ERECTILE DYSFUNCTION FREQUENTLY ASKED QUESTIONS

Q1: Where should I go to get the best treatment for impotence?

Your first stop should be your GP. If they cannot help you, they will refer you to an NHS consultant who has a special interest in erectile dysfunction (impotence). There are also private clinics, but these charge for their assessment and treatment. Most private clinics are perfectly reputable, but, do be careful, as with all walks of life, some 'cowboy' clinics do exist.

Q2: How long will I have to wait for treatment on the NHS?

There is, inevitably, a waiting list for a condition which is not life-threatening. The length of time you will need to wait will depend on the hospital you are referred to. This is something that your GP will be able to advise you on.

Q3: What will happen when I visit a hospital consultant?

You will have an initial assessment, either by the consultant or by a nurse specialist. This may take up to 1 hour. It will involve a discussion of your problem, a physical examination and some investigations. You will probably have a review where the results of your investigations and treatment options will be discussed. More information about this can be found in 'Your visit to the doctor'.

Q4: Will I have any say in the treatment I get?

For some patients, certain treatments are unsuitable. However, in most, the pros and cons of the different forms of treatment will be discussed with you. You will then choose which treatment is best for you. The hospital staff will support you through the whole process of starting and maintaining treatment.

Q5: Will my partner be able to go to the appointment with me?

Most clinics encourage the partner to attend. Any treatment should be a matter of agreement between the consultant, yourself and your partner.

Q6: As a homosexual, can I get treatment for my impotence?

Yes. You will be treated no differently from any other man with erectile dysfunction.

Q7: I have heard that injection treatment is the most widely used. Is this painful?

ICI (Intracavernosal injection) is relatively painless. Most men find it easy to do at home. It is a very effective treatment for erectile dysfunction. Some systems are easier to use than others, as they need little preparation. The injection is administered into the shaft of the penis where it is least sensitive.

Q8: What if I am worried about getting the injection right?

When you start using an injection, it is bound to take a little time to get used to it. With a little practice, however, you will soon feel confident. All you need to do is follow the advice given by your doctor/nurse and the instructions given with the pack.

Q9: Is there a pill to cure impotence?

In simple terms, no. However, the introduction of sildenafil now means some patients may be able to take a tablet treatment that will help them achieve an erection. While sildenafil will work for some patients, it certainly won't work for everyone - but don't worry, as injection therapies can be of help for most men.

Q10: Where can I buy sildenafil?

You cannot buy sildenafil over the counter. It has to be prescribed by a doctor following a careful assessment of your general health.

Q11: Where can I obtain a vacuum erection assistance device?

Erection assistance devices can be bought in sex shops; however, it is advisable to use only medically approved versions. These have built-in safety features and are available only from a hospital specialist. Although you can try these devices on loan, they are not always available on the NHS. You will, therefore, probably have to buy your device if you decide to keep using it. The cost of these devices varies from £100 to £300.

Q12: Are there any creams that can be applied to the penis to produce erections?

A number of drugs have been used as applications to the penis to produce erections. As yet, however, none of them has received a medical licence as a treatment for erectile dysfunction (impotence). The effectiveness and safety of such products, therefore, is still in doubt.

Q13: My doctor says my problem is psychological. Does that mean I cannot get any physical treatment?

No. In some patients with psychological problems, physical treatment can encourage the return of normal erections. This is best assessed by a hospital consultant or a psychosexual counsellor.

Q14: If I need surgery for my impotence, will I have to pay for this?

Not necessarily, although it may depend on where you live. In some areas all types of surgery (including prostheses) for impotence are available on the NHS. Elsewhere the service available is restricted. Your consultant will therefore advise you of what options are available and also of any waiting-list times.

Q15: What if my treatment doesn't work?

If the treatment you try doesn't work you will be invited to try another form of treatment. You will normally be followed up by the clinic to assess the effectiveness of your treatment. If you are not happy with things, mention this to the doctor or nurse when you see them.

Q16: Is there such a thing as the 'male menopause'?

In theory, yes. In reality, however, although male testosterone levels gradually decrease with age, this rarely causes any specific symptoms. Waning erections in the elderly are due more to ageing of the muscles in the penis, which relax to produce an erection, rather than hormone deficiency.

Q17: Can I get testosterone supplements to boost my erections?

Not usually. If the level of testosterone in your blood is normal, testosterone supplements will do you no good, and may in fact do harm. If your levels are low, however, you will undergo further investigations to determine whether this is a simple deficiency or is a sign of another underlying hormone problem. Even if you do receive supplements for a low blood level, it may have no effect on your libido or your erections.

Q18: My doctor has recommended surgery to my prostate gland for urinary symptoms. Is this likely to make me impotent?

Prostate surgery does carry a risk of causing impotence. This risk will vary according to the type of surgery you will be undergoing and also your own specific medical condition. Your consultant, therefore, is best placed to advise you of the potential risks relating to your operation.

Q19: Will my treatment harm my partner?

Injection treatment should not have any effect on your partner, as it is injected into your penis then quickly broken down by your body. This means it can't 'escape' or come into contact with your partner. Intraurethral therapy, however, may affect your partner, so a condom should always be worn if there is a chance your partner is pregnant.

Q20: Will my erections be any different from natural erections?

You and your partner will probably notice that your erections are different from those you have had recently. For one thing, your erection is likely to be harder than before. Another difference you may notice is that your erection lasts for some time after you have ejaculated, although this differs from person to person.

Q21: We are trying for a family. Will treatments affect my fertility?

Medical treatments will have no effect on your fertility. However, ejaculation can be impaired if you are using a vacuum device, as a ring is positioned around the base of the penis.

Q22: How effective are treatments for impotence?

With the current medical treatments available almost all men with ED, regardless of the cause, can regain their erections. Although there has been a lot of publicity about the sildenafil pill, this definitely will not work for everyone and its use is associated with certain side effects, such as headaches. However, don't worry, as injection therapy, for example, can give almost everyone a good erection. Some forms of treatment do require 'practice' to get the best results, so don't be disappointed if at first you don't succeed.