Commonly known as impotence, this distressing and worrying condition can affect us all at some time in our lives. One man in four has some difficulty in getting an erection satisfactory for intercourse after the age of 50 years- sometimes younger men can be affected.

What causes Erectile Dysfunction?

There are a wide number of reasons why some men unfortunately have some difficulty with achieving a satisfactory erection. Some of these are

· Age- as we get older, the nerves and blood vessels simply wear out

· Hardening of the arteries- the blood vessels taking the blood to the penis don’t work as well as they used to

· Diabetes

· Some drugs- especially some heart, blood pressure and nerve drugs

· Some operations- especially on the pelvis, prostate and nerves in the lower back

· Alcohol- we’ve all heard of “Brewer’s Droop”

· Smoking

· some diseases of the nervous system

· Anxiety, Tiredness and Overwork- sometimes one temporary problem with an erection, perhaps through tiredness, starts a vicious circle of worry and anxiety that keeps repeating itself

· Relationship Problems

· any serious illness can cause lowering of performance throughout the body

· etc., etc.

What Treatments Are There?

Please understand that the situation with regard to treatment on the NHS is far from clear at time of writing- June 1999. The matter revolves around what the politicians and the Primary Care Group is prepared to pay for on the NHS- see comments overleaf.

If it’s been going on for more than a few weeks, you might have a problem that you need help with. You can -

Ì put up with it...... or......

Ì consider psychological treatments. If you can get a decent erection in some circumstances (especially if it is not likely you will have intercourse shortly), e.g. watching something erotic on TV, or waking in the morning, this may be worth considering. Your usual doctor may help you, or may refer you to a special clinic. However, sometimes the confidence boost of getting a decent erection with a treatment such as alprostadil injection or Viagra tablets is all that you need.

Ì try a vacuum pump A hand vacuum pump sucks blood into the penis, and a ring at the base of the penis stops the blood escaping. It produces a coolish penis, but is often hard enough for intercourse. The device costs you over £100. Some people find the pumping-up gets in the way of intercourse, and dislike the flabby erection they tend to get.

Ì use injections into the penis You learn to give yourself an injection of a drug called alprostadil or thymoxamine into your penis to produce an erection. This works for about 60- 70% of men in about 30 minutes. It very occasionally can cause a persistent erection, which needs the blood draining out with needles in hospital. Your usual GP can prescribe this on the NHS, or is available privately. Some people feel inhibited about injecting their penis, and others find it spoils their spontaneity.

Ì use pellets inserted into your penis. You learn to insert pellets of alprostadil into your penis 20-30 minutes before intercourse. Success rates and potential problems are similar to the injection. Again, your doctor can prescribe this for you on the NHS.

Ì try Viagra tablets. Viagra (sildenafil) is a drug that sensitises the penis to erotic stimulation. If an erotic situation occurs within an hour or so of taking a Viagra tablet, about 70-80% of men will develop a decent erection, sufficient for intercourse. Some men get headache (16%), facial flushing (10%), indigestion (7%), dizziness and colour visual disturbances (3%). It must not be taken with certain other drugs- particularly nitrates or nicorandil for angina. Very, very rarely, death has occurred following its use- it is thought unaccustomed exertion is to blame. There are three strengths available. It can only be taken once in 24 hours.

Ì try apomorphine (Uprima) tablets, which work in a slightly different way to Viagra. They are dissolved under the tongue about 20 minutes before anticipated need. They can cause nausea, headache, dizziness, yawning, sore throat, sleepiness, pain , cough, sweating , flushing & taste problems. They must not be taken by anyone who has had a recent heart attack or who has unstable angina.

Ì have a penis implant. A bendable, but solid rod can be implanted into your penis. Can help those who find this acceptable. Inflatable reservoirs containing hydraulic fluid can be implanted into your lower abdomen, to pump up when the need arises. NHS funding for these is few and far between.

Does Sexual Orientation Matter?

No. All the treatments work in similar manner for heterosexual or homosexual men. None of the drug treatments are currently recommended for women.

Am I Too Old?

No. Age is not a bar; provided you are in reasonable shape for intercourse, not taking any nitrate angina drugs and your partner wishes to resume intercourse, perhaps after a break of many years. You should discuss this with your partner prior to making an appointment.

What is available on the NHS?

NHS Regulations mean that your NHS GP can prescribe certain treatments (injections, tablets & pills) on the NHS for certain categories of patient only. This is limited to one treatment per week maximum. Eligible patients are those who-

· have had previous radical prostatic surgery or their prostate removed or treated for prostate cancer (surgery or other treatments)

· have treatment for renal failure (transplant and dialysis)

· spinal cord and severe pelvic injury

· diabetes

· multiple sclerosis

· single gene neurological disease

· poliomyelitis

· spina bifida

· Parkinson’s Disease

· Those men receiving treatment for impotence on 14 September 1998

· Additionally, there may be some men who will be defined by NHS Guidelines as suffering from “severe emotional distress” who may be prescribed treatments following assessment by a Urologist

Private prescriptions for sildenafil (Viagra) cost about £30 for 4 tablets.

In the current unsatisfactory situation, if you are not in one of the categories of eligible patients above, your options are-

· To wait and see how the Government finally decides to ration Erectile Dysfunction Services- though it seems unlikely the situation will change from above.

· To go and see a doctor outside the Surgery privately (NHS Regulations mean that an NHS GP cannot charge for his time to patients on his NHS list for “General Medical Services”- whether Impotence Treatments are “General Medical Services” is not yet defined by the Government.) A private consultation with one of the local Urologists costs upwards of £65.

· To be put on the Waiting List to see a Urologist on the NHS – this is currently around a year

If you feel as unhappy as we do at the Filey Surgery about the current situation, you should lobby our MP, Mr. J. Greenway: our local Primary Care Group at Ryedale Building, 60 Piccadilly, York YO1 9PE, asking them how they intend to commission GP’s time to provide a first class NHS Erectile Dysfunction Service.