or occasionally losing one too quickly, does not indicate Erectile Dysfunction. The key word is “occasionally”.  The following four pointers should help make the definition a bit more precise.  ED may very well be present if:

    1. Frequently or all the time you cannot get a sufficient erection or sexual penetration.
    2. The level of hardness of your erection is not sufficient for adequate penetration until you ejaculate.
    3. Even if you get hard and penetrate her vagina you lose the erection before you ejaculate.
    4. You experience ED with certain partners and not others.

Very few men go throughout life without experiencing occasional failure to attain or maintain an erection. This usually results from stress, tiredness, anxiety, or excessive alcohol consumption. This is nothing to worry about.

    • 20-29 years: 9.2%
    • 30-39 years: 8.4%
    • 40-49 years: 13.1%
    • 50-59 years: 33.5%
    • 60-69 years: 51.5%
    • 70-79 years: 69.2%
    • 80 + years: 76.2%

Regrettably, only about 10% of sufferers actually receive treatment. This is a pity as ED can be treated in most cases and for all men to enjoy one of life’s most beautiful experiences: sex.

psychological and physical causes. Occasional ED in nothing to worry about. However, our socialisation sometimes makes men worry about it. This introduces psychological sources which may also be exacerbated by negative partner reactions. They may set the scene for a more persistent problem due to "fear of failure" or “performance anxiety”. The man becomes so preoccupied with previous ED encounters negative emotional conditions negate the arousal feelings associated with sexual stimulation. This in turn, sets him up for another ED encounter. Psychological causes: Generally, the onset of ED in men who can achieve erections under some circumstances but not others suggest a psychological cause. Triggering factors vary and could be partner, stress and general anxiety related which provide negative conditions for arousal.

Psychological causes of erectile dysfunction include:
    • Anxiety from one's performance and high expectations
    • Stress and anxiety from work or home
    • Marital conflicts and dissatisfaction (as can also occur with premature ejaculation)
    • Depression
    • Sexual boredom
    • Unresolved sexual orientation Until about 25 years ago,
ED was considered to be caused almost entirely by psychological factors. With research, we now know that physical conditions are present in about 75% of male sufferers. Physical causes: Men whose erectile dysfunction is of a physical origin often experience a gradual onset of erectile failure which tends to occur with all sexual activities.

Physical causes of erectile dysfunction include:
    • Deficient blood flow to the penis such as resulting from blocked arteries     • Excessive drainage of blood from the penis ("venous leak")
    • Damage or diseases affecting the nerves or erectile tissue that go to or from the penis
    • Hormone abnormalities
    • Genetic abnormalities
    • Diseases such as heart conditions, diabetes, kidney and liver failure
    • Side effect of prescribed drugs
    • Alcoholism, drug abuse and high cholesterol
    • Heavy smoking

Risk Factors for Erectile Dysfunction
Risk factors to look out for diagnosis of an ED condition are as follows: Medical condition such as Diabetes ( refer to Diabetes and ED), Heart Disease (refer to Heart Disease and ED), Hypogonadism ( reduced function of the Testes); Psychological issues (e.g. anxiety, stress or depression) Lifestyle factors (e.g. physical inactivity, excessive alcohol or smoking, party drugs) which can all affect ED. They are usually interconnected. These risk factors increase with the onset of Age. Therefore early recognition of ED is important as it may indicate other medical conditions and a holistic approach with due consideration of each condition is the appropriate way for the diagnosis and management of patients with ED. The sources of ED are complex and hence it is imperative to identify the source so that treatment can be targeted. This is the basis of our Therapy Program. Don’t fall into the trap of quick fix drugs, herbs or potions that guarantee “immediate rock hard erections” or to immediately make you “last longer” all night. Taking multiple drugs for various medical conditions has been confirmed as an independent source of ED. Research reported in the British Journal of Urology found that, generally, men who take more medications have a higher propensity to experience ED problems. This confirms the inter connection between medical conditions and ED. The most common medications are: antihypertensives (beta blockers, thiazides, and clonidine) and antidepressants (selective serotonin reuptake inhibitors, tricyclics, MAO inhibitors). A host of over-the-counter medications can also cause ED. These include the acid blockers Zantac and Tagamet, the antihistamine Benadryl, and the painkiller naproxen. The baldness drug Propecia has also been linked to erectile dysfunction as well as loss of libido, according to a study from Boston University School of Medicine. Therefore, don't underestimate this source if you are taking medications for various health conditions, including diabetes, hypertension, and depression.

As your GP has knowledge of your medical history it makes sense to consult your GP first. But keep in mind that general medical courses do not adequately deal with the issues leaving most GPs under-prepared to deal with the condition. Even if a patient overcomes his anxiety to discuss the problem with his GP, many GPs do not have specialist therapeutic strategies in place to deal with the issue.  Some GPs have set up clinics within their surgeries and are able to offer a full range of treatments. Finally, we recommend you be prepared, as the development of effective treatment depends as much as anything on a readiness for self help.

