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      • some men with anatomical problems with their penis; or
      • some men with infections of their penis.

      Alprostadil can cause the following side effects: changes in your blood pressure, dizziness, headache, pain in your penis, urethral burning or bleeding, reactions at the site of the injection, such as swelling. You should always read the patient information leaflet.

      Hormone therapy

      If your doctor thinks that your erectile dysfunction is related to your hormones, chances are you will be referred to a hormone specialist (an endocrinologist) who will look to rebalance your hormone levels (probably with a series of hormone injections.)

      Surgery

      Surgery is a last resort for treating impotence. It is normally only recommended for younger men who have seriously injured their pelvic area or men who have an anatomical problem with their penis. 

      It used to be the case that if a man had a blockage in the blood vessels leading to the penis, then surgery could be used as a way to unblock these to allow the blood to flow again. However, evidence shows that this surgery is often not successful in the longer term, so it is now rarely used to treat this problem.  

      Penile implants are another type of surgery. This is not normally available on the NHS, but about 75% of men who have it are satisfied with it.

    . .
  • Flu antivirals .

    Treating erectile dysfunction due to underlying health issues

    If you are suffering from erectile dysfunction as a result of an underlying health condition, youíll usually need to treat the underlying condition first, before you embark upon a course of treatment for impotence. You may then find that by treating the underlying condition, this solves the problem of your erectile dysfunction too. Speak to your doctor about the fact that you are struggling with ED as well as your underlying condition, so that they can factor this into your treatment plan. 

    If you are taking medication for another condition and you think that this is causing erectile dysfunction, have a chat with your doctor about it. It may be that they can suggest an alternative type of medication. Make sure that you talked to your doctor or healthcare professional before you stop taking any medication that youíve been prescribed. 

    Psychological Treatment Options

    Counselling can be very helpful for people who have erectile dysfunction that is caused by psychological problems like anxiety or depression. Another type of treatment for people who have ED that has a psychological cause is called Sensate Focus. 

    Sensate focus is a type of sex therapy. You and your partner agree not to have sex for a set period of time. During this time, you can still touch each other, but you agree not to touch each othersí genitals (or a womanís breasts). During the agreed timeframe, you then set aside time to spend together as a couple to explore each othersí bodies without having sex. Clothed or naked, you can massage each other, explore touch, and stroke each other. Once the agreed timeframe has passed, you can then start to touch each othersí genitals, you can start to use your mouth as a way of exploring each othersí bodies through kissing or licking your partner, for example. Gradually, you can then build up to penetrative sex together. If you would like to read a bit more about Sensate Focus or about sex therapy in general, the College of Sexual and Relationship Therapists website is very useful: /www.cosrt.org.uk/information-for-members-of-the-public/tips-for-sexual-wellbeing/

    Psychosexual counselling is a talking therapy. It has mixed results and can take a while to work, but many people find it really helps. It provides space for you and your partner to talk about any issues that might contribute to or cause your erectile dysfunction. The aim of talking it through is to help you feel less worried or anxious, so that you can overcome your problems. The counsellor can also offer advice on sex, like practical foreplay techniques and how you might like to incorporate other treatments for erectile dysfunction into your plans to improve your sex life. The NHS offers advice on good sex which includes practical tips on arousal. You can read this on the NHS website: /www.nhs.uk/LiveWell/Goodsex/Pages/Goodsexhome.aspx

    Cognitive Behavioural Therapy can also be helpful in treating impotence. Cognitive Behavioural Therapy explores the link between the way we think and how we feel. It aims to change the way you think about and react to a situation, to help you feel happier. A CBT therapist can work with you to identify factors that are contributing to your erectile dysfunction. They will look for unhelpful thoughts or thought patterns that might be linked to: your self esteem, your sexuality or your personal relationships. With the therapist, you can then work to change these by practicing different ways of thinking. 

    Complementary therapies

    Like acupuncture claim to improve impotence. The evidence of whether this is effective is limited. If you decide to try to treat your erectile difficulties with complementary therapies, speak to your doctor first because sometimes they can interact with other medicines. 

    Pelvic Floor Muscle Exercises

    The pelvic floor muscles are grouped under the bladder, around the rectum and at the base of the penis. The exercises strengthen and train the muscles used to urinate and to control the anus (back passage). There is some evidence to suggest that for some people, exercising these muscles can improve erectile dysfunction. If you think this might help you, have a chat with your GP who might refer you to a physiotherapist so that you learn how to do the exercises correctly. 

    The vacuum pump

    A vacuum pump is made up of a clear plastic tube connected to a hand or battery activated pump. You put your penis into the tube and pump out all of the air. This increases the blood flow to your penis so that you can get and sustain an erection. You then put a rubber ring around the base of your penis to keep the blood there. Using this, you will be able to sustain an erection for about 30 minutes. It can take a bit of practice to get used to using the pump properly, but 90% of men who used it found that they were able to sustain an erection (regardless of the cause of their impotence).

    Cautions

    You shouldnít use the vacuum pump if you have a bleeding disorder or take anti-coagulant (blood thinning) drugs. Under a third of people find that they experience side effects of pain or bruising using the pump. If you qualify for erectile dysfunction treatment on the NHS, then you might also be able to get a pump, but normally most people have to buy their own. You can get advice on using pumps and other topics from the Sexual Advice Association: /www.sda.uk.net/advice.php

    Alprostadil

    If you find that your erectile dysfunction is not responding to your course of treatment, or if you canít use Viagra, Cialis, Levitra or the vacuum pump, then your doctor might suggest you try Alprostadil (a synthetic hormone that increases the flow of blood to the penis given either as injection into the penis or as a pellet placed inside the urethra). You can be trained in how to inject or insert the pellet of Alprostadil. It usually takes effect within five to fifteen minutes. The length of time that the erection lasts for varies with the dose. If your partner is pregnant, youíll need to use a condom during sex. 

    Alprostadil when placed in the urethra is effective in 2 out of 3 men with ED. Alprostadil injections worked for just over 8 out of 10 men who found that Viagra, Cialis and Levitra didnít work for them.

    Cautions, risks, side effects, interactions

    Men with the following conditions should not use Alprostadil:

    .
    • Semi-rigid implants Ė can be appropriate for older men who donít have regular sex
    • Inflatable implants Ė made up of two or three parts that are inflated to maintain a more natural erection. They are often very expensive.

    About 5% of men who have penile implants experience mechanical issues with the implants within five years.

    Side Effects and Warnings

    Men who have cardiovascular disease including conditions like coronary heart disease, should use PDE-5 inhibitors with caution. Speak to your doctor if this applies to you. Sex can be a good way to improve your cardiovascular health, but you need to ensure that you are fit enough to take the medication safely.

    If you have an anatomical issue with your penis, like Peyronieís Disease, again you need to consult your doctor to see if it is safe for you to take an erectile dysfunction treatment. 

    If you are taking medicines (for example, to treat angina) or using recreational drugs (such as butyl nitrate, also known as poppers) that contain nitrates, then you must not take PDE-5 inhibitors. Using the two drugs together can be very dangerous for your heart. 

    If you suffer from priapism (a painful erection that lasts several hours), or if you are taking long-lasting alpha-blockers (a type of medication used to treat high blood pressure), then, again, you need to be very cautious about taking any erectile dysfunction treatment, so speak to your doctor first. 

    Unless your doctor has said you can, do not take PDE-5 inhibitors if you:

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