Erectile dysfunction

What is erectile dysfunction?

Erectile dysfunction (ED) is a common male sexual disorder. It is the inability to get or keep an erection that allows for satisfying sexual activity. It can happen occasionally or regularly, with or without any clear reason. Some men with ED are not able to get an erection at all.

ED is not a life-threatening disorder, but it can have a negative impact on your quality of life and that of your partner.

What is an erection?

Getting an erection is a process that includes physical, hormonal, and psychological elements. The penis is made of soft, spongy, elastic tissue that fills with blood to make it grow in size and become rigid. Around the spongy tissue and the prostate, there are nerves that send signals so that the blood vessels supply the blood (Fig. 1). These signals are controlled by the male hormone testosterone.

How common is ED?

ED is a common condition in men of all ages and ethnicities. The risk of having ED increases with age.

Fig. 1: Anatomy of the penis.
Fig. 1: Anatomy of the penis.

ED after treatment for localised prostate cancer

Prostate cancer is a malignant tumor in the prostate gland. It is the most common form of cancer in older men. There are various treatment options for localized prostate cancer. Two of the most common ones are radical prostatectomy and radiation therapy. These treatment options can affect sexual health, and men frequently experience erectile dysfunction (ED) after treatment.

Why is prostate cancer treatment associated with erection problems?

The prostate gland is located just below the bladder and is surrounded by nerves and blood vessels. These nerves and blood vessels are needed to achieve a normal erection. Much research has been done to understand where these nerves are located and how to prevent them from getting damaged during surgery or other treatments.

Will I be able to have normal erections after the treatment?

The risk of having ED after prostate cancer treatment depends on the surgical technique or type of radiation used by your doctor, but also on your:

  • Age
  • Build
  • Disease characteristics
  • Sexual health before the treatment

Living with ED

Nearly every man can experience brief problems with erectile function. In almost all cases it is related to certain and specific life circumstances, problems, or stressful situations. Usually, these erectile problems disappear once the situation is resolved or changed. You generally don’t need to go to the doctor.

If you experience erectile dysfunction (ED) for more than 6 months you should seek professional help. Your doctor can help you find the causes by performing physical and psychological tests. Read more about them in the section Diagnosis of ED.

ED can have a negative effect on quality of life. Quality of life involves both physical and psychological health. It is important not only to feel healthy but also to feel free of the psychological discomfort of living with ED. Another important issue is that different people can experience the same symptoms differently. Therefore both your personal experience and your quality of life should not be underestimated: they are as important as diagnostic tests and treatment results.

Seeking help

ED is a very intimate and private condition. Most patients consult multiple sources of information for erectile problems: friends, the Internet, media, a sexual health shop, a pharmacist, a psychologist, or a medical doctor.

Some men choose not to discuss it with anybody or not to go to their doctor because they:

  • Think they have normal erection, so it is unnecessary to take any treatment
  • Assume they can stop their sexual life, so it is unnecessary to take any treatment
  • Are afraid they may have an incurable disease
  • Are worried about a wrong diagnosis
  • Do not have easy access to a doctor
  • Have had a negative experience in the hospital
  • Have friends or relatives who had a negative experience when treated for a similar condition
  • Do not know about possible treatment options
  • Have financial issues
  • Feel isolated because of their age or condition

While these reasons may seem convincing they should not prevent you from seeking help and improving your quality of life.

Questions to ask your doctor

You may have a lot of questions regarding your condition. EAU Patient Information on ED covers many of these questions but it does not deal with your personal situation. The urologist and the sexologist are the best people to discuss this with and you should not feel embarrassed about addressing any of your concerns.

Here are some of the questions you could ask your doctor:

  • Why have I developed this problem?
  • Why is this happening to me?
  • What will happen in the next months and years if I do not get treatment?
  • What will happen in the next months and years if I choose to have treatment?
  • Which are the available treatment options?
  • Which treatment option do you recommend for me?
  • Why do you recommend this treatment option for me?
  • What can I expect from that treatment?
  • What are the possible side effects or risks of this treatment?
  • Will it cure my condition?
  • How long will I need to be treated for?

This information was produced by the European Association of Urology.

  • Dr. Maarten Albersen, Leuven (BE)
  • Dr. Eduardo García-Cruz, Barcelona (ES)
  • Prof. Dr. Kostas Hatzimouratidis, Thessaloniki (GR)
  • Prof. Dr. Markus Margreiter, Vienna (CH)
  • Dr. Ege Can Serefoglu, Istanbul (TR)
  • Dr. Chaira Simonelli, Rome (IT)
  • Prof. Dr. Wolfgang Weidner, Giessen (DE)

Updated March 2018 by the EAU Patient Information Working Group

  • Dr. Mazhar Ortac, Istanbul (TR)