What is it?

Erection difficulties are also known as erectile dysfunction and impotence, and occur when men experience regular problems in achieving an erection suitable for sexual intercourse.

It is a common problem among men. It is estimated five to 10 percent of men at 40 years and up to 25 percent of men at 65 years have trouble getting erections.

Men may not be able to get an erection at all, only have them for a short time, or have them inconsistently.

The problem is psychological in about 20 percent of sufferers. One third have medical reasons for not getting erections and the remainder have a combination of both causes.

There are now highly successful treatments for erectile dysfunction.

What are the symptoms?

A sufferer will experience regular problems achieving an erection satisfactory for sexual intercourse.

This may involve only being able to achieve an erection for a brief time, having them on inconsistent occasions or not being able to get one at all.

A combination of mental and physical stimulation causes a man's penis to become erect. Impulses from the brain allow muscles in the penis to relax and fill with blood.

Men who get normal erections during their sleep may have psychological problems which inhibit erections.

Psychological factors include stress, guilt, fear of sexual failure, depression and low self-esteem.

Damage to arteries and muscle tissue will prevent an erection. Diseases like heart disease, diabetes, and multiple sclerosis account for about 70 percent of erection problems.

Prostate surgery and other pelvic surgery can also damage nerves, causing erection problems.

Some medicines also cause impotence including antidepressants, and antihistamines.

What can be done to help?

Counselling may be useful for some men with psychological impotence. However, this can take a long period of time and have limited value for many sufferers.

There is a wide range of products available to treat the condition, with major advances in the past few years.

Viagra (sildenafil) has been the most recent advance, and has already been used by millions of sufferers around the world.

Taken as a tablet, it works by relaxing the blood vessels in the penis when a man is sexually excited.

The tablet is taken one hour before you have sex. The erection will normally subside after ejaculation. The drug will stay in the body for four to six hours and men may be able to obtain more than one erection during that time.

Viagra works well in an estimated 70 percent of sufferers.

Do no take Viagra if you are taking nitrate medication for angina or other heart conditions, or using amyl nitrate, or have allergies to any of the ingredients. Tell your doctor about any other medicines you are on before taking Viagra.

The Caverject injection is still considered one of the best options. The effective ingredient is prostaglandin which is injected on one side of the penis and aids blood flow into the penis.

The injection works within 10 minutes and erection subsides after ejaculation.

It is effective in about 90 percent of patients including those who have prostate surgery.

The drug has hardly any side effects, however, some men find injecting themselves difficult and have complained of pain in the penis or testicles after injection.

Other treatment methods include the MUSE system in which a pellet of prostaglandin is placed in the urethra and produces an erection within 15 minutes.

Vacuum therapy is now becoming outdated as new advances take over.

Surgery to insert a penile prosthesis is considered a last resort, but is useful in patients with diabetes, hardening of the arteries or have had pelvic surgery. There are various models available including a semi-rigid product which does stick out or a more discrete, and expensive, inflatable model.

Laboratory tests can help confirm impotence, including tests to measure the amount of testosterone in the blood to establish whether testosterone replacement may be helpful.

How can it be prevented?

Men whose sexual performance is affected by psychological factors such as stress or fear of failure may find counselling and stress management useful.

Future trends

The discovery of Viagra has opened up more opportunities for developing new and better drugs to treat the condition.

Researchers around the world are studying better ways to cure the problem.

Getting help

Men are reluctant to seek help but this need not be so. Most doctors are aware of the problem and will be able to make suggestions for you on which treatment may be most helpful.