The importance of early Treatment of ED
ED can be related to Heart Disease and hence the importance of early detection of ED and proper diagnosis to reduce the risks of Heart Disease. Research has shown that the risk of heart disease
(cardiovascular) mortality is greater in men with ED.
Research has also shown that , almost as many men die of cancer related causes as of cardiovascular causes, with a higher proportion of oncological deaths occurring sooner subsequent to the first manifestation of ED. ISSM: Article first published online: 22 MAR 2011

Depending on the source of your ED condition possible treatments or combinations are

• Sex and/or couple's therapy
• Oral Treatments: Currently four effective oral drugs are available
but research is continuing for more.
• Transurethral therapy: A small pellet of drug is introduced into the urethra.
• Intracavernosal injection therapy: The patient (or his partner) is taught to inject a drug directly into the shaft of the penis when he wants an erection.
• Vacuum constriction devices.
• Hormone treatment: Only a small proportion of cases of erectile
dysfunction are caused by hormone abnormalities. The most frequent hormone abnormality is a reduced level of testosterone (male sex hormone) which can be restored by appropriate testosterone replacement. It is unwise to take testosterone preparations unless laboratory investigations confirm deficiency.
• Penile prosthesis: As implantation of penile prosthesis causes destruction of erectile tissue, they should never be considered until other forms of treatment have been tried.
• Surgical treatments: A few cases of erectile dysfunction that are caused by abnormalities in blood-flow into and out of the penis can be treated by surgery.

What about Counterfeit Drugs – Source: ISSM
Counterfeit drugs are a significant threat to public health. In most studies of the content of counterfeit drugs, the counterfeit product does not contain the amount or type of drug claimed by the product packaging. In many cases, the counterfeit drug contains pharmacological substances not named by the product’s packaging, some of which are illegal and dangerous. Deaths and serious illnesses have been caused by the presence of unnamed pharmacological products in counterfeit drug products. It is impossible for a patient or a healthcare practitioner to know whether or not the stated content of a counterfeit drug is accurate or whether dangerous substances have been added to a product.
Physicians have a role to play in patient education about counterfeit drugs. Because of the risk of serious illness or death, physicians should warn patients not to use counterfeit drugs of any type. Patients should obtain medications only from a reputable pharmacy. It is unethical for physicians to condone the use of counterfeit drugs, including PDE5-inhibitors, in any circumstances.

What if the Drugs don’t work?
In practice, doctors require 6-8 attempts at the right dose before they conclude that the prescribed drugs don’t work. So, if you’re finding the tablets aren’t working after only one or two doses, keep trying.

• Aim for a healthy weight – overweight and obesity can directly affect
erectile function and some of the associated factors such as low testosterone levels, depression and sleep apnoea.
• Regular exercise – there are many well documented benefits. It may even boost testosterone levels which in turn may help achieve more regular erections.
• Quit smoking - Tobacco has a harmful affect on circulation and good blood flow is needed for good erections. Research has proven men who smoke cigarettes have a greater chance of developing ED than men who don’t.
• A balanced diet - may help to lower cholesterol levels and in turn reduce the chance of cholesterol blocking your arteries, which reduces the blood flow needed to achieve an erection.
• Responsible drinking - heavy drinking reduces the ability to have an erection. Long-term, excessive drinking can cause serious problems - nerve damage, liver damage and hormone imbalances; several good reasons to take it easy on the alcohol and have regular alcohol free days.
• Reduce stress and fatigue – being physically and emotionally worn out affect the situation conditions that work for your increased arousal. Our Program will help you identify the Situation Condition Factors that work for you.

• Elevated blood glucose levels, associated with Diabetes,
cause blood vessel and nerve damage to the tiny blood vessels in the penis. • Men with Diabetes are prone to conditions such as obesity, high blood
pressure and high cholesterol. These conditions increase the risk of heart disease, affect blood flow and increase the risk of developing ED. As a man with diabetes, your ED treatment options are the same as any other man who has ED from other causes. You can however, expect some differences in the results. Because heart disease may be present but not show any symptoms it is recommended that men with Diabetes undertake a fitness assessment before targeting treatment for ED. Our recommended oral drugs: Viagra®, Cialis® and Levitra® work well in many men with diabetes although the success rate is not as high as the general population.

Research has shown that the risk of heart disease mortality is greater in men with ED. Source: ISSM
In a study to investigate the interaction of age in the association between ED and Heart Disease it was found that Men with less than 60 years of age who report ED presented a higher risk of having chronic Heart Attack and more severe disease diagnosed by coronary angiography.
Source: ISSM
If you are taking medicines known as ‘nitrates’, which are used for the treatment of angina (chest pain) or other heart conditions, refrain from trying oral drugs normally prescribed for ED and seek medical advice. A sudden and serious drop in blood pressure can occur if you take both medications at the same time.