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Sexual Dysfunction

Sexual Dysfunction: Free advice – ask me today!

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By Dr Helen Webberley MBChB MRCGP MFSRH | GMC no. 3657058

I am a GP and a sexual health and hormone specialist. I can give advice on any medical matter, and I offer safe access to medical advice, prescription medication, blood tests and x-rays, and specialist referrals to your local private hospital as needed.

Sexual Dysfunction

 

Erectile dysfunction is also known as impotence and it is translated as the inability to acquire and maintain an erection.

This condition is an important issue among middle-aged men – about half of them experience some sort of sexual dysfunction – and because of the embarrassing nature of this condition, only a small percentage consult their GP for proper management. Most of them purchase medication online and are not aware of the contraindications of such drugs.

Modern science has discovered a handful of medical and psychological causes for erectile dysfunction and people should know that there are serious underlying conditions that are important to address.

Frequently Asked Questions

When do you know that you have an erectile dysfunction?
Medical encyclopedias define erectile dysfunction as the difficulty in getting or maintaining a firm erection to be able to achieve sexual penetration, or if it interferes with non-penetrative sexual activity.

Of course, there are some rare occasions when most men have some difficulties in getting their penis erect or staying firm, but this is not a diagnosis of erectile dysfunction. You have to be concerned when this problem persists for a consistent period of time (more than 3 months) and doesn’t offer a satisfactory sexual performance. This is the time when you should consult your GP.

What are the causes of erectile dysfunction?
The most common organic causes of erectile dysfunction include:

  • Vascular: high blood pressure, atherosclerosis or diabetes
  • Neurologic: multiple sclerosis, Parkinson’s disease, stroke, diabetic neuropathy, spinal injury, epilepsy, pelvis surgery.
  • Hormonal: hypogonadism (low testosterone levels), overactive or underactive thyroid gland, Cushing syndrome
  • Anatomical: Peyronie’s disease.
Could my inability to hold and erection be psychological?
Yes, there are many psychological and emotional causes, but they account for less cases of persistent erectile dysfunction (about 10%) than the physical causes. These include:

  • Depression
  • Severe Anxiety
  • Stress
  • Relationship issues
  • Previous sexual problems
  • Sexual abuse
  • Starting a new relationship
  • Insufficient sexual knowledge
  • Feelings of guilt
  • Fear of intimacy
  • Poor communication with the partner
Which drugs can cause erectile dysfunction?
There are many medicines or illegal drugs that can induce erection problems. If you experience symptoms of erectile dysfunction while taking a prescription medication, you should consult a health care practitioner immediately.

Medical substances that induce ED:

  • Antihypertensives (beta-blockers, clonidine or certain diuretics)
  • Digoxin
  • Psychiatric medications (antipsychotics, antidepressants, anxiolytics, amphetamines or sleeping pills)
  • Opioids or pain-management drugs
  • Corticosteroids
  • Ulcer medications
  • Anticonvulsivants
  • Antihistamines
  • Prostate treatments (cancer treatments, anti-androgen drugs)
  • Anticholinergics
Are there any lifestyle choices that can influence my erection?
Of course. Like in most medical conditions, lifestyle plays an important part in the person’s health and wellbeing. Certain lifestyle choices that can induce erectile dysfunction are:

  • Excessive alcohol intake
  • Sedentarism
  • Smoking
  • Use of illegal drugs like cannabis, heroin or cocaine.
  • Riding a bicycle for more than 3 times per week
  • Excessive porn use
How is ED treated?
First, you have to tackle the cause, be it psychological or organic. For the physical causes you have either medical treatments (statins, blood pressure medications etc) or lifestyle changes (the reverse of the previous list). For the psychological causes you have Cognitive Behavioral Therapy and sex therapy.

There are a number of possible treatments for Erectile Dysfunction that can include medications – like Viagra, devices – like vacuum pumps, surgical treatments – like implants and vascular surgery, or dietary supplements and alternative treatments – like Korean red ginseng, DHEA, L-arginine and acupuncture. These are the only FDA approved treatments for ED.

Medication

PDE5 inhibitors

Sildenafil (Viagra), Tadalafil (Cialis) and Vardenafil (Levitra) – are the recommended first-line treatment for Erectile Dysfunction. This substance blocks a specific enzyme (PDE5) in the smooth muscle cells of the penis helping the body’s natural response to sexual stimulation.

These drugs are not to be used with certain heart medications (nitrates) or if you have an unstable heart disease. All current medications should be discussed with your physician before taking PDE5 inhibitors.

Alprostadil injection (Muse)

Alprostadil injection (Muse) – uses a prostaglandin (hormone-like lipid compound) that relaxes the penile muscles and widens the blood vessels, consequently increasing the blood flow to the penis. Do not use it if you have :

  • any known allergies to a specific ingredient in Alprostadil Injections,
  • blood or bone marrow problems
  • priapism
  • penile implant
  • medical interdictions for sexual intercourse

Safe, real prescriptions for Sexual Dysfunction.

Whether you know which HRT suits you best or whether you need advice on what you should take,

ask me here about safe prescriptions for hormone replacement therapy.

Blood Tests

Total testosterone

Total testosterone – is used to diagnose several conditions apart from ED like delayed puberty, infertility, testicular/ovarian tumors, hirsutism, hypothalamus/pituitary disorders and many other conditions related to abnormal testosterone levels. Testosterone is the main sex hormone in men and it is produced by the testicles.

Full male hormone panel (profile)

Full male hormone panel (profile)is used to monitor hormone status in men (especially those in the andropause years). For best results, you should take the test 2-6 hours after eating and 48 hours after performing any prostate stimulating activities (ejaculation, heavy lifting or cycling). The comprehesive male hormone panel includes:

  • Sex hormones – DHEA-S, DHT, Estradiol, Pregnenolone, Testosterone and SHBG
  • Stress hormone – cortisol
  • Thyroid hormones – TSH, Free T4 and Free T4
  • General Health Markers – complete metabolic panel, complete blood count and PSA (Prostate Specific Antigen)

Lipid profile

Lipid profile – this test is used to assess the risk factors for developing ED, especially for atherosclerosis. The full lipid panel includes:

  • Total cholesterol
  • HDL cholesterol (“good” cholesterol)
  • LDL cholesterol (“bad” cholesterol)
  • Triglycerides

Contact me now for advice, prescriptions, blood tests and referrals.

Please note that this service does not aim to replace advice given to you by your own doctor, it is meant to supplement your health knowledge and awareness.

It is never to be used in the case of a medical emergency.

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