Erectile Dysfunction

Most men at some point in their lives may be affected by Erectile Dysfunction (also called impotence) on at least one occasion. The inability to obtain or sustain an erection can have devastating effects on an individual’s quality of life.

Common causes of erectile dysfunction are stress, fatigue, and excess alcohol to name a few. However, some men consistently struggle to get an erection. Erectile Dysfunction becomes more common with age. Approximately half of the men are affected aged 40-70, rising to two-thirds of men over 70.

Here at ROC, we have a dedicated clinic for patients affected by Erectile Dysfunction. The aim of the clinic is to provide a personalised and holistic approach to Erectile Dysfunction.

The clinic involves a series of appointments in order to ensure we have detailed knowledge of your medical history and lifestyle factors so that we can identify the likely cause of Erectile Dysfunction and develop a tailored treatment plan.

Do get in touch to find out more about the Erectile Dysfunction Clinic at ROC!

Erectile Dysfunction FAQ

There are several different causes that can be grouped into physical or psychological causes. The majority of cases (8/10) are physical. With most physical causes of Erectile Dysfunction, men notice a gradual onset of the problem, for example, they may notice intermittent or partial Erectile Dysfunction which may become worse after a while.

Physical causes

  • The main physical cause of Erectile Dysfunction is due to the reduced blood supply to the penis. This is due to narrowing of the small arteries in the penis.  The narrowing occurs due to a build-up of a fatty substance that forms plaques called atheromas.  This is the same process that occurs in other arteries throughout the body that can give rise to other problems such as angina (the narrowing of the coronary arteries that supply the heart) or strokes that can be caused by narrowing arteries in the brain.
    • Certain risk factors can increase the rate at which the arteries become narrowed. These include increasing age, smoking, high cholesterol and high blood pressure.
  • Diabetes is another common cause of ED. Diabetes can affect both the nerves and the arteries in the penis and it is thought that diabetic men are affected by Erectile Dysfunction on average 10-15 years earlier than men who are not diabetic.
  • Diseases that affect the nerve supply to the penis are also a cause of Erectile Dysfunction. These can include Parkinson's Disease and multiple sclerosis (MS).
  • Hormonal problems can be a less common cause of Erectile Dysfunction, eg lack of testosterone which is a hormone that is produced in the testicles. Symptoms of testosterone deficiency can include, loss of libido (sex drive), fatigue and changes in mood.
  • Medication can sometimes be the cause of Erectile Dysfunction. Commonly taken medicines such as b-blockers, anti-depressants and some types of indigestion medication are all linked to Erectile Dysfunction.
  • Excess alcohol and drug usage are frequently associated with Erectile Dysfunction.
  • Nerve injuries can also cause Erectile Dysfunction, for example after spinal or prostate surgery.

Psychological causes

A number of mental health conditions can cause Erectile Dysfunction including stress, anxiety, depression and relationship difficulties. In general, psychological causes often result in sudden onset of Erectile Dysfunction that may resolve when mental health improves. If men can achieve a full erection at other times (for example masturbating or morning erections) then it is likely that there is a psychological cause for their Erectile Dysfunction.
There are a number of simple tests that can be performed in order to help understand the cause of Erectile Dysfunction. These include a physical examination, various blood tests and procedures such as blood pressure checks, a heart tracing (ECG) and urine check. The main reason for performing these tests is to check for risk factors that can increase the risk of narrowing of the blood vessels. At ROC Clinic we developed our own protocol for assessing men with Erectile Dysfunction to ensure that the best treatment is recommended for you.
  1. Oral medication (Phosphodiesterase type 5 PDE5 inhibitors). Examples of these include Sildenafil (Viagra) and tadalafil (Cialis) amongst others. They work by affecting a chemical responsible for widening the blood vessels during sexual arousal. These medications will only give an erection if the man is sexually aroused. This medication is not suitable for everyone as it can interact with other medications, for example, angina and blood pressure medications.
  1. Alprostadil. This is a medication that is available in several formulations:

- Topical cream (Vitaros). The cream comes with a plunger and is inserted applied to the tip of the penis and surrounding area up to 30 minutes before sex.

- Urethral application (Muse). A pellet is inserted into the tip of the urethra.

- Injection (Caverjet). This medication is injected into the base of the penis.

Topical and urethral applications are available on prescription from ROC Clinic.

  1. Vacuum devices. These involve placing the penis into a container and using a pump to remove air from the container.  This creates a vacuum that draws blood into the penis. Once erect, a rubber band is then placed around the base of the penis to maintain the erection and the container is removed. The band can remain in place for up to 30 minutes. 
  1. Surgery, for example, a penile prosthesis or implant. A surgeon can implant a rod into the penis permanently. Some advanced models have an inbuilt pump, whilst others need to be straightened by hand. Vascular reconstruction surgery is also available where a surgeon can try to improve blood supply to the penis but it has been shown to work in very few cases
  1. ED shockwave therapy. This is a new development in the treatment of Erectile Dysfunction and is described as a curative technique that uses painless shockwaves directed at the penis to stimulate the growth of new blood vessels that improves blood flow. This is relevant for the majority of men with Erectile Dysfunction caused by the narrowing of blood vessels or diabetes. Please contact us for more information or read more on our blog about treatment options here and here.
  1. Testosterone. Deficiency in this hormone is not a common cause of Erectile Dysfunction. It is used as a treatment for men who have symptoms of Erectile Dysfunction and a medically confirmed testosterone deficiency.
  1. Lifestyle modification. Erectile Dysfunction can often be improved by addressing risk factors, for example, cholesterol and diet, smoking and alcohol.
  1. Counselling. This can be very useful if Erectile Dysfunction is due to a psychological cause such as stress or anxiety.

Meet our experts

Dr Mairi Hope

  • Qualifications: BSc., MBChB., PhD., MRCGP.
  • Location(s): Aberdeen - ROC Private Clinic
  • Clinical Interest(s): Preventative Healthcare, Microbiology and Infectious Diseases, Sexual Health, Ageing Medicine, Andrology, Sexual Dysfunction, Chronic Disease Management
  • BIO:

    Dr Mairi Hope appreciates a holistic approach to patient care and her interests lie in health prevention and management of the ageing individual. Her exceptional background and extensive training in microbiology, give her top skills when managing infections, being acute, chronic, common or rare. Her approach is thorough and determined with the only scope of improving the physical and emotional well-being of her patients.

Dr. Wassim Fayed

  • Qualifications: BSc., LMSSA., MRCP., MRCGP.
  • Location(s): London - ROC Harley Street Clinic
  • Clinical Interest(s): Integrative Health, Preventative Health, Sexual Health, Men’s Health, Gut Health, Occupational Health, Complex presentations and Multiple Co morbidities
  • BIO:

    Dr Wassim Fayed is the current Medical Director of ROC London Clinic and he ensures that the ROC London Clinic performs to the level expected of ROC and meets the demands and challenges of modern medicine at an ultimate personal level of healthcare delivery.

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