Getting answers to common questions

There’s no need to be embarrassed. You may feel 'you are the only one', but at least 1 in 10 men suffer from erectile dysfunction (ED) ⁴². This increases to 1 in 2 men who are between the ages of 40 to 70 years old¹⁴. Your doctor or a practice nurse will be able to support you if you speak to them. Speak to whomever you feel more comfortable with. They will have had similar discussions with many other men who are suffering from ED.

Did you have sufficient sexual stimulation when you tried the PDE5 inhibitor? Often, patients take the tablet and don’t have enough stimulation to make the tablet effective. Your mood or that of your partner can also affect the outcome. The maximum dose (if suitable) of some PDE5 inhibitors should be taken on at least eight occasions before it is considered a failure ²⁹.

Research has shown that over one third of men who were prescribed a PDE5 inhibitor said they were unable to have satisfactory sex with their first ED treatment²² . If your treatment doesn't work at the recommended dose, ask your doctor to check your testosterone level, or try switching you to another PDE5 inhibitor, as different treatments work better for some individuals than others. All three PDE5 inhibitors should be tried independently, as patient response varies even though they all belong to the same class of drug. It does not necessarily mean your ED is permanent. Other options to consider are intracavernosal injections and transurethral treatments. Relationship counselling and vacuum constriction devices, as well as other options, can also be of benefit.

First of all, discuss your history with your GP or practice nurse. They may perform some blood tests to see why your erection is 'too soft'. ED is often the result of medical causes. For example, there may be an altered blood and nerve supply to the penile tissue. However, ED can also be a marker of significant underlying health conditions such as diabetes mellitus and heart disease. ED may also be partly or purely psychological. Your GP or practice nurse will help to assess this. If a cause is found, treatment can be very effective. Sometimes medicines such as oral treatments (PDE5 inhibitors) can be used to help you get a stronger erection.

Your husband may have feelings of failure because he has ED and is therefore unhappy talking to anyone about it. Please reassure your husband that ED is a very common condition, which affects 1 in 2 men between the ages of 40 to 70 years old ¹⁴. He’ll be relieved to know that nowadays ED is very treatable - though it may be necessary to try more than one medication before he finds the right one for him. The Sortedin10 website is full of information that might help your husband - and you - feel less worried. Browse the site together until you feel confident enough to pick up the phone and make that appointment.

ED doesn't only affect older men. Young men can also suffer, particularly if they suffer from diabetes mellitus or heart disease. So please, do go to your doctor if only to rule out medical problems and make sure you are healthy. Your doctor will also be able to prescribe oral treatments. If there are no medical problems, then the problem might be psychological and down to performance anxiety; you're so worried about not being able to get an erection, you become unable to do so. Try to relax and take the pressure off yourself by not having intercourse for a while and get your confidence back through foreplay.

If you have Type 2 diabetes, PDE5 inhibitors are the first line of treatment for ED. If your first treatment doesn't work at the recommended dose, ask your doctor to try switching you to another, as different treatments work better for some individuals than others.

It would also be advisable to have your testosterone level checked. Sufficient levels of testosterone are required for ED therapies, especially PDE5 inhibitors, to achieve the optimal response. If testosterone levels are low, testosterone replacement therapy may help you. When testosterone levels are restored to normal, you can experience a general improvement in sexual function, improved erections and an enhanced response to your PDE5 inhibitor ¹⁸.

It is important to talk to your GP about your options. They may refer you to a specialist who can talk you through each option and give you the chance to try a number of different treatments.

Some medications cannot be taken with ED tablets (PDE5 inhibitors), e.g. nitrates, which are often used for the treatment of heart conditions. However, if your condition is stable, your cardiologist may be able change the nitrates to a different medication. Ask your cardiologist about any other options. If for any reason your medication cannot be changed, you could opt for intracavernosal penile injections and/or a vacuum pump, all of which should be discussed with a specialist.