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Erectile Dysfunction

A good sex life is important. But what if you have problems getting and maintaining a hard penis – erectile dysfunction? Is normal sex possible, what are the causes of this condition, and can something be done about it? In this article you can read all about this subject.

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What is erectile dysfunction?

Erectile dysfunction affects the ability to get an erection. This means that the penis does not become completely erect despite sexual arousal. Sometimes the penis does not become erect at all. Also, an erection may occur but only last for a very short time. In these cases, sexual intercourse may not be possible. 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 open. This allows more blood to flow into the penis. That blood fills the erectile bodies that are 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 sexual excitement decreases.

When erectile dysfunction occurs 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 is no erection, a weaker 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 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 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 gland 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 desire to perform;
  • Relationship problems;
  • A traumatic 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 patients, impotence has a purely physical cause. But most of the time (in about 45% of cases) it is a combination of factors. In 5% of men, no cause is found for erectile dysfunction.

How can you recognise erectile dysfunction?

You may immediately think of erectile dysfunction if the penis does not harden properly. However, this may not be due to erectile dysfunction. Every man has trouble getting an erection once in a while. This can happen, for example, after drinking too much alcohol or in the case of overtiredness. Only when the erection problems persist and making love is not possible should erectile dysfunction be considered.

Impotence often has a psychological or emotional reason. If the penis does not become hard at all, then there is usually a physical cause. 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 erectile dysfunction. That is certainly not the case. Impotence is common. It is estimated that 4.3 million men in the UK 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 erectile dysfunction?

An important factor is to improve your ability to cope with stress through a healthier lifestyle. Erectile dysfunction is not usually permanent. For example, it can help you to change your lifestyle, do exercise, or stimulate yourself with sexual fantasies.

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

  • Eat healthily.
    A healthy diet consists of 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;
  • Maintain a healthy weight, or lose weight until you reach a healthy weight;
  • Limit stress;
  • Sleep enough
    Read more about this subject in the section on lifestyle changes.
  • Exercise your penis.
    You can find several exercises to improve your erection capacity on the internet. Sometimes you just need a little extra stimulation. It can help to use lubricant, a vibrator or other sex toys. Looking at erotic photos or watching movies can also provide extra stimulation.

Have you tried to do something about your erectile dysfunction yourself, but the results are not as you expected? Then make an appointment with your doctor to discuss the possibility of using an ED treatment.

What are the treatments for erectile dysfunction?

Erectile dysfunction can be treated in different ways. A doctor will always first check if the cause of the impotence can be addressed, for example:

  • If there is a hormone imbalance, a doctor can treat this with a hormone treatment;
  • If a certain medicine is a 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 advanced age, a doctor may also prescribe erection medication. These medicines temporarily improve erectile capacity. If you cannot be treated with erection medication, 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.

What erection medications are there?

Medication to treat erectile dysfunction comes in different forms – erectile dysfunction tablets, or medication that is applied locally (on the penis).

Erection pills

The active substances in erection pills are called phosphodiesterase (PDE)-type 5 inhibitors. Among other things, these help the smooth muscle cells in the penis to relax it. 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), Avanafil (the active substance in Spedra) and Tadalafil (the active substance in Cialis).

How fast and how long do erection pills work?

Erection pills work fairly 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. It will not give you an erection if you are not excited. The effect of erection tablets 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 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 sex in advance.

Do erection pills work for everyone?

Erection pills work in about 41-82% of men with impotence. Phosphodiesterase (PDE) type 5 inhibitors are usually ineffective if erectile dysfunction is caused by severe nerve damage. For example, after prostate removal or a disease such as MS. Note that the effect does not always start immediately. The effect also depends on other factors. Excessive alcohol consumption or severe fatigue, for example, can reduce the effect of erection tablets. Auto-injection therapy

In addition to taking erection pills, some methods work locally. These medications are applied directly into the penis. That is why this 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.

ED treatments used in auto-injection therapy are Phentolamine/Papaverine and Alprostadil. Phentolamine with Papaverine

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


The active substance Alprostadil has a similar action to the endogenous hormone prostaglandin E1. This substance causes the blood vessels in the penis to widen so that the blood supply increases. This creates a strong erection. Alprostadil is supplied as a cream or liquid. The cream is applied to the urethra using a special applicator. You inject the fluid into the penis yourself with a thin needle. The active ingredient Alprostadil also causes an erection if there is no sexual stimulation. Medications containing Alprostadil are, for example, Muse, Vitaros and Caverject. It is not recommended to use 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 erection pills or injections 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 and make it hard. The blood is then held in the penis using an elastic ring that slides over 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.

Penile implant

If nothing else works, you can choose a penile 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 ejaculate and have an orgasm. There are several types, including a flexible one-piece implant and a multi-component inflatable implant. With the flexible implant, you bend the penis to 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 make the penis erect you have to 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 method is more complicated than with the flexible implant.

Changes in lifestyle to treat erectile dysfunction

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.
  • Keep your cholesterol and blood pressure under control.
    If these are too high it can cause damage to the blood vessels and 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. These improve the blood flow to the genitals, which is important for a strong 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 symptoms persist despite lifestyle changes consult a doctor.

Do erectile dysfunction treatments have any risks and side effects?

ED treatment sometimes involves risks. You may also experience side effects. It is important to understand this in advance. What are the risks and side effects of erection pills?

Erection pills are not a suitable 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 high. 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 should not take erection pills.

The active substances in erection pills can cause side effects.

The most common side effects of erection pills are:

  • Hot flushes;
  • Blocked nose;
  • Headache;
  • Dizziness;
  • Stomach upset (nausea);
  • Back pain;
  • Visual disturbance.

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 an erection pill more than once a day to prevent side effects.

What are the 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 inject the medicine. Using the cream can irritate 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 heart rhythm and certain antibiotics and discuss these with your doctor before using auto-injection therapy. 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.

What are the risks and side effects of a 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. Your 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.

What are the risks and side effects of a penis implant?

A penis implant is surgically inserted into the penis. This entails the usual risks when undergoing an operation. Apart from this, the penis prosthesis may break and need 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 a prosthesis implanted.

How can you prevent erection problems?

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 overweight and you smoke, you are 16 times more likely to develop erectile dysfunction.

By adjusting your lifestyle, you can reduce the risk of erectile dysfunction immensely.


Andros Mannenkliniek (z.d.). Erectile dysfunction? Consulted on 25-11-2018 at (z.d.). Phentolamine with papaverine. Consulted on 26-11-2018 at

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

Penis implants. (z.d.). Consulted on 27 November 2018 at (z.d.). Erectile dysfunction. Consulted on 26-11-2018 at (z.d.). I want to use an erection pill. Consulted on 26-11-2018 at (z.d.). I have erectile dysfunction. Consulted on 26-11-2018 at

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