Are you experiencing Difficulty having intercourse or an erection?
Erection problems are very common and are often nothing to worry about. However if it happens regularly, it may be caused by physical health or emotional problems. This is when it’s time to get checked out!
Some men just want their testosterone level checked, but I always recommend having a consultation face to face so that physical examination can be carried out to ensure there is no disease of the penis or the testicles. BOOK NOW for a confidential consultation with one of our doctors.
WHAT HAPPENS AT A CONSULTATION WITH our doctor?
If you come to Vitalis for an appointment regarding erectile dysfunction then the doctor will ask about your history, lifestyle, relationships and the problems you are having as well as give you a physical examination:
We will carry out basic health checks: taking your blood pressure, measuring your height and weight to calculate your BMI. You will also be asked to give a urine sample. We always check your urine for blood that you cannot see (microscopic blood) signs of infection and glucose.
A physical examination will include examination of the abdomen, examination of the penis itself and the testes.
We will always ask about anabolic steroids, if you smoke marijuana or tobacco and if you drink alcohol.
We will ask if you are on any medications.
We will assess your risk factors for heart disease based on your body weight, BMI, your blood pressure, whether you have diabetes or you smoke, whether you have a strong family history of heart disease, your cholesterol and if you have underlying inflammation due to another disease.
If we decide it is necessary then I will advice on blood tests: an early morning testosterone level between 8am - 10am, prolactin level, PSA (for the prostate) and if the testosterone is low we would also check the FSH and LH levels which comes from the pituitary gland within the brain.
We will ask you specific questions about your erectile dysfunction such as:
The duration of your symptoms of not being able to have an erection.
the onset gradual or did it happen suddenly? Is it consistently not happening or does it just happen intermittently?
Are you having an early morning erection?
What is the quality of the erection when stimulated by yourself or your partner?
Can you sustain an erection once it has begun?
Is there a loss of libido ?
Is there an issue with ejaculation? Does it happen too early, is it delayed or is it painful?
Are you having any discharge from the penis or pain on passing urine?
Is your partner having any issues with intercourse?During the COVID pandemic I have seen a lot of young men who have had difficulty having intercourse, this has almost always been related to stress or anxiety.
What is the treatment for erectile dysfunction?
Treatments for erectile dysfunction are usually effective and the problem often goes away.
In terms of psychological causes, if depression and anxiety are the main drivers for the inability to have an erection to perform intercourse then it is really important to address this first. We refer most patients for a course of mindfulness-based therapy to improve their understanding of the link between depression or anxiety and the ability to have an erection; this proves very successful in the vast majority of people. Of course it does suit suit everyone and we may suggest other modalities/counselling to reduce fear/stress in life.
We would discuss any medication you are on and if this could be causing problems. If this is a problem we would look at options to change medication safely.
High blood pressure and high cholesterol causing a narrowing of penis blood vessels can be treated with specific medicine to lower blood pressure or statins to lower cholesterol. It will also be advised for you to exercise and lose weight. We can support you with this, particularly with our Weight Loss Programme.
In cases where more in depth assessment is required and in order to start any treatment to improve sexual function we would always refer to a specialist Urologist for erectile dysfunction for onward management.
WHAT CAUSES ERECTILE DYSFUNCTION?
Psychological stress It will no surprise that stress can cause problems in this area, as it does in nearly every area of our body! Stress can be recent or chronic originating from childhood. Most of us never address our stress adequately, but that is changing. At Vitalis Health we believe in looking for alternative ways to improve your confidence and wellbeing.
Medication / drugs There are many drugs that affect erections and libido including anti depressants and medication for blood pressure.
Lifestyle High blood pressure and high cholesterol can cause a narrowing of penis blood vessels. Regular drinking over the advised limit of alcohol as well as regular smoking can effect erectile functioning.
Diabetes. Erectile Dysfunction is common in men with diabetes. It causes early and severe hardening of the arteries. Problems with the nerves controlling erections are also often seen in men with diabetes.
Organic impotence. It is the most common cause of Erectile Dysfunction, especially in older men. It can be related to hardening of the arteries throughout the body. Injury or a venous leak in the penis may also cause Erectile Dysfunction.
Disease If you are not taking any medications, have no psychological issues and do not have diabetes or pre-diabetes, then we have to look for other underlying conditions. These include but are not limited to vascular disease (this is particularly common if you are a smoker or have had a heart attack or stroke) and neurological disorders such as multiple sclerosis.
Hormone-induced impotence. Hormone abnormalities including increased prolactin, a hormone made by the pituitary gland, can cause Erectile Dysfunction.
SELF HELP for erectile dysfunction
Here are some things you can do to investigate and work on your problems even before booking an appointment.
If you are under stress, try to build some stress free time into your day. Even ten minutes before breakfast doing deep-breathing/meditation will help. Keep a diary or journal and write down how you’re doing each morning. Consider abstaining from intercourse for 4 weeks while improving your mental health and then see where you are after that.Things may have improved.
Get your blood pressure checked, this can be done in a pharmacy or we can do it for you.
If you are overweight or unfit or both, then build ten minutes of exercise into your day. Whether you lose weight or not, becoming stronger and fitter will improve your blood pressure, your overall health and confidence. Again reassess things 4 weeks to see if there is any change.
If you are taking any medications that could affect having an erection, such as a blood pressure tablet or an anti-depressant, ask your doctor if there is an alternative that you could try and then again reassess things in about 4-6 weeks.
Why Choose Vitalis Health for Private STD tests in Northern Ireland?
All of our sexual health examinations and treatments are administered with the utmost confidentiality and discretion. The results are reported and shared by one of our doctors. Your report will give clear instructions on their meaning and what to do next. Our patient reviews show how efficient, attentive, confidential and effective our care is. We are frequented by visitors from all over the world passing through Belfast City and from places all over Northern Ireland such as Lisburn, Antrim, Derry/Londonderry, Strabane, Omagh, Enniskillen, Armagh, Tyrone, Coleraine, Larne, Craigavon. We are an experienced team who want your time at Vitalis Health to feel important, seamless and a great experience. If we get anything wrong we will aim to learn from this and improve our service further using our robust complaints procedure.
Dr Graham is highly experienced in the field of general practice. Her extensive life experiences daily inform her medical practice including what she learned while travelling around the world, her sports and yoga practice, her family life including having two small daughters as well as supporting her brother Christopher who has Down syndrome. She understands the complexities of each medical condition and how they can affect individuals differently physically and mentally.