Erectile Dysfunction

A/Prof Katz – Experienced, Trusted, Caring

A/Prof Katz, one of Australia’s experts in Erectile dysfunction diagnosis and treatments, was recently invited to write the latest update on Erectile Dysfunction management for a journal/magazine targeted at GPs and urologists click here to read it. He was also involved in writing an article (click here to read it Focus Erectile Dysfunction ) in the  official journal for all General Practitioners around Australia. 

Penile injections:

Click here to find out about the newest techniques in administering pro-erection drugs directly to the penis.

What is Erectile Dysfunction?

Erectile dysfunction is also called or referred to as impotence.

Erectile dysfunction is when a man cannot obtain or maintain a penile erection firm enough during sexual activity.

Who does Erectile Dysfunction affect?

Erectile dysfunction affects men typically with pre-existing medical conditions (noted below) as well as men aged > 50 years old.

The largest group affected by Erectile dysfunction are patients suffering from Diabetes, Obesity-related disorders and after surgery (prostate or bowel surgery)

What are the Causes of Erectile Dysfunction?

As men age, there are many contributing health conditions that may give rise to a reduced erectile function.

Lifestyle Choices that contribute to heart disease and vascular problems also increase the risk of erectile dysfunction.

Common health issues that are associated with erectile dysfunction include:

  • Diabetes and Obesity
  • Heart disease
  • Clogged blood vessels (atherosclerosis)
  • High cholesterol and/or blood pressure
  • Side effects from certain prescription medications including antihypertensive, antidepressants, sedatives and hormonal medication
  • Tobacco, alcohol or other forms of substance abuse
  • Poor sleep and stress
  • Prostate cancer
  • Kidney disease
  • Multiple sclerosis
  • Vascular disease, and
  • Neurologic disease

Surgical Causes of Erectile Dysfunction

Surgery, especially radical prostate/bladder surgery as well as certain types of rectal surgery can injure nerves and arteries near the penis, causing Erectile dysfunction.

Injury to the penis, spinal cord, prostate, bladder, and pelvis can cause Erectile dysfunction by injuring nerves, smooth muscles, arteries, and the fibrous tissues of the corpora cavernosa

Psychological Causes of Erectile Dysfunction

Experts believe that psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure may also cause Erectile dysfunction.

Men with a physical cause for Erectile dysfunction frequently also experience some sort of psychological reactions (stress, anxiety, guilt, and depression).

How Does Erectile Dysfunction Occur?

An erection requires a precise sequence of events. Erectile dysfunction cannot occur when any of the events is disrupted. The sequenced events involve:

  • generation of nerve impulses in the brain,
  • Messages being sent down the spinal column to the area around the penis,
  • Muscle and fibrous tissue response, and
  • Blood flow to the vasculature in and around the corpora cavernosa.

Symptoms of Erectile Dysfunction

Erectile dysfunction symptoms might include recurring problems associated with:

  • Inability or difficulty gaining an erection.
  • Trouble maintaining a firm erection sufficient for intercourse,
  • Problems with premature ejaculation, and/or
  • A sense of reduced sexual desire.

Consequences of not treating Erectile Dysfunction

Erectile Dysfunction left untreated can lead to lowered self-esteem, frustration psychological trauma and relationship problems.

Erectile Dysfunction can be a symptom of chronic health conditions such as cardiovascular disease, hypertension and diabetes mellitus. Ignoring either erectile dysfunction or associated diseases can be a danger to your health and longevity.

Diagnosis of Erectile Dysfunction

The diagnosis of erectile dysfunction involves the following steps:

Patient History

Medical and sexual histories help define the degree and nature of erectile dysfunction.

A medical history can disclose diseases that lead to erectile dysfunction, while a simple recounting of sexual activity might distinguish among problems with sexual desire, erection, ejaculation, or orgasm.

Physical Examination

A physical examination can give clues to systemic problems.

For example, if the penis is not sensitive to touch, it may indicate a problem in the nervous system.

Abnormal secondary sex characteristics, such as hair pattern or breast enlargement, can indicate hormonal problems, which would mean that the endocrine system is involved.

Unusual features of the penis itself could indicate the source of the problem for example; a penis that bends or curves when erect could be the effect of Peyronie’s disease


Several laboratory tests for systemic diseases such as blood counts, urinalysis and lipid profile, can help diagnose erectile dysfunction.

Measuring the amount of testosterone in the blood can give information about problems with the endocrine system and is useful to measure is some men


Penile ultrasound with Colour Doppler enhancement can give an accurate diagnosis as to the underlying cause the erectile dysfunction. Dr Glenn Duns has a vast experience with penile ultrasounds.

Once a clearer understanding of a patient’s general health and possible causes are identified various treatment pathways can be explored

Erectile Dