Erectile Dysfunction

Erectile dysfunction (ED) describes the inability to achieve and or maintain an erect penis adequate for sexual intercourse. It is one of the most common sexual problems for men and the chance of developing it increases with increasing age. It is also commonly seen in men with other medical conditions, such as diabetes and heart disease.

Other causes:

The most common medical conditions causing ED are diabetes, high blood pressure, high blood cholesterol, and cardiovascular disease. Other conditions associated with ED include neurological disorders such as multiple sclerosis, benign prostatic enlargement, and depression. Other conditions associated with reduced nerve and blood flow include aging and smoking.

Low levels of circulating testosterone may cause ED, although low testosterone is found in a minority of men who develop ED. Low levels of sexual desire, lack of energy, mood disturbances, loss of muscle strength and depression can all be symptoms of low testosterone.

Smoking, drug or alcohol abuse, particularly over a long period of time, will compromise the blood vessels of the penis. Lack of exercise and a sedentary lifestyle will contribute to the development of ED. Modifying these risk factors may contribute to overall health and may in some individuals correct mild ED.


For most patients, the diagnosis will require a medical history, physical examination including blood pressure, examination of the penis and testes, and a rectal examination. A few routine blood tests are done in all patients, and include a measurement of blood lipids, glucose and testosterone. More blood tests may be required if any of these are abnormal.


If erection returns with simple treatment like oral medication and the patient is happy, no further diagnosis and treatment are necessary.


Other options

When tablets no longer work, alprostadil, is approved for use in men with ED. This drug comes in several forms: injections that the patient places directly into the side of the penis, as an intraurethral pellet formulation (MUSE) or a cream. Mr Zakikhani doctor will be able to discuss with you whether these are suitable.



Common side effects of alprostadil use are a burning sensation in the penis and a prolonged erection lasting over four hours, requiring medical intervention to reverse the erection. This latter side effect is an emergency, and if it occurs you need to seek medical help urgently.

For men who cannot or do not wish to use drug therapy, an external vacuum device may be acceptable. This device combines a plastic cylinder or tube that slips over the penis, making a seal with the skin of the body. A pump on the opposite end of the cylinder creates a low-pressure vacuum around the erectile tissue, which results in an erection. 75 percent of men can achieve a functional erection using a vacuum erection device.