What is erectile dysfunction?
First, let’s define the problem. ED means an inability to get a good enough erection to achieve satisfactory intercourse.

Some sufferers can’t get a hard-on at all; others get one but it isn’t firm enough to penetrate the partner; and others can manage penetration for a bit, but then lose it

Why does ED occur?

ED is very common, and it occurs for a variety of reasons and at different ages.

Teenagers and young men
In younger males, the most frequent cause is anxiety – particularly nervousness about having sex, about causing a pregnancy, or about using a condom. A lot of men in this age group complain that they ‘can’t get on with a condom’ because as soon as they try to put it on, they lose their ‘stiffy'.

Middle age
Common causes in this age group are overwork, stress, guilt and bereavement (ED often happens when a widowed man tries to form a new sexual relationship). A few cases are due to diabetes.

Post-middle age
In this group of men, ED gets commoner with increasing age. Nonetheless, 70 per cent of all 70-year-olds are sexually potent.

It is now clear that in a very high proportion of cases, the problem is due to deterioration in the blood vessels that carry blood into the penis. Research which was carried out in 2007 suggests that in addition there may often be deterioration in the arteries of the brain or the heart.

Therefore older men with ED should take care to protect themselves against strokes and heart attacks – for example by keeping their blood pressure and cholesterol down.

What treatments are now available?

Treatment depends on the cause of the ED. For instance, psychological causes may require:

• commonsense advice to one or both partners

• counselling

• psychotherapy

• relationship counselling.

Personally, I feel that in some cases of psychologically-induced ED, it’s worth trying erection-aiding drugs to help ‘kick-start’ the man back into action and boost his confidence. Not all doctors agree with me.

The treatments for ED that have a physical origin are listed below.

Erection-aiding drugs

Oral drugs which help produce an erection in response to sexual stimulation have revolutionised the treatment of ED over the last eight years. They don’t work for everybody, but they do work for the majority – even in diabetes. They can also help people with neurological and spinal problems.

Also, the choice of available drugs means that if one particular drug doesn’t suit you, it’s well worth trying one of the others.

There are now only three orally-administered drugs available in the UK. They all have side effects, only a few of which we can list here. For more information, read the package insert leaflet, and if in doubt ask your doctor.

It is not safe for some people to use these drugs, and some medications interact dangerously with them. Therefore, before going on any of these pills you should always see a doctor, talk things over with him, and have a physical check-up.

The oral drugs currently available are:

Sildenafil
Widens the bloods vessels, so giving an erection – provided there is some sexual stimulation. In most men, works within an hour. Effect lasts for about four hours. (This doesn't mean the erection lasts for four hours, rather that an erection can be produced for up to four hours after taking a tablet.) Easily blocked by food in the stomach.

The most common side effects are headache, visual disturbances, blocked nose, flushed face, indigestion, palpitations – and dizziness after getting out of bed too quickly! Blue vision occurs at higher doses. sildenafil is very dangerous with certain heart drugs. It interacts with many medications. Do not drink grapefruit juice on the day of use, because that pushes up the blood level of the drug.

In April 2005, a report from the University of Minnesota suggested that a small group of men have suffered blindness as a result of sildenafil use. It was claimed that the drug may rarely cause a serious eye condition called ‘non-arteritic ischaemic optic atrophy.’ In 2008, it is apparent that a very small number of British men have suffered similar eye problems. If you are taking sildenafil, you should ask your doctor to keep you informed of any further research on this development.

Tadalafil
Works in the same way as sildenafil. Now popular with a lot of men, because its effects last so long – at least 12 hours in most cases, which means sex can be more spontaneous. Manufacturers claim it is not blocked by food.

Side effects are similar to those of sildenafil, but it can also cause back pain and muscle pain. Interactions with other drugs and with grapefruit juice are similar to those of sildenafil, but also clashes with the antibiotic clarithromycin and the sedative phenobarbital. tadalafil is very similar in structure to sildenafil and there have been several reports of blindness occurring while on it.

vardenafil
Works in same way. Side effects and interactions are similar to those of sildenafil. Not as long-lasting as tadalafil. There have been a few reports of blindness.

Please note the alleged relationship between these three drugs and blindness is the subject of litigation. A 'cause and effect' has still not been proved.

The above three drugs are supposed to be ‘prescription-only’ in the UK and most other countries. However, Boots the chemists has opened several centres where men can obtain sildenafil (for a fee) after careful counselling from a pharmacist. There is back-up from a group of private doctors. If this scheme turns out to be a success, then sildenafil and similar drugs may become more widely available over the counter.