.

Pelvicfloormuscleexerciseinvolvesstrengtheningandtrainingthemusclesusedtocontroltheanus(backpassage)andurinate.IfyourGPfeelsthistypeof
exercisecouldbebeneficial,thenyoumaywanttodiscussitwithaphysiotherapisttolearnitcorrectly.

Bystrengtheningandtrainingthesemuscles,youmaybeabletoreducethesymptomsoferectiledysfunction.

Complementarytherapies

Somecomplementarytherapies,suchasacupuncture,haveclaimedtotreaterectiledysfunction.However,thereislittleevidencetheyareuseful.

Insomecases,theymayevenincludeingredientsthatcouldinteractwithothermedicationsandcausesideeffects.

AlwaysspeaktoyourGPbeforeusinganycomplementarytherapies.

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Counsellingmayberequirediftheunderlyingcauseofyourerectiledysfunctionispsychological

ManagingEDontheinternet

Aserectiledysfunction(ED)canbeanembarrassingproblem,somemenaretemptedtolookfortreatmentontheirown.Itispossibletobuymedicationover
theinternet,butyoushouldalwaysexercisecautionastherearemanysitesthatoffercounterfeitmedicines.Thesemedicationsarenotregulatedandthe
amountofactiveingredientsinthemcanvary.Theycouldcauseunpleasantsideeffectsortheymaynotbesuitableforyou.

AlwaysensurethatanyonlinedoctorserviceisregisteredwiththeCareQualityCommission(CQC),thatalldoctorsareregisteredwiththeGeneralMedical
Council(GMC)andthatanyprescribedmedicinescomefromapharmacywhichisregisteredintheUK.

Itisalsopossiblethatanunderlyinghealthconditionmaybecausingyourerectiledysfunctionandgettingthisdiagnosedandtreatedmayresolveyour
symptoms.Therefore,alwaysseeyourGPforafullcheckup.

Pagelastreviewed:23/09/2014

Nextreviewdue:23/07/2017

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