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Impotence

Published by BUPA's health information team, June 2007.

This factsheet is for men with impotence, or people who would like information about it.

Treatment

Impotence can nearly always be treated - 95 percent of men find a suitable treatment. The simplest are talking therapies, such as cognitive behavioral therapy, and medicines.

If the cause is mainly because you are anxious or are having relationship difficulties, then talking to a counselor or psychosexual therapist will probably be most helpful for you. You may also find this useful if you think you may have other psychological problems such as depression.

Self-help

A healthier lifestyle may prevent your impotence getting worse. The following changes can help.

• If you smoke, make a plan to stop.
• Take moderate intensity exercise (so you feel warm and slightly out of breath - brisk walking for instance) for half an hour, most days of the week.
• Eat a balanced diet that is rich in fruit and vegetables and low in fat.
• Drink alcohol in moderation. If you use illegal drugs, bear in mind that these can also          cause impotence.
• Aim to reduce stress in your life by looking at the balance between your work and home/leisure time. You may find relaxation                  techniques are helpful. If you                 have diabetes, you should make sure that you control your blood sugar levels properly.

If your doctor thinks prescription medicines are causing or contributing to impotence, it may                  be possible for you to switch to an alternative.

Medicines

In most other circumstances, the next step will be a trial with a medicine that will help you         obtain and keep an erection.

 However, you will only be able to  receive these medicines on the NHS if you have a specific medical condition, such as diabetes, multiple sclerosis or Parkinson's disease.   You may also be  eligible if you have had major pelvic surgery, spinal injury or kidney failure.

There are now three different types of medicine known as phosphodiesterase    type-5 (PDE5) inhibitors. The most well-known of these is   sildenafil (Viagra).   There are two other similar medicines called tadalafil (Cialis) and vardenafil (Levitra)                 that work in the same way. All three medicines cause the blood vessels in your penis to             relax so more blood can flow into it, leading to an erection. They don't increase your libido            so you will still need sexual stimulation. The        medicines will enable you to have erections for several hours.

There are other medicines available and your doctor will be able to advise which is most suitable for you. As with all medicines, you may have side-effects.         With these treatments they are usually minor and include headaches, nausea, indigestion and flushing. However, there have been rare cases of more serious complications including heart problems.

All of these medicines are only legally approved for use in men and have not been shown in clinical trials to be safe for women.

It's now possible for you to buy some of these medicines over the counter in pharmacies, following a consultation with a pharmacist. Be careful if you are considering buying medicines on the internet, particularly prescription medicines. If you buy medicines over the internet there is a risk that they are from unregulated and illegal websites. If they are, there will be no guarantee of safety, quality or effectiveness of the medicines provided. It's illegal to sell medicines on the internet in the UK. To protect patient safety, the law is that they must be prescribed by a doctor, and dispensed by a pharmacist. If you do wish to purchase medicines online, speak to your doctor about the provider first.

Alternatives

You may be able to get an external vacuum pump device from a hospital impotence clinic or you can buy one. These pump out the air from the penis and so suck blood into it. You can use them with a constriction band to trap blood inside the penis.

It may be an option for you to have surgery to increase the blood supply to your penis or to have a penile implant inserted. Your doctor will be able to tell you more about these procedures

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