Erectile dysfunction: What is impotence, what causes it and how can it be treated?

The condition was a key talking point of Sunday night's episode of Line of Duty

(Getty Images/iStockphoto)

Erectile dysfunction (ED), also known as impotence, is the term prescribed to men who cannot get or maintain an erection. It’s very common, particularly in men over the age of 40.

The condition was a talking point from Sunday evening's episode of Line of Duty after Steve Arnott (Martin Compston) experienced it during an intimate scene with his on-off love interest Sam Railston (Aiysha Hart).

Arnott later confessed that he is still recovering from an attack in the previous series that left him temporarily wheelchair-bound.

There are countless lifestyle factors that can cause ED in the short-term, such as stress and tiredness, but if it’s a long-term problem, there might be deeper physical or psychological causes at play.

Read on for everything you need to know about erectile dysfunction, from its myriad causes to how it can be treated.

What is erectile dysfunction?

Erectile dysfunction is the inability to obtain or maintain an erection sufficient for penetration and for the satisfaction of both sexual partners, according to the British Association of Urological Surgeons. It is a very common condition, but is more frequent in men over the age of 40.

The NHS states that an erection occurs when a man is sexually aroused and his brain sends signals to the nerves in his penis, causing an increase in blood flow that enables the tissue to expand and harden.

ED happens when something interferes with a man’s nervous system or with his bloody circulation.

What causes ED in the short-term?

ED is considered a common condition because there are a number of lifestyle causes, such as stress, tiredness, anxiety, or drinking too much alcohol. Use of illegal drugs, such as cannabis or cocaine, may also cause ED, states the NHS.

In these instances, ED might be a one-off and you may not need to seek medical advice.

What physical causes are there for long-term ED?

If ED is becoming a regular problem, there might be an underlying physical cause.

According to the NHS, there are four main types of physical problems that can lead to ED.

Vasculogenic conditions

These are illnesses that affect the flow of blood to the penis. They include high blood pressure, high cholesterol or diabetes.

ED is also strongly linked to cardiovascular disease, particularly atherosclerosis, which is a when plaque builds up in your arteries and subsequently inhibits blood flow.

Neurogenic conditions

These conditions affect the nervous system. They include multiple sclerosis, Parkinson’s disease, spinal injuries and stroke.

Hormonal conditions

There are a number of hormonal conditions that can lead to ED, such as hypogonadism (this means you have abnormally low levels of testosterone) and Cushing’s syndrome, which is when your body makes too much of the cortisol hormone.

Anatomical conditions

These are conditions that affect the physical structure of the penis, such as Peyronie’s disease, which is caused by scar tissue, that forms inside the penis and causes it to become curved when it's erect, the NHS states.

ED can also be a side effect of taking certain medications, such as antidepressants, diuretics (used to increase the production of urine) and anticonvulsants, which is used to treat epilepsy. See a full list of medications linked to ED here.

What are the psychological causes of long-term ED?

The NHS states the the cause is more likely to be psychological if you only have difficulties getting an erection on some occasions, such as during sexual activity, but still get them in the mornings.

In addition to depression and anxiety, emotional causes include concerns about your relationship, previous sexual issues, being in a new relationship and a lack of sexual knowledge.

How can you treat it?

How ED is treated depends on the cause. If the problem is emotional or psychological, the NHS recommends seeking the support of your GP, who may recommend cognitive behavioural therapy (for anxiety and depression) or sex therapy. This is available on the NHS or for a fee at organisations such as Relate.

Some doctors may prescribe medicines such as sildenafil (sold as viagra) to treat ED, though this is available without a prescription from most chemists. It works by increasing blood blow to the penis. According to the NHS, at least two-thirds of men experience improved erections after taking it.

ED-sufferers may also be advised to use a vacuum pump, which is a clear plastic tube connected to a pump that is either hand or battery operated. It works by placing the penis into the tube and pumping out the air. These work for most men and are often suggested to men who cannot take sildenafil.

Other doctors may suggest making lifestyle changes to reduce stress and anxiety levels, such as exercising daily, quitting smoking or eating healthier.

If the cause is an underlying physical issue, ie it falls under one of the four aforementioned categories, that health condition may need to be treated first in order to assuage ED symptoms.

You can read more about ED and its various treatment procedures here.