Patient information from the BMJ Group
Erection problems
Erection problems
If you have problems getting an erection, you're not on your own. More than 2
million men in the UK have erection problems. Doctors see men with this problem
all the time. And once you see your doctor, there are good treatments that can

What are erection problems?
Most men have trouble getting an erection at some point. It can happen for all sorts ofreasons. But when doctors talk about erection problems, they mean that you can't usuallykeep an erection long enough to have sex.
For many men, erection problems happen because of something physical. An injury, anillness, or problems with your hormones can all cause erection problems. Some medicinescan cause erection problems as a side effect. But your emotions can also play a part.
Stress, unhappiness, and depression can all cause erection problems.
What are the symptoms?
Some men with erection problems can't get an erection at all. For others, the problemcomes and goes. Some men can get an erection, but it doesn't last long enough or isn’tfirm enough to have satisfying sex.
Men who have erection problems often don't like to ask for help. But there are at leasttwo good reasons for seeing a doctor. First, there are treatments that can probably helpyou. Second, erection problems can be an early warning of serious health problems, likediabetes and heart disease. Few men with erection problems will have these conditions.
But your doctor may suggest tests to check for other health problems, just to be safe.
What treatments work?
Most men can find a treatment that helps them have erections again.
An occasional side effect of drugs for erection problems is an erection that doesn't godown. If you have an erection for longer than about four hours, you need to get medicalhelp straight away. Having an erection for too long can damage your penis.
Drug treatments
You've probably heard of Viagra. It's the brand name of a drug called sildenafil. And
there are two other drugs that work in a similar way. They're called tadalafil (brand name
Cialis) and vardenafil (Levitra).You take them as tablets.You need to take them between
half an hour and an hour before you want to have sex.
BMJ Publishing Group Limited 2013. All rights reserved.
Erection problems
There's lots of research to show that these drugs work. They help about 7 or 8 out of 10men have firmer, longer-lasting erections. They may also help you and your partner enjoysex more. These drugs seem to work no matter what's causing your erection problems.
They'll probably help even if you have heart problems, prostate cancer, diabetes, or aninjury to your spinal cord.
Some men get side effects, but they're usually mild. You may get a headache, getheartburn, or turn red in the face. The side effects aren't usually bad enough for men tostop taking their treatment. There have been rare cases of men losing some of their sightwhile taking these drugs. There isn't enough research to say whether these drugs coulddamage your sight. But you should get help straight away if you have problems with yourvision while you're taking them.
It's dangerous to take sildenafil, tadalafil, or vardenafil together with drugs called nitrates.
You could get very low blood pressure or even die. Nitrates are used to treat a heartproblem called angina. Some examples are isosorbide dinitrate, isosorbide mononitrate,and glyceryl trinitrate (sometimes called nitroglycerin).
Apomorphine (Uprima) is another drug for erection problems. It works in a different way
to Viagra. You take it as a tablet that you dissolve under your tongue about 20 minutes
before you want to have sex.
Apomorphine works for about half the men who take it. There's no research comparingit with Viagra or similar drugs. But one advantage is that it doesn't seem to cause anyserious problems for men taking nitrate drugs.
About 1 in 10 men who take apomorphine feel sick. But this side effect tends to wear offafter they've used the drug for a while.
A drug called alprostadil can also help, but you have to inject it into the base of your
penis or put it in your penis as pellets. The pellets come in an automatic dispenser. You
put a thin tube into your penis, then press a button to release the pellet. Brand names
for alprostadil injections include Caverject and Viridal Duo. The brand name for the pellets
is Muse. If your doctor suggests this treatment, he or she will explain how to use it
Alprostadil injections work for about 9 in 10 men. The pellets help 6 in 10 to 7 in 10 men.
Some research found that alprostadil injections worked just as well as Viagra.
Alprostadil can have side effects. Some men get pain or an ache in their penis. Givingyourself an injection can be painful. A few men who take alprostadil as an injection geta lump of thickened tissue in their penis.
Drug treatment and the NHS
Drug treatments for erection problems aren't always free on the NHS. They're free if youhave erection problems because of some illnesses, because of an injury, or as a sideeffect of an operation. You may also get free drug treatment if you're suffering severedistress because of your erection problems. For example, you may be having trouble inyour relationship, or find it hard to socialise or go to work.
