Blast of sound that can give your love life a lift

Though they may not want to talk about it, at  any one time around one in ten British men suffers from erectile dysfunction  (ED) — the inability to have and maintain an erection.

Sometimes known as impotence, the condition  can be triggered by stress, depression and anxiety.

However, around 70 per cent of cases are  caused by the damaging effects of vascular disease such as furring of the  arteries, high blood pressure and diabetes, says Roland Donat, urological  surgeon at the Western General Hospital in Edinburgh.

This is because erections are caused by extra  blood flow into the penis and a reduction of blood flow out of the  penis.

The worry is that many men don’t realise that  problems in the bedroom are often a marker for an underlying health  concern.

‘Being overweight, excessive drinking and  smoking are linked to impotence because they can cause vascular disease,’ he  says.

Obesity is also associated with low  testosterone levels, which can lead to difficulties. A hormone problem can be  treated with testosterone gels and patches.

Because of the possibility of underlying  health problems, ED should be investigated by your doctor, no matter how  embarrassing this might seem, says Robert Calvert, urologist at the Royal  Liverpool Hospital.

‘You should be given screening tests for  blood pressure, cholesterol and sugar levels,’ he says.

There are a variety of treatments available  for the problem, depending on the severity and cause. Here, we asked the experts  to explain the options, their pros and cons. . .

BLOOD  SUPPLY BOOSTING DRUGS

Known as phosphodiesterase-5 inhibitors,  drugs such as Viagra boost the blood supply to the penis by dilating blood  vessels.

Viagra needs to be taken 30 to 45 minutes  before lovemaking and lasts around four hours.

Another drug, Cialis, has a longer acting  effect and works for around 30 to 48 hours, allowing for greater spontaneity.  Neither drug can be used by angina sufferers as they interfere with the  medication.

They should be taken on a relatively empty  stomach as a heavy meal can reduce absorption by the stomach and so the  effectiveness of the drug.

ADVANTAGES: Tablets are the least invasive  way to deal with ED. If used correctly, the success rate is around 80 per cent,  but the user has to be sufficiently aroused.

‘You can’t sit back and wait for it to work  while watching Coronation Street,’ says Vijay Sangar, a urological surgeon at  Wythenshawe Hospital in Manchester.

In the 20 per cent of cases where the drugs  don’t work there is probably more extensive damage to the blood vessels.

DISADVANTAGES: The drugs can cause hot  flushes and headaches because of increased blood flow to the skin and brain.

Rarely they can interfere with nerve  receptors in the eye, causing vision to have a blue tint, which can be  permanent.

Cialis sometimes causes temporary backache  because of dilation of blood vessels in  the back.

In rare cases, drugs can cause a sustained  erection because of excessive blood flow to the penis — known as priapism. Go to  A&E immediately if an erection lasts more than three hours, as it can cause  irreversible damage.

AVAILABILITY: As with all erection  treatments, NHS availability is limited to patients with recognised health  problems such as diabetes or those who have had prostate surgery. Otherwise,  they are available on private prescription or from some chemists for £8 per  tablet.

VACUUM PUMP

Here the penis is placed in a plastic  cylinder from which the air is sucked out to create a vacuum. This causes blood  to rush to the penis, causing an erection.

Once the penis is engorged, a ring is placed  around the base of the shaft to prevent blood leaking back out; this is removed  after sex.

ADVANTAGES: Non-invasive.

DISADVANTAGES: Some people may find the penis  does not feel sturdy. If the ring is left on for too long it can cause  bruising.

AVAILABILITY: This is available on the NHS  for those with recognised medical conditions such as diabetes or following  prostate surgery.

Otherwise, it is advisable to buy only from a  respected medical supplier such as mediwatch.co.uk. An Erectease vacuum pump  costs around £112.

A  BLAST OF SOUNDWAVES

An intense form of soundwaves, similar to  ultrasound, is used to trigger the regrowth of blood vessels and improve blood  flow.

