Everything you need to know about Erectile Dysfunction

What is Erectile Dysfunction?

Erectile Dysfunction (ED) is a commonly experienced issue that is defined as the inability to attain an erection or to sustain one long enough for sexual intercourse. It can be a topic that is difficult for many men (and women) to discuss. Occasional erectile dysfunction, from stress, tiredness, alcohol or sickness, is not something to worry about. However, ED can be an early indicator of cardiovascular disease, which can result in a heart attack or stroke. ED can impact self esteem, confidence and interfere with intimate relationships. An estimated 50% of men aged 40 -70 years old will experience some form of Erectile Dysfunction at one time or another.

Erectile Dysfunction

Dr Katelaris aims to ensure that all men are able to access support, ED treatment options and encouragement that this is nothing to be embarrassed about. This article aims to provide you with the correct knowledge and understanding of ED so that you can spot early symptoms and identify when you may need to seek help.

What causes Erectile Dysfunction?

There are two main scenarios that can result in ED, and sometimes is a combination of both:


This can stem from previous bad experiences, stress, anxiety, depression or relationship issues. Often these men need a sympathetic ear and encouragement to regain their confidence.


Physical/organic ED often occurs due to lifestyle or medical history, and may require physical treatment in return. A few of the causes of physical ED include:

  • Illnesses affecting the blood vessels – such as diabetes, heart disease, and high blood pressure.
  • Other illnesses – for example multiple sclerosis, or Peyronie’s disease (plaques in the erectile tissue).
  • Lifestyle activities – such as smoking, drug abuse or excess alcohol. It’s well known for instance that smoking can negatively affect the health of the blood vessels.
  • Penile trauma -from injuries sustained, or from prostate cancer surgery.
  • Nerve damage from surgeries of the bladder, rectum or bladder
  • Other factors – such as side effects from prescription medication, or hormone imbalances such as low testosterone (this can be determined from a blood test).

Regardless of the cause, ED is ultimately a result of poor blood flow to the penis, which is why it can be an early warning of vascular disease, such as heart disease.

What can be done?

In order to determine the most effective long-term treatment for ED, it is important to identify the underlying cause, whether physical, psychological, or a combination of both. In the majority of cases, the cause is physical and frequently relates to conditions that affect the blood vessels and blood flow, such as diabetes or heart disease.

Many sufferers of physical erectile dysfunction may benefit from lifestyle changes including:

  • Weight loss
  • Quitting smoking
  • Reducing alcohol consumption
  • Improving overall health through diet, exercise and reduction of stress.

In some cases of psychological ED, the cause may be temporary and resolve itself over time, such as:

  • Illness
  • Anxiety
  • Depression
  • Stress
  • Tiredness

These short-term impacts may go away when the cause is treated through medication, therapy or rest.

In more serious cases of erectile dysfunction, following prostate cancer treatments for example, surgery involving penile implants may provide an effective and successful long-term solution. Surgery is not for everyone however – some sufferers do not need surgery, and some prefer to choose non-surgical treatments. However, specific treatments may still be called for – especially if the damage is already done.

Non-surgical Treatments


For men with mild erectile dysfunction, surgery is often not necessary and oral medications can be quite effective. Some drug treatments need to be taken just prior to intercourse, while others should be taken on a daily basis. They are generally safe, but should not be used without medical supervision.

Medications such as Viagra, Levitra or Cialis are known as PDE-5 inhibitors, and work by increasing blood flow to the penile tissue in order to create an erection. These tablets are to be taken one hour before sex and require sexual stimulation to take effect. It’s important to note that these drugs are not a hormonal treatment, nor are they designed to increase libido. Side effects may include headaches, stomach pain, nausea and flushing. Men who are taking nitrate compounds for a heart condition like angina may not be able to take these medications, but they are a safe option for all other men.

Injection therapy

Penile injections open the blood vessels and increase blood flow to the penis, creating an erection within minutes which lasts for up to 30 minutes. Side effects may include a temporary dull ache, penile scarring, or prolonged erections – which may indicate the dose needs adjusting. Injection therapy must be done under medical supervision, and when proper care is taken this treatment can be very effective.

Vacuum constriction device

This device – also sometimes called a vacuum pump – can be used to produce an erection within a few minutes. The erection can last for up to 30 minutes. The device is made up of a cylinder and pump, either hand or battery-operated, with the vacuum effect being created through pumping air out of the cylinder.

As with the other treatments mentioned, vacuum pumps are designed to increase blood flow to the penis. It can be a very effective treatment for men who have a physical erectile dysfunction problem, and who do not wish to take the surgical option. It is also relatively inexpensive. Some men report a cold feeling and a loss of sensation in the penis, or a loss of spontaneity. Some bruising may also occur, although it is usually not painful.

Linear shockwave therapy

This is a new treatment that uses low-intensity shock waves to reverse vascular dysfunction in the penis. It involves having four or five treatments over several weeks in a day clinic. Treatment is usually pain-free and no adverse side effects have been reported. This treatment may suit men who cannot take PDE-5 drugs or those who have undergone prostate cancer treatment.

Psychological treatments

Psychotherapy and counselling may be helpful on their own where the cause of erectile dysfunction is psychological. They may also be used in conjunction with physical treatments, particularly for men who are struggling with anxiety and loss of self-confidence as a result of erectile function problems.

Lifestyle changes

As previously mentioned, lifestyle factors can be a major contributor. Even if other treatments are being used, taking steps to improve overall health may help improve sexual function naturally. Healthier life choices such as exercising regularly, reducing stress, stopping smoking, drinking alcohol, taking drugs and talking to your partner about your fears and concerns may mean that treatments work better or may eventually not be required at all.

Surgical Treatments

Penile prosthetics or implants are highly effective in enabling the patient to produce an erection ‘on demand’ and restoring confidence and sexual ability, particularly in older men who are suffering from erectile dysfunction as a result of diseases such as diabetes or treatment for cancer.

The implants are made up of cylinders that are inserted into the penis, and a pump. They work by filling up the cylinders with fluid when the pump is manipulated, thus producing an erection. Prosthetics generally have high satisfaction and success rates. As for all surgery, this treatment carries some risk. Also, once implants are used, achieving erections naturally may no longer be possible.

Case Study: Patient Education

If you’ve ever wondered what advice is appropriate to give to someone who is suffering from Erectile Dysfunction, you may be interested in our patient education series produced by Katelaris Urology. In this video, David and Pam Sandoe offer advice to other men and couples who are experiencing ED, and the various processes and treatments that helped them get their lives back after prostate cancer.

If you want a confidential and open discussion about erectile dysfunction, penile implants and what other treatment option may be right for you, contact Katelaris Urology today. Doctor Katelaris offers Erectile Dysfunction treatment methods in the Urology Outpatient Clinic in Hornsby.