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What Is Impotence? |
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Impotence (also known as erectile dysfunction) is the inability to get (or keep up) an erection (hard-on) sufficient for sexual intercourse. Men may experience failure in achieving an erection at some time in their lives for a variety of reasons including stress, tiredness and too much alcohol. However, for some men it becomes a continuing problem.
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How Common Is It? |
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You may think impotence is rare but this is because most men are reluctant to talk about it. In fact it is a common problem with one in ten men experiencing a problem at some time in their lives. It can occur at any age but becomes more common later in life and over the age of 70 one man in three has an erection problem. As we get older, the normal slowing of age means that it takes longer to become aroused, and erections may be less rigid. This is a normal process and for many men, sex can gradually become a more leisurely and less frequent activity.
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Is It More Common In Men With Diabetes? |
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Yes, there are a number of reasons why erection problems are more common in men with diabetes. As in all men, problems become more common with advancing age and over the age of 70 more than three quarters of men with diabetes have some form of erection problem: for some it may be that erections simply don't last as long while others may stop having erections altogether.
We often don't know the exact reason or reasons why the problem happens, but possible causes include:
Drugs: alcohol is the best known drug to affect erections. Some men make the mistake of thinking that an erection problem is due to stress and try to cure it with a drink but this can make things worse. Although not really a 'drug' cigarettes are a major cause of impotence as over the years smoking damages the blood vessels in the penis. Men with diabetes who smoke are even more likely to develop erection problems. A variety of prescribed medications have side effects which can contribute to erection problems, including some used to treat high blood pressure. Your doctor will be able to advise you if this may be the case but remember that treating high blood pressure is very important in protecting you against a number of serious problems and so you must never simply stop taking your medications. It may be possible to change your tablets to ones without this side effect.
Damage to blood vessels: diabetes can lead to damage of the blood vessels in the penis making erections less effective.
Damage to nerves: for an effective erection to occur the blood supply to the penis is controlled by nerves and if these nerves are damaged by diabetes, erection problems can occur.
Stress: for the vast majority of diabetic men there is a physical cause for their erection problems but stress, particularly a fear of failure after a previous erection problem can make the problem worse. Many couples don't like to talk about sexual difficulties for fear of causing further stress but this can lead to misunderstandings. Some partners, especially those who do not understand the cause of the problem, feel rejected and angry and sometimes wonder if their partner no longer loves them. They are usually relieved when it is explained to them that the problem has a physical, rather than emotional, cause. Therefore, if you are able, you should try to discuss your erection problem with your partner.
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Can I Prevent Impotence From Happening? |
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Keeping your diabetes under good control is important in reducing the risks of a number of problems including impotence and your doctor will also ensure your blood pressure and cholesterol are satisfactory. Smoking increases the chances of impotence (something the tobacco companies like to keep quiet!) so stopping smoking will also reduce the likelihood of erection problems.
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Do I Need Treatment? |
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There are a variety of treatments to help men with erection problems, but not all men want specific treatment. Some men are happy with an explanation of the problem, and the reassurance that it isn't due to them 'going off' their partner. There is no 'normal' amount of sexual activity: some couples want sexual intercourse very frequently while others much less often or not at all. The actual frequency does not matter as long as it suits both partners.
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What Treatments Are Available? |
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There are a number of treatments available to help with impotence. They don't all work in all men and so you may need to try more than one until you find one that suits both you and your partner. The simplest treatments are tablets which are taken before sexual activity. Men with diabetes are entitled to have these tablets prescribed on the NHS, and your GP should be able to prescribe these for you without needing to refer you to a specialist clinic. It is important to stress that these tablets are not aphrodisiacs and do not cause erections in the absence of sexual stimulation.
There are 2 tablets currently available with more likely to become available in the near future:
Viagra (also called sildenafil): the tablet is swallowed 1 hour before sexual intercourse.
Uprima (also called apomorphine): this tablet dissolves under the tongue and is taken 20 minutes before sexual intercourse.
These tablets work in just over half of men with diabetes. Generally, a low dose is tried first and the dose can be increased if the initial dose proves ineffective. If one tablet doesn't work it is worth trying the other as they work in different ways and some men respond to one tablet and not the other.
Pro's: simple easy and painless, generally few, if any side effects.
Cons: don't work for just under half of men, not suitable for everyone e.g. patients on medications called 'nitrates' cannot take viagra.
If they are not successful, we can arrange for you to be seen in a clinic dedicated to the treatment of erection problems where the range of other treatment options will be shown to you. Clinics run both at City Hospital and Queen's Medical Centre campus. Your doctor or diabetes nurse will be able to refer you to the clinic and if you feel you may benefit from the clinic just let one of the team know and we can arrange this.
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What Happens At The Erectile Dysfunction Clinic? |
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The clinic at QMC is staffed by diabetes specialist nurses while at City Hospital the clinic is run by doctors in the Urology Department. Staff are specially trained to support patients psychologically as well provide the full range of available treatments. They may check a blood test to make sure there is no other cause for the problem and they can provide you with any equipment and ongoing support you may need.
Below is brief summary of the treatments currently available. Your doctor or diabetes nurse will be able to provide you with more details on request:
Vacuum Devices: this method relies on physically drawing blood into the penis and does not involve any drugs. A hard plastic cylinder fits over the penis then a simple pump sucks air from the cylinder causing an erection which is maintained by slipping a rubber band over the base of the penis.
Pro's: simple and effective.
Cons: requires practice, the erect penis feels cold and can be costly (the devices cost £120 to £450, though we can loan you one for 2-4 weeks so you can be sure it suits you before you buy).
MUSE: this involves inserting a pellet of a drug called alpostadil into the opening at the end of the penis using an applicator, which then stimulates an erection.
Pro's: painless and can be prescribed.
Cons: can be fiddly and very rarely has a very prolonged effect called priapism, where the erection lasts for several hours, which requires medical treatment to sort out.
Injections into the penis: the same drug used in the MUSE technique is given as an injection into the penis before intercourse.
Pro's: higher success rate than MUSE.
Cons: involves an injection and can cause the same prolonged erections as MUSE.
Finally a variety of implants can be put into the shaft of the penis. The simplest simply permanently stiffen the penis while more sophisticated implants involve a tiny pump in the scrotum which can pump fluid into the implants producing an erection. These implants need to be inserted surgically under anaesthetic by the Urology doctors at City Hospital and if necessary you can be referred to the relevant doctors to discuss the options.
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Common Misconceptions |
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"I feel like I'm the only one" - not true, it is a common problem
"It's all in my mind" - in most men the problem has a physical cause, though stress can make it worse.
"If he can't get an erection, does it mean he doesn't love me any more?" - erection problems can lead to partners feeling rejected, and so it is important that it is explained to them that it is usually a physical problem rather than due to a lack of love.
"Erection problems are an old man's problem" - although more common as we get older, they can occur at any age.
"There's nothing that can be done about it" - not true, there are many effective treatments already available with more being developed all the time.
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Contact Us |
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Finally, please remember that if you or your partner have any questions or concerns please do not hesitate to ask the doctor or diabetes nurse. Alternatively, further information is available from:
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The Impotence Association
PO Box 10296,
London,
SW17 9WH
Tel: 020 8767 7791 (Mon-Fri 9am-5pm)
Web: http://www.impotence.org.uk
Email: theia@btinternet.com
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