As with traditional ultrasound, a layer of  jelly is applied to the area and then the device is pointed at five places  along the shaft of the penis. The treatment is done twice a week for three  weeks, followed by a break after which the treatment is repeated for another  three weeks.

This is a new treatment and studies so far  have only been able to show that the effects last for two years.

ADVANTAGES: Non-invasive and not painful.

DISADVANTAGES: It is used only on men who  have already tried Viagra without success and whose ED is caused by vascular  disease,  says Mr Sangar.

AVAILABILITY: At present, the treatment is  available only privately, at a cost of at least £2,000.

TINY  BALLOONS

Inflatable devices or bendable rods are  implanted in the penis under general anaesthetic to act  as a ‘prop’.

The simplest type consists of a pair of  malleable rods, made from medical plastic or silicone, which are surgically  implanted within the erection chambers (spaces within the penis that fill with  blood).

The penis will always then be semi-rigid and  only needs to be lifted into the erect position.

The alternative is a device that consists of  three connected pieces: two small, deflated balloons, a fluid-filled reservoir  and a pump.

The balloons are surgically inserted in the  penis and the reservoir is placed under the groin muscle. The pump sits under  the loose skin of the scrotal sac.

Pressing on the pump pushes the fluid into  the balloons and the penis should become erect within 30 seconds. Pushing on a  deflation valve at the base of the pump drains the fluid back into the  reservoir.

ADVANTAGES: More spontaneity, says urologist  Chris Eden at the Royal Guildford Hospital and the Hampshire Clinic,  Basingstoke.

DISADVANTAGES: Patients must avoid sex for  six weeks afterwards as the body heals, and take anti-biotics for a week — there  is a risk of infection in 2 per cent of cases. It may be painful for around a  week, too. Inflatable implants may require replacing after eight to ten years;  the rods are permanent.

AVAILABILITY: Unlikely to be available on the  NHS unless you’re in an approved patient group and other treatments such as  Viagra have failed. The cost privately is around £6,000.

COUNSELLING

ED is often linked to psychological issues.  Counselling sessions, such as psychosexual therapy, can help with underlying  relationship problems or depression.

ADVANTAGES: Doesn’t use medication or  invasive treatments.

DISADVANTAGES: ‘It will work only with the  right sort of patients,’ says Mr Donat. ‘Many men, even with psychological  issues, simply want a quick fix. And even if there is a psychological component,  it’s still vital to see a GP first to rule out any underlying clinical  reason.’

AVAILABILITY: A GP can organise a referral.  Otherwise, private treatment costs £40 to £60 per session.

MUSCLE RELAXING JABS

This treatment involves injecting a naturally  occurring chemical called prostaglandin E1 into the penile tissues. This causes  the blood vessels to widen by relaxing the thin layer of muscle in the blood  vessel wall. Unlike Viagra, the medication can induce an erection without  external stimuli. It has around a 60 per cent success rate.

ADVANTAGES: Injections work faster than pills — it can take as little as ten minutes and last up to four hours. A GP should  show you how to use it the first time.

DISADVANTAGES: Every time it is used, a small  amount of scar tissue forms and over the years this can lead to pain and prevent  erections, says Majid Shabbir, a urologist at Guys Hospital in London.

AVAILABILITY: If not considered eligible on  the NHS, the jabs are available through private prescription or from some  pharmacies, costing £39 for one treatment.

PELLETS

Sponge-like pellets, around 3mm long and 1mm  in diameter, containing the drug prostaglandin E1 are pushed into the end of the  penis into the ureter (the tube that carries urine and semen) using a thin rod.

Though this is self-administered, a GP would  usually demonstrate the first time. The medicine works by relaxing blood vessels  to improve blood flow.

ADVANTAGES: Good for those who are needle  phobic.

DISADVANTAGES: A lower success rate than  other treatments, at 30 to 50 per cent. Some people experience a burning pain or  some temporary discomfort in the ureter when they place the pellets. Needs to be  applied about 40 minutes before sex.

AVAILABILITY: Rarely prescribed on the NHS.  On private prescription, this treatment costs around £16 a dose.

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