Impotence Q&As
Published by Bupa's health information team, July 2009.
Answers to questions about impotence
This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.
- What other treatments are available apart from medicines?
- Is there a link between impotence and heart disease?
- Can you tell me more about the medicines available to treat impotence?
- Can hypopituitarism caused by a serious head injury lead to impotence?
What other treatments are available apart from medicines?
Tablets are the main treatment for impotence. However, there is a range of others available if these don't work for you, or if you have other medical conditions that prevent you from taking them.
Explanation
If you have impotence, your GP is likely to suggest tablets as the first treatment to try and for many men these work well. However, around one in every four men find that they don't work and some men can't take them because of other medical conditions. There are a number of other treatments that can be tried instead.
Injections are a very effective treatment for impotence. You or your partner injects a medicine into the shaft of your penis just before you want an erection. This allows blood to enter your penis more easily, increasing the high pressure flow of blood to it. The trapped blood then gives you an erection. You should get an erection within about 15 minutes of having the injection - this should last for about half an hour.
Another treatment that uses the same medicine is medicated urethral system for erection (MUSE). When you want an erection, you place a small pellet inside your urethra using a special applicator - this doesn't hurt. You should get an erection about 15 minutes later which will last for between half an hour and an hour. It works for about half of men who try it.
Vacuum devices are an effective way of getting an erection - there are very few side-effects. You place a plastic cylinder over your penis and create an airtight seal using a lubricating jelly. You then pump the air out of the cylinder to create a vacuum and this causes blood to rush into the penis. When your penis becomes erect, you slip a plastic ring from off the cylinder and down to the base of your penis. The ring traps the blood in your penis and can give you an erection for about half an hour.
If you have tried other treatments but they haven't worked, you may be offered a penile prosthesis. There are two kinds - semi-rigid and inflatable. A semi-rigid prosthesis consists of two rods put inside your penis to provide some stiffness. An inflatable prosthesis is a splint put inside your penis which you can inflate using a pump placed under the skin in your scrotum. You will need to have an operation to insert both types of prosthesis.
Speak to your GP for more information about any of these treatments.
As emotional and mental issues are sometimes the cause of impotence or can make it worse, many men find that sex therapy with their partner can help. You may find that therapy can help you to build up a sexual relationship again after a period when you have had problems or haven't been having sex. Sex therapy also works well with other treatments for impotence.
Further information
- Sexual Dysfunction Association
www.sda.uk.net
Sources
- British Society for Sexual Medicine guidelines on the management of erectile dysfunction. www.bssm.org.uk, accessed 4 February 2009
- Injection and urethral treatments for erectile dysfunction. Sexual Dysfunction Association. www.sda.uk.net, accessed 4 February 2009
- The vacuum pump. Sexual Dysfunction Association. www.sda.uk.net, accessed 4 February 2009
- Impotence or erectile dysfunction. Sexual Dysfunction Association. www.sda.uk.net, accessed 4 February 2009
Is there a link between impotence and heart disease?
Yes. One of the main causes of heart disease is fatty deposits which narrow and eventually block the arteries that supply your heart. This process can also affect the blood vessels that supply your penis, which can lead to impotence. Because the blood vessels in your penis are smaller than those which supply your heart, difficulty getting an erection is often one of the first signs that they are becoming narrowed.
Explanation
The most common cause of impotence is a problem with the blood flow to your penis. Lots of small blood vessels supply your penis and these can become furred up and start to narrow. Eventually they can become completely blocked by fatty deposits.
The blood vessels that supply your penis are smaller than those that supply your heart muscles, so a problem getting an erection is often one of the first signs that your blood vessels are becoming narrowed. More than half of men with impotence may have heart disease that they don't know about.
If you're having problems with impotence, it's a good idea to see your GP. He or she can also assess your risk of developing heart disease in the future. Your GP will check your cholesterol levels and blood pressure and ask you about your lifestyle, for example whether you smoke and how active you are. He or she can then work out your risk of developing heart disease over the next 10 years. Your GP may suggest that you make changes to your lifestyle such as trying to lose excess weight or giving up smoking to help reduce your risk of heart disease. These may also help improve your impotence as well.
Further information
- Sexual Dysfunction Association
www.sda.uk.net
Sources
- British Society for Sexual Medicine guidelines on the management of erectile dysfunction. British Society for Sexual Medicine. www.bssm.org.uk, accessed 3 February 2009
- Erectile dysfunction and the heart. Sexual Dysfunction Association. www.sda.uk.net, accessed 3 February 2009
- Erectile dysfunction. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 3 February 2009
Can you tell me more about the medicines available to treat impotence?