BMJ Publishing Group Limited 2013. All rights reserved.
Erection problems
Even if you don't qualify for NHS treatment, you can still be prescribed drugs for erectionproblems by your usual doctor. But you'll have to pay for the drugs at the chemist. Pricesvary, so it's worth phoning a few local chemists to see where's cheapest.
It's legal in the UK for a pharmacy to sell drugs on the internet. But you'll still need adoctor's prescription. Lots of companies sell treatments for erection problems on theinternet, and it isn’t always easy to tell which ones are reliable. If you choose an onlinepharmacy, make sure they're registered with the Royal Pharmaceutical Society. You cancheck at their website (http://www.rpsgb.org.uk).
A few pharmacies have made special arrangements to sell Viagra over the counter. Youwon't need a doctor's prescription, but you'll have a detailed check-up with a pharmacist.
However, this scheme isn't available in most parts of the UK.
Talking treatments
If your erection problems are linked to your thoughts or emotions, and not a physicalproblem, your doctor may suggest a talking treatment (psychotherapy). You can see atherapist on your own or with your partner.
If you have psychosexual therapy (also called sex therapy), a counsellor listens to your
problems and makes suggestions. For example, they may help you find ways of being
relaxed with your partner, or teach you to understand the feelings you get from your body
during sex. Interpersonal therapy involves talking about your relationships and important
events in your life. Cognitive behaviour therapy is a practical treatment that helps you
find ways of coping with problems and avoid unhelpful ways of thinking.
There's not much research on talking treatments for erection problems. In one study,interpersonal therapy and psychosexual therapy both helped. About 8 in 10 men whohad interpersonal therapy were still better after a year, compared with 4 in 10 men whohad psychosexual therapy. But the study was too small to be sure about how well thesetreatments work.
It can be difficult to get talking treatments on the NHS. An organisation called Relateoffers counselling for all kinds of relationship and sexual problems.You can contact themthrough their website (http://www.relate.org.uk).
Other treatments
Ginseng and yohimbine are both herbal remedies for erection problems. A pure version
of yohimbine is available as a prescription drug. There's some research to suggest these
treatments can help, but it's a good idea to talk to your doctor before you try them. Herbal
treatments can have side effects and interfere with other drugs that you're taking.
You shouldn't take yohimbine if you're taking antidepressants; have heart, liver, or kidneyproblems; or have high blood pressure. Between about 1 and 3 in 10 men get side effectssuch as feeling anxious, getting headaches, or needing to urinate more often. In onesmall study of yohimbine, one man stopped taking it because he got high blood pressure.
Another stopped because he got heart palpitations (an abnormal heartbeat).
BMJ Publishing Group Limited 2013. All rights reserved.
Erection problems
The research on ginseng didn't talk about side effects. However, ginseng can interferewith some medicines. For example, it may make your blood sugar too low if you're takingcertain drugs for diabetes. It can also make warfarin and other blood-thinning drugs notwork as well as they should.
Vacuum pumps have a plastic tube that's connected to a pump. You fit the tube over
your penis and push it against your groin. Then you work the pump. This sucks blood
into your penis and gives you an erection. You need to put a special elastic band around
the base of your penis to keep it firm while you have sex. You shouldn't keep this band
on for more than about half an hour.
There's not much research on vacuum pumps. One small study found that they helpedmen get erections but not necessarily enjoy sex more. After using a pump, some mengot pain, bruising, or damaged skin on their penis. In one study, 1 in 6 men stopped usingthe pump, or used it less often, because of the side effects.
What will happen to me?
You may have thought of erection problems as something you just had to put up with,or even a normal part of getting older. But there are treatments that work for most men.
If you have treatment, your erection problems and your sex life are likely to get better.
It's also worth remembering that there are lots of ways to give and receive sexual pleasure.
If you have a partner, it's often helpful for them to understand your difficulties and for youto approach them together.
This information is aimed at a UK patient audience. This information however does not replace medical advice.
If you have a medical problem please see your doctor. for this content.
For more information about this condition and sources of the information contained in this leaflet please visit the BestHealth websiteThese leaflets are reviewed annually.
BMJ Publishing Group Limited 2013. All rights reserved.
Last published: Aug 13, 2013

Source: http://www.clinicalevidence.org/x/pdf/clinical-evidence/en-gb/summary/532203.pdf

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