Erectile Dysfunction Clinic Patient Information Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaﬂets please visit www.uhb.nhs.uk/patient-information-leaﬂets.htm What is erectile dysfunction? Erectile Dysfunction (ED) is the persistent inability to get or maintain an erection that is sufﬁcient for successful sexual intercourse. How common is ED? ED effects approximately half of all men between the ages of 40-70. What causes ED? ED can have many causes that are either physical (within the body) or psychological (related to mind). Common causes are: • high cholesterol • diabetes • some medications • hormonal problems • blockage of blood supply to penis • venous leakage of blood away from penis • Peyronnies disease Psychological causes may include anxiety, depression, relationship problems, and stress. Your healthcare practitioner will discuss with you your individual case and what may be contributing towards your ED. Is there a cure for ED? ED can have a signiﬁcant impact on your quality of life and currently there is no known cure for ED. However there are treatments available, which may be able to provide you with a good quality erection to have satisfactory sexual intercourse. 2 What can I expect to happen at clinic? The healthcare practitioner will ask you some questions to assess your erections. Blood tests will be taken and you will be given a physical examination. The healthcare practitioner will discuss treatment options, and in some cases shown to you, in clinic. Can I refuse any part of the assessment? Of course you may refuse to have any part of the assessment carried out. The healthcare practitioner may not be able to assess your symptoms fully or recommend the most beneﬁcial treatment to you, without being able to gain all of the information. What are the treatment options? The symptoms of ED may be helped by making lifestyle changes which can reduce risk factors which make you more at risk from getting ED. These include: • Losing weight • Reducing alcohol intake • Not taking illegal drugs • Giving up smoking • Exercising regularly These changes may also have an impact on improving your general health. Your treatment options will depend on the ﬁndings of the healthcare practitioner. If your ED is caused by an underlying medical condition, it may be necessary to treat the condition ﬁrst, before treating the ED. 3 If a hormonal problem is identiﬁed, it may be necessary to refer you to an endocrinologist. An endocrinologist is a specialist in the treatment of hormonal conditions. There are 4 different treatments available for erectile dysfunction. • Tablets taken prior to intercourse (VIAGRA, CIALIS and LEVITRA) • A pellet of medication that goes into your urethra (water pipe) called MUSE (medicated urethral system for erection) • Injections that go directly into the penis called CAVERJECT • Vacuum suction devices - an external plastic tube placed over the penis. When activated it creates a vacuum that allows the penis to ﬁll with blood. To keep the penis erect a rubber constriction band is placed on the penis during intercourse • Psychological therapy (counselling) Medication for ED Viagra – This is available in different strengths, and your healthcare practitioner will discuss this with you. Viagra needs to be taken at least 30 to 60 minutes prior to sexual intercourse, and lasts for around 8 hours. Cialis – This is available in different strengths, which can change how you take this medication. One type of Cialis is taken in the same way as Viagra, at least 30 minutes prior to sexual intercourse, but each tablet may be effective for a maximum of 36 hours. Another type of Cialis is taken on a daily basis. Levitra – This is available in different strengths and also needs to be taken at least 30 minutes prior to sexual intercourse. Manufacturer recommendations are that it lasts around 8 hours. These tablets work through sexual stimulation and therefore you need to be aroused in order for them to become effective. The type of tablet that may be best suited to individual need, will be discussed by your healthcare practitioner at your appointment. 4 Side effects from tablets may affect some people and not others. How you will be affected is unknown until you have tried the tablets. Below is a list of the most reported side effects in our clinics: • ﬂushing (redness) • indigestion • nausea (feeling sick) • vomiting (being sick) • a blocked or runny nose • back pain • vision disturbances • muscle pain • headaches and migraines MUSE and CAVERJECT The active drug in MUSE and CAVERJECT is Alprostadil. This is a man-made hormone which stimulates blood ﬂow to the penis. You will be taught how to use these treatments at your appointment, by your healthcare practitioner, and it may take between 1 and 8 weeks, to establish you on a dose which is effective. Alprostadil will usually produce an erection within 15 minutes and how long it lasts can vary from patient to patient. The side effects of Alprostidil again vary depending on the route of administration but include: • changes in your blood pressure • dizziness • headache • pain in your penis • urethral burning or bleeding • reactions at the site of the injection, such as swelling • dizziness and sometimes fainting 5 MUSE – is a pellet of medication that goes into your urethra (water pipe). CAVERJECT – is an injection that goes directly into the penis. Both of these treatments need to be tried within the clinic setting and cannot be prescribed by your GP until the dose of medication has been determined and your technique in using these treatments has been assessed as being safe. Vacuum suction devices If a vacuum suction device is appropriate for you, your healthcare practitioner will arrange a further appointment for you with the product specialist. They will show you how these devices work. You can try a device to see what effect you get before deciding to order one. These devices can cost around £150, therefore we want you to be completely happy with the outcome prior to purchase (if you are entitled to a prescription on the NHS then these pumps are prescribed by your GP and you would only pay the prescription charge, if this applies to you). Do I have to pay for ED treatments? The Department of Health guidelines state that unless patients have one of the following conditions, then they must pay for their ED treatments. Your GP and healthcare practitioner cannot change these national guidelines. • Diabetes • Multiple sclerosis • Parkinson’s disease • Poliomyelitis • Prostate cancer • Prostatectomy • Radical pelvic surgery • Renal failure treated by dialysis or transplant 6 • Severe pelvic injury • Single gene neurological disease • Spinal cord injury • Spina biﬁda • Patients who were taking treatments for ED prior to 14 September 1998 Once you are happy with a treatment option, your healthcare practitioner will write to your GP asking him to provide you with a prescription. If you do not meet the requirements to receive free prescriptions, this prescription is commonly known as a ‘Private Prescription’. When you take this to a pharmacy, they will know that you are required to pay the full cost of the prescription. If you do meet the requirements then you will receive a prescription in the usual manner. How much will I have to pay for treatments? Each treatment will have a different cost and will also change over time. The current average costs will be discussed with you, by your healthcare practitioner. For further information please contact: Advanced Nurse Practitioner Michele Miletic Telephone: 0121 672 7843 Urology Clinical Nurse Specialist Kelly Calame Telephone: 0121 627 2284 Mr Subramonian Secretary Telephone: 0121 371 5737 7 The Trust provides free monthly health talks on a variety of medical conditions and treatments. For more information visit www.uhb.nhs.uk/health-talks.htm or call 0121 371 4957. Urology Queen Elizabeth Hospital Birmingham Mindelsohn Way, Edgbaston, Birmingham, B15 2WB Telephone: 0121 627 2277 PI11_1247_01 UHB/PI/1247 (Edition 1) Author: Kelly Calame Date: August 2012 Review date: August 2014