Lorraine Grover's response
You may feel 'you are the only one' but at least 1 in 10 men ¹ (and 1 in 2 men over 40 ²) suffer with erectile dysfunction (ED). Not only your doctor, but also a practice nurse will be able to support you if you speak to them. Speak to whoever you feel more comfortable with. They will have had other men tell them that they suffer with erectile dysfunction.

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Lorraine Grover's response
There are a number of things that may be preventing your treatment working. Firstly, did you have sufficient sexual stimulation when you tried the PDE5 inhibitor? Often, patients take the tablet and do not have the stimulation which is required to make the tablet effective. Your mood or that of your partner can also affect the outcome. The maximum dose (if suitable) of a PDE5 inhibitor should be taken on at least eight occasions before it is considered a failure ³. In a recent study, over one third of men who were prescribed a PDE5 inhibitor said they were unable to have satisfactory sex with their first ED treatment ⁴. If your first treatment doesn't work at the maximum dosage, ask your doctor to try switching you to another, as different treatments work better for some individuals than others. All three PDE5 inhibitors should be tried independently of each other, 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 pharmacological treatments to consider are intraurethral alprostadil and intracavernosal alprostadil ⁵. Sex therapy and vacuum constriction devices, as well as other options, can also be of benefit.

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Lorraine Grover's response
Discuss your history with your GP/practice nurse. Performing some blood tests to see why your erection is 'too soft' will be helpful. We know that there can be an 80% incidence of medical causes when ED occurs. 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 ^{1, 2}. There can also be a psychological aspect to ED in addition to this medical cause. Alternatively, ED can be attributed purely to psychological causes. Further assessment regarding this will be of benefit. If a cause is found, treating the problem may help. Sometimes using medicines such as a tablet (PDE5 inhibitor) to help you get a stronger erection can be very beneficial.

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Susan Quilliam's response
Tackling the source of this problem may lie in treating the ED rather than the depression. Nowadays most types of ED can be very easily treated. So how can you get past your GP's hesitation?

If you suspect the problem is embarrassment at having to talk about things face to face, then you could initially write to your GP. Or, ask to see another doctor who might be more at ease with the topic. It might also help to take your partner or a friend along - to provide you with additional support.

Whichever route you take, ask for a further examination, diagnosis and if necessary, referral.

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Susan Quilliam's response
Your husband could be experiencing feelings of failure because he has ED - and that's why he doesn't want to talk it through with you or to approach his doctor.

Please reassure your husband that ED is a very common condition, affecting 1 in 2 men over the age of 40 ². Tell him too that nowadays ED is eminently treatable - though it may be necessary to try one or two medications before he finds one that is right for him.

The Sorted in 10 website is full of information that might help your husband - and you - feel less worried. Trawl the site together and then support each other to pick up the phone and make that appointment.

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Susan Quilliam's response
ED doesn't only affect older men. Young men can also suffer, particularly if they suffer from diabetes mellitus or heart disease, which can strike at any age. 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 are unable to do so. What's needed is to relax, take the pressure off by not having intercourse for a while and get your confidence back through foreplay.

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Dr Mike Callander's response
ED is a common condition affecting 1 in 2 men over the age of 40 ². ED can be a marker of significant medical conditions such as diabetes mellitus and heart disease ^{1, 2}. There are three oral treatments available to treat ED called PDE5 inhibitors - Levitra ⁶, Viagra ⁷ and Cialis ⁸, and they are prescribed as a first treatment option. You should consult your GP to discuss which one is best for you as different treatments work for different people. If you are taking nitrates or nicorandil you will be unable to take this treatment. Provided you can walk 1 mile on the flat in 20 minutes the treatment may help you and should not be harmful to your heart condition.

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Dr Mike Callander's response
Your doctor may have been misinformed. PDE5 inhibitors work in over 50% of men with diabetes mellitus ⁹. Losing weight could help and it would also be advisable to have your testosterone level checked. If it is low, testosterone replacement therapy may help you to lose weight and improve your diabetic control. When testosterone levels are restored to normal, you may experience significant improvements in erections and efficacy of your PDE5 inhibitors ¹⁰.

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Dr Mike Callander's response
I advise you to see your doctor for a check up as they will be able to advise you about losing weight if necessary and give you a prescription for a PDE5 inhibitor, if appropriate.

Internet medication may or may not be what it says it is so it is best to get your treatments through a healthcare professional. First time success has been identified as an important factor in identifying the most appropriate PDE5 inhibitor to treat ED ⁴. After their ED treatment failed to work first time 32% of men reported feeling depressed ⁴ and overall confidence was affected in 58% of men ⁴.

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Emile Morgan's response
Certainly for Type 2 diabetes, PDE5 inhibitors are the first line of treatment for ED. The maximum dose (if suitable) of a PDE5 inhibitor should be taken on at least eight occasions before it is considered a failure ³. If your first treatment doesn't work at the maximum dosage, 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 to achieve the optimum response from PDE5 inhibitor treatments ¹⁰. If testosterone levels are low, testosterone replacement therapy may help you. When testosterone levels are restored to normal, you can experience significant improvements in erectile function and efficacy of your PDE5 inhibitors ¹⁰.

Failing this, you could try intra cavernosal penile injections and / or a vacuum pump. Vacuum pumps work either on their own or in combination with the intra cavernosal penile injections. As a last resort you could have a penile implant.

It is important to talk to your GP about your options. You could suggest that they refer you to a specialist who can talk you through each option, and give you the chance to try all of these things.

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Emile Morgan's response
Some medications are contra-indicated with the use of PDE5 inhibitors, for example nitrates which are often used for the treatment of certain heart conditions (e.g. angina or heart failure). 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 then you can always opt for intra cavernosal penile injections and / or a vacuum pump, all of which can and should be discussed with a specialist.

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Emile Morgan's response
ED can be caused by a number of factors not just cardiovascular disease and diabetes mellitus. Whilst ED is a common marker for these other serious diseases ^{1, 2}, the fact that you have only been suffering for the last six months could mean that the problem is psychological or neurological. It is important that you consult your GP to identify the underlying cause so that this can be addressed, and talk to them about possible treatments for your ED.

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Emile Morgan's response
The government do not fund ED treatments on the NHS, except when the ED is caused by certain conditions such as spinal injury, diabetes mellitus and severe depressive illness. The list of exceptions can be obtained from your GP. If you feel very strongly about this decision, why not write a letter to your local MP?

I think that the purpose of not funding ED treatments on the NHS is the fear that people might abuse such powerful drugs and use them only as a booster to an already functioning system.