There are three medicines available to treat impotence - they are called phosphodiesterase type-5 (PDE5) inhibitors. They all work in a similar way and are equally effective, but their effects last for different lengths of time. They work well for about three out of four men who take them and usually have few side-effects.
Explanation
The three PDE5 inhibitor medicines are called sildenafil, tadalafil and vardenafil. They work by relaxing the blood vessels in your penis allowing blood to flow into it - this gives you an erection. They don't increase your libido so you will still need sexual stimulation.
The effects of sildenafil and vardenafil last for around four hours whereas tadalafil lasts for 24 hours, sometimes longer. This makes sildenafil and vardenafil a good choice if you need occasional help to get an erection whereas tadalafil is more useful if you want to have sex over a longer period. All the medicines take at least 30 minutes to start having an effect. If you have just had a large meal it may take longer.
You may need to try different tablets at different doses until you find the one that works for you. Don't take more than the maximum recommended dose as it won't make the tablet any more effective but it will increase your chance of having side-effects. Don't take more than one tablet a day.
About three-quarters of men find these medicines effective and most have few side-effects. You can also take PDE5 inhibitors if you have other medical conditions like diabetes or have had surgery to remove your prostate. However, you shouldn't take PDE5 inhibitors if:
- you're taking other treatments for impotence
- you're taking medicines called nitrates - this includes medicines like isosorbide mononitrate or glycerol trinitrate spray for heart conditions and angina
- you take recreational drugs called poppers (amyl nitrate)
- you have been told that being sexually active may cause you problems - for example if you have serious heart problems
You will only be able to receive these medicines on the NHS if you have a specific medical condition, such as diabetes, multiple sclerosis or Parkinson's disease. You may also be eligible if you have had major pelvic surgery, spinal injury or kidney failure. If your impotence is having a serious effect on your relationships and mental health, certain specialists are also able to prescribe PDE5 inhibitors on the NHS. Speak to your GP to make sure that you're healthy enough to be sexually active.
Further information
- Sexual Dysfunction Association
www.sda.uk.net - British National Formulary
www.bnf.org
Sources
- Oral treatments for impotence. Sexual Dysfunction Association. www.sda.uk.net, accessed 4 February
- Erectile dysfunction. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 4 February 2009
- British Society for Sexual Medicine guidelines on the management of erectile dysfunction. British Society for Sexual Medicine. www.bssm.org.uk, accessed 4 February 2009
- Simon C, Everitt H, Birtwistle J, Stevenson B. Oxford handbook of general practice. 1st ed. Oxford: Oxford University Press, 2004
Can hypopituitarism caused by a serious head injury lead to impotence?
It's possible. If you have an underactive pituitary gland (hypopituitarism) this can lead to reduced production of certain hormones (chemicals occurring naturally in your body) called gonadotrophins. These trigger the release of the male sex hormone testosterone and control the production of sperm.
Explanation
If you have a condition known as hypopituitarism, this means that your pituitary gland doesn't produce enough of the hormones it usually releases. Your pituitary gland produces a number of hormones including two of those involved with reproduction, sexual characteristics and fertility. These are called the gonadotrophins.
If your pituitary gland doesn't produce enough of the gonadotrophins, it can lead to a condition known as hypogonadism. In men this can cause symptoms such as less hair on the face and body, a reduced libido and impotence.
Hypopituitarism usually occurs as a result of a benign (not cancerous) tumour. However, more rarely it can be caused by an infection, serious blood loss or a serious head injury that causes damage to the pituitary gland. Therefore, it's possible that if you have had a serious head injury, even if it happened some years ago, you may be at risk of impotence. Speak to your GP if you're concerned that a past injury to your head may be causing you sexual problems.
Further information
- The Pituitary Foundation
0845 450 0375
www.pituitary.org.uk
Sources
- Hypogonadism and infertility. A guide for men. The Pituitary Foundation. www.pituitary.org.uk, accessed 5 February 2009
- For medical professionals. Hypopituitarism. The Pituitary Foundation. www.pituitary.org.uk, accessed 5 February 2009
- Hypopituitarism. The Pituitary Foundation. www.pituitary.org.uk, accessed 5 February 2009
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This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: July 2009
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