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Erectile Dysfunction

A good sex life is important. But what if you have an erectile dysfunction? Is normal sex ever possible, what are the causes of this condition, and can something be done about it? In this text you can read all about this subject. 

What is an erectile dysfunction?

With an erectile dysfunction, the ability to get a good erection is disturbed. This means that the penis does not become very erect despite sexual excitement. Sometimes the penis does not become erect at all. It can also happen that an erection occurs, but only lasts for a very short time. In all these cases, normal sexual acts, such as sexual intercourse, are not possible or not properly possible. An erectile dysfunction is also called impotence.

What are the causes of erectile dysfunction?

A normal erection occurs as a reaction to sexual arousal. Sexual stimuli cause the blood vessels in the penis to be widely opened. This allows more blood to flow into the penis. That blood fills the erectile bodies, spongy tissues in the penis. This makes the penis erect and hard. Due to the pressure of the tissue on the vessels, it is difficult for the blood to drain away. This keeps the erection until an orgasm occurs and / or the sexual excitement decreases.

In the case of an erectile dysfunction, this complex process is disturbed. The blood vessels do not dilate, or the collected blood flows out of the penis after a short time. The result: no erection, a less powerful erection or an erection that only lasts for a short time.

What types of erectile dysfunction are there? 

Erectile dysfunction comes in two forms: impotence with a physical cause and impotence with a psychological/emotional cause. 

Physical causes of an erectile dysfunction are, for example: 

  • Old age: as a man gets older, his erectile capacity decreases.
  • An unhealthy lifestyle: eating too much fat, smoking, lack of exercise and drinking alcohol can make the veins less flexible. This makes it more difficult for them to dilate and limits the blood flow to the penis.
  • The use of certain medicines: some medicines can have a negative impact on the erection process.
  • Certain conditions: nerve-damaging illnesses can interfere with the stimulus transfer between the brain and the penis. This can occur, for example, with diabetes or multiple sclerosis. An operation on the prostate can also cause impotence in this way.  
  • Hormonal imbalance: in some men, impotence is due to a shortage of the male sex hormone testosterone. This hormone plays a major role in whether or not an erection occurs. 
  • Problems with the penis itself, such as too narrow a foreskin or the curvature of the penis (Peyronie’s disease), which makes getting an erection very painful and reduces the desire to have sex.

Psychological/emotional causes of erectile dysfunction are for example: 

  • Stress
  • Overtiredness
  • Depression
  • Fear of failure, insecurity; perfectionism or the urge to perform
  • Relationship problems
  • An unprocessed trauma or violent event, such as sexual abuse, a divorce or the death of a loved one

About a quarter of erectile dysfunctions are the result of psychological/emotional issues. In another quarter of the patients, the impotence has a purely physical cause. But most of the time (in about 45% of the cases) it is a combination of factors. In 5% of the patients no cause is found for the erectile dysfunction. 

How can you recognise an erectile dysfunction?

You may immediately think of an erectile dysfunction if the penis does not stiffen properly at some point. That is not always right. Every man has trouble getting an erection once in a while. This can happen, for example, after drinking too much alcohol or in case of overtiredness.  Only when the erection problems persist and making love is no longer possible do we talk of an erectile dysfunction.  

Do you occasionally get a (morning) erection? Then the impotence often has a psychological or emotional background. If the penis does not become stiff (properly) at all, then there is usually a physical cause. An erectile dysfunction can have a significant impact on your life. You may experience feelings of insecurity or shame. This can also have a negative impact on your relationship.  

A lot of men think they are the only ones with an erectile dysfunction. That is certainly not the case. Impotence is common. It is estimated that 1 in 10 men in the Netherlands have difficulty getting an erection. Older men in particular suffer from this. It is normal for the ability to get an erection to decrease in later life.  

Is there anything you can do yourself about an erectile dysfunction? 

An erectile dysfunction is not always definitive. For example, it can help you to change your lifestyle, do exercises, or to stimulate your sexual fantasy a little extra. Improving the ability to cope with stress through a healthier lifestyle 

A healthy lifestyle helps to improve blood circulation in the genitals. This also improves the erectile capacity. A healthy lifestyle means that you: 

  • Eat healthily. A healthy diet consists of many fresh fruit and vegetables, lean meat, healthy fats, low-fat dairy products and whole grain products. Avoid foods with a lot of saturated fats, sugar and salt. 
  • Do not smoke (or stop smoking)
  • Only drink a little or no alcohol
  • Regularly move
  • Have a healthy weight, or lose weight until you reach a healthy weight
  • Limit stress to a minimum
  • Sleep enough: read more about this subject in the section on lifestyle changes. 
  • Exercise makes perfect. On the internet you can find several exercises to improve your erection capacity. Sometimes your erectile capacity just needs a little extra stimulation. It can then help to use lubricant, a vibrator or other sex toys. Watching erotic photos or movies can also provide extra stimulation. 
  • Have you tried to do something about your erectile dysfunction yourself, but the results are not as good as you would expect them to be? Then make an appointment with the general practitioner.  

What are the forms of treatment? 

Erectile dysfunction can be treated in different ways. A general practitioner will always first see if the cause of the impotence can be tackled, for example: 

  • If there is a hormonal imbalance, a doctor can treat it with a hormonal treatment.  
  • If a certain medicine is the cause, then another medicine can be prescribed.  
  • If the symptoms are caused by trauma, low self-esteem or other psychological problems, a doctor can refer you to a psychologist or sexologist. 

If the cause cannot be solved, for example because the impotence is related to an advanced age, a doctor may also prescribe erectants. These medicines temporarily improve the erectile capacity.  If you cannot be treated with erectants, for example because the medicines do not work or because you cannot use them? There are also other options such as using a vacuum pump or a surgical procedure. 


Erectile dysfunctions come in different forms: pills to take and medication that is applied locally (in the penis). 

Erection pills 

The active substances in erection pills are so-called phosphodiesterase (PDE)-type 5 inhibitors. Among other things, these medications help the smooth muscle cells in the penis to relax better. This allows more blood to flow to the penis and gives you a better erection that lasts long enough to have normal sex. Known phosphodiesterase (PDE) type 5 inhibitors are sildenafil (the active substance in Viagra), vardenafil (the active substance in Levitra), avenafil (the active substance in Spedra) and tadalafil (the active substance in Cialis). 

How fast and how long do erection pills work? 

Erection pills work pretty quickly. Most variants produce results within half an hour to an hour. However, this medication only works if you are sexually aroused. An erection pill will not make you want to have more sex. They will not give you an erection even if you are not excited. The effect of erection pills decreases after a few hours. 

How do I use erection pills? 

Most erection pills allow you to take a tablet approximately one hour to half an hour before the start of the sexual activity. There are also erection pills that you should take every day, even if you are not having sex. The effect is then continuous, so you do not have to plan the sex in advance. 

Does an erection pill work for everyone? 

Erection pills work in about 41-82% of patients with impotence. Phosphodiesterase (PDE) type 5 inhibitors are usually ineffective if the erectile dysfunction is caused by severe nerve damage. For example, after a prostate removal or a disease such as ms.  Please note that the treatment does not always start immediately. Sometimes you only notice it after a number of times that it works. The effect also depends on other factors. Excessive alcohol consumption or severe fatigue, for example, can flatten the effect of the erection pill. 

Auto-injection therapy 

In addition to taking erectants, there are also erectants that work locally. These medications are applied directly into the penis. That is why it is called auto-injection therapy. The medications work almost immediately; within a few minutes they cause an erection which decreases by itself after about an hour. 

Erectants used in auto-injection therapy are fentolamine/papaverine and alprostadil. 

Fentolamine with papaverine 

The active substances fentolamine and papaverine dilate the blood vessels in the penis. This results in a firm erection almost immediately. This medicine consists of a liquid that you apply directly into the penis using a thin needle. An erectile medicine based on fentolamine and papaverine, for example, is Androskat.  


The active substance alprostadil is similar in action to the endogenous hormone prostaglandin E1. This substance causes the blood vessels in the penis to widen so that the blood supply increases. In this way, a good erection is created. Alprostadil is supplied as a cream or liquid. The cream is applied to the urethra using a special applicator. You inject the fluid yourself into the penis with a thin needle. The active ingredient alprostadil also causes an erection if there is no sexual stimulation. Erectants with alprostadil are for example Muse, Vitaros and Caverject. It is not recommended to use erectants by means of auto-injection therapy frequently. The recommended frequency is two to three times a week and not more often than once a day. 

Alternative treatment for erectile dysfunction 

If you cannot or should not use erectants, there are alternatives, such as a vacuum pump or an implant that is surgically inserted into the penis. 

Vacuum pump (penis pump) 

With a vacuum pump (also known as a penis pump or erection pump) you can get an erection without the use of medication. The pump consists of a plastic tube that is placed over the penis. Using a pump, the air is sucked out of the tube, creating a vacuum. This causes blood to be directed to the penis to become stiff. The blood is then held in the penis by means of an elastic ring that is slid around the penis. This ring may remain in place for a maximum of 30 minutes. The vacuum pump can be used by almost everyone and has few or no side effects. There are penis pumps that you can operate by hand, but there are also electric penis pumps. 

Penis implant 

If nothing else works, you can choose a penis implant (also called a penis prosthesis or an erection prosthesis). A prosthesis is then surgically inserted into the penis. With a penis prosthesis you can just get an ejaculation and orgasm. There are several types, including a flexible one-piece implant and a multi-component inflatable implant.  With the flexible implant, you can put the penis in the erection position by hand. After intercourse, bend the penis back.  The inflatable implant consists of cylinders, a pump and possibly a water tank. To get the penis to erection, squeeze a scrotum pump. This fills the cylinders in the penis with air or water and expands the penis. The result looks more natural, but the use is more complicated than with the flexible implant.  

Changes in lifestyle 

If you suffer from erectile dysfunction or if you want to reduce the risk of developing impotence, a healthy lifestyle is essential. If you have unhealthy habits, tackle them one by one: 

  • Stop smoking. Smoking narrows the blood vessels, including those in the penis. This causes the erectile dysfunction to decrease faster. 

  • Stop drinking. Liquor lowers testosterone levels in the blood. This male sex hormone plays a major role in the functioning of the genitals. 
  • Make sure you are a healthy weight. Being overweight and obesity increase the risk of type 2 diabetes. This disorder can eventually cause damage to the nerves, which can lead to impotence, among other things. 
  • Keep your cholesterol and blood pressure under control. If these values are too high, it can cause damage to the blood vessels. Also on the blood vessels in the penis. 

Healthy eating, more exercise and not smoking and drinking are the most important ways to get or stay fit. It improves the blood flow in the genitals, which is an important condition for a good erection. If you are fit, you usually look better and feel more energetic. This gives your self-confidence a boost, and also has a positive influence on your performance in bed. 

If the symptoms persist despite the lifestyle changes, please consult a doctor. 

Additional risks and side effects 

Treatment for erectile dysfunction sometimes involves risks. You may also experience side effects. It is good to realise this in advance.  

Risks and side effects of erection pills 

Erection pills are not a good solution for everyone. For example, men taking certain medicines (such as those containing nitrates or releasing nitric oxide) should not use phosphodiesterase (PDE) type 5 inhibitors because the risk of serious side effects is too high. Even if you have recently had a stroke or a heart attack, suffer from very low blood pressure, a certain eye condition, liver problems or a serious heart condition, you may not take erection pills.  

The active substances in erection pills can cause side effects. The best known side effects of these erection pills are: 

  • Flush
  • Blocked nose
  • Headache

  • Dizziness

  • Stomach discomfort (nausea)

  • Back pain

  • Visual disturbances

Severe and rare side effects include heart attacks and sudden loss of vision. The risk of side effects increases if you take the medication frequently. Do not take the erection pill more than once a day to prevent this from happening.  

Risks and side effects of auto-injection therapy 

In auto-injection therapy, the side effects are often related to the penis. This can cause irritation, bruising or lumps at the place where you injected the medicine. Using the cream can cause irritation in the urethra. A serious side effect, which is fortunately rare, is priapism; a painful and prolonged erection. This can damage the tissue in the penis. Contact a doctor if your erection has still not decreased after three hours. 

Medications for auto-injection therapy are not suitable for people who have an abnormality of the penis. Also be aware of the use of other medicines, such as certain antifungal medicines, medicines that affect the heart rhythm and certain antibiotics. Injecting the fluid into the penis can be risky for men taking blood thinning medication. The risk of side effects increases if you take the medication frequently. Auto-injection medication should not be used more than two or three times a week, and not more often than once a day. 

Risks and side effects of vacuum pump 

If you use the penis pump and the penis ring according to the instructions, there is little chance of problems. However, if you take blood thinners, you may suffer from bleeding. Even if you are anaemic, the use of a penis pump can involve risks. Consult a doctor if this applies to you.  A penis pump has little or no side effects. However, the vacuum can give the erection a purple colour. The orgasm may also feel different. Sometimes bruises appear on the penis after using the pump. Usually these are not painful and disappear by themselves after a while. 

Risks and side effects of a penis implant 

A penis implant is surgically inserted into the penis. This entails the usual operating risks. Apart from that, it can happen that the penis prosthesis breaks and needs to be removed. The penis may also become warped, shortened or have unsightly scars. It is also important to realise that you will never have a natural erection after you have placed a prosthesis. 

How can you prevent erection problems?

An erectile dysfunction is often the result of several factors. Your lifestyle is one of them.  

An unhealthy lifestyle increases the risk of erectile dysfunction; the figures are clear. For example, men who are obese (their BMI is 30 or more) are four times more likely to become impotent. The same goes for men who smoke. If you are much too heavy and you smoke, you are 16 times more likely to develop an erectile dysfunction. 

By adjusting your lifestyle, you can reduce the risk of erectile dysfunction to a large extent. 


Andros Mannenkliniek (z.d.). Erectile dysfunction? Consulted on 25-11-2018 at (z.d.). Fentolamine with papaverine. Consulted on 26-11-2018 at! (z.d.). Erection pills. Consulted on 26-11-2018 at (z.d.). Auto-injection therapy. Consulted on 26-11-2018 at (z.d.). Vacuum pump. Consulted on 25-11-2018 at (z.d.). Penis prosthesis. Consulted on 26-11-2018 at 

Jeroen Bosch Hospital (z.d.). Erectile dysfunction. Consulted on 25-11-2018 at 

Penis implants

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