Fact Sheets

Erectile Dysfunction (Impotence)

Erectile dysfunction is defined as the inability to achieve and/or maintain an
erection that is suitable for penetration. Erectile dysfunction is often referred to as "impotence". However this term is no longer used. It is important to distinguish erectile dysfunction from other forms of sexual problems such as low libido or premature ejaculation.

Erectile dysfunction is an increasing issue in older men. About one third of men over the age of 50 complain of erectile difficulties. It is important to stress that the change in erections with age are not necessarily a physical disorder requiring treatment, often an understanding of the nature of these changes is sufficient treatment alone. The firmness of the erection changes with age and the ability to re-engage in sexual activity increases up to a number of days. An erection is obtained by a process of the spongy tissues in the penis becoming engorged with blood. This vascular process is initiated by a signal from the brain that travels down the spinal cord through the pelvis directing blood vessels in the penis to dilate. There are chemical factors involved in this vascular process and the mechanism that traps the blood in the penis is known as the veno-occlusive mechanism. When this does not work effectively the leakage of blood is known as venous leakage. This commonly occurs when anxiety is present during sexual activity or as a consequence of age and the effects of other medical conditions.

The causes of erectile dysfunction may involve issues around the brain and nervous system, the arteries and veins in the penis and the actual penile spongy tissues. Some medications used to treat medical conditions may affect the erection process and these include blood pressure and cholesterol lowering tablets. Conditions such as high cholesterol, high blood pressure and diabetes may be associated with erectile dysfunction. Peyronie's disease may affect erections. Excessive alcohol intake and substance abuse are other known factors. Treatment of erectile dysfunction may simply involve counselling and explanation of the normal anatomy and physiology of erections. Counselling will certainly benefit relationship issues that may be a cause of or result in erection problems.

A common and popular treatment these days is the use of oral medications known as PDE5 inhibitors. The current products available on the Australian market include ViagraT, CialisT or LevitraT tablets. These medications are effective in most situations but cannot be used if the patient is not fit enough to engage in sexual intercourse and/or is on nitrate medication. A different type of oral medication known as apomorphine is not available in Australia.

A vacuum erection device is a non-invasive treatment that allows an erection to occur by creating a vacuum with a plastic cylinder placed over the flaccid penis. Penile injection therapy has been available for over 10 years. The current prescription injection medication in Australia is Caverject ImpulseT. There are other prescription injection mixtures using Prostaglandin E1 that are prepared by special compounding pharmacies.

In some cases regular treatments are not effective and a further treatment option is to insert a penile prosthesis. This operation is performed by a urologist. Vascular surgery is mainly performed in younger men when trauma has damaged the blood vessels leading to the genitals.

There is much development in treatment for erectile dysfunction currently underway.