Erectile dysfunction

Erectile dysfunction (ED) is a sexual disorder characterised by insufficiently hard erections. It is also sometimes called "impotence."

How common is erectile dysfunction in men?

ED is a common condition, and its incidence increases with age. Around 5% of men under the age of 20 years experience ED. This increases to 10–30% of men aged 20–30 years, 30–40% of men aged 30–40 years, 40–50% of men aged 40–50 years, 50–60% of men aged 50–60 years, and 60–80% of men over 60 years of age.

The word "impotence" scares every man, but it is not always incurable. In the past, the leading causes of impotence were thought to be psychogenic disorders or a lack of testosterone. However, studies over the past few decades have shown that the most common cause of impotence is organic changes in the mechanism of erection. Problems with ejaculation and decreased libido are not impotence.


Is impotence forever?

Even in the most challenging cases, modern medical techniques can help patients regain their masculinity and everyday sex life. Age does not matter: even at 80 years or older, you can have a full and satisfying sex life, using individually selected therapies and following the doctor's directions to manage your ED.

Buying expensive drugs is not necessary to increase potency; in most cases, the treatment needed is for the underlying cause of the problem. To choose the right treatment method, you need a medical evaluation and advice. Trying to treat yourself can be dangerous.

  • Vascular problems (such as hypertension and impaired blood flow to the genital organs)
  • Diabetes (which also causes nervous system disorders, such as diabetic neuropathy)
  • Hypertension (high blood pressure)
  • Low testosterone levels.
  • Injuries to the genitals, the nerves supplying the genitals
  • Alcohol, smoking, drugs, and abuse of anabolic steroids
  • Stress (including chronic stress and acute stressful situations)

Many tests and a complete examination of the patient are required to form a clear understanding of the cause of ED in each patient before developing a treatment plan. The male reproductive system is examined for the presence of inflammatory diseases, sexually transmitted infections must be excluded, and the level of sex hormones can be examined.

Tests include:

  • General blood tests (for blood cell counts and markers of inflammation)
  • Tests for blood sugar levels.
  • Blood tests for hormone levels like testosterone.
  • Biochemistry blood tests for lipoproteins and cholesterol.
  • General urine analysis for the presence of blood, protein, inflammatory markers
  • Urine culture for the existence of bacteria.
  • Penile doppler

Visual examination and palpation can be helpful to determine signs of hormone abnormalities, for example:

  • If the size of the testicles does not correspond to the anatomical norms.
  • A lack of facial hair or its complete absence.
  • Breast tissue enlargement (gynecomastia).

Examination by an andrologist can also indicate:

  • Presence of a weakened arterial pulse in the lower limbs (a sign of atherosclerosis).
  • Damage or abnormality of the anatomical structure of the penis

Treatment of ED

The treatment of impotence is always targeted: that is, it is personalised to take into account the patient's age, physical and psychological or emotional state, general health, and tolerance of or reasons to avoid some specific types of drugs. 

Understanding the exact cause is essential to getting the proper treatment! Dr Fabio Castiglione can conduct a thorough assessment at his central London clinic to determine the cause of your problem and provide the optimal treatment.

The treatment course is personalised, taking into account each man's physical and emotional characteristics and tailoring the drugs or treatments offered to the cause of the ED.

Notably, impotence can be associated with psychological concerns, so the patient might need to consult a psychologist.

If Dr Castiglione feels that consultation with a psychotherapist would be helpful, he can refer you to a specialist in this field.

Therefore, Dr Castiglione will create a personalised therapy plan to help the patient have more robust erections and have a satisfying sex life. He will choose tailor-made treatments that target the different underlying causes of erectile dysfunction.

  • As-needed solutions (allow patients to get erections before and during intercourse)
    • Oral medications (belonging to the PDE5 inhibitor category) such as Viagra®, Cialis®, Levitra® and Spedra®.
  • Topical drugs such as:
    • Penile injections.
    • Alprostadil intraurethral pellets (MUSE®).
    • Alprostadil cream (Vitaros®).
  • Vacuum devices (vacuum pumps).
  • Penile prostheses.
  • Shock wave therapy.
  • Pelvic floor strengthening exercises.
  • The innovative P-Shocks® treatments
  • Vascular surgery to increase blood flow or reduce venous leakage.

As we have seen, there is no single solution to ED, and the subject of ED treatments remains an active area of research. The most important thing for a patient with this disorder is to approach the topic of assessment and treatment with an open mind. The goal of therapy is to restore the normal sexual function of patients. Dr Castiglione will use the most up-to-date techniques to identify the cause of your ED so he can offer the correct method to help you return to having a full and satisfying sex life.

Leading on from this introduction to ED therapies, Dr Fabio Castiglione and the staff at his London clinic will be happy to assist you if you have further questions on the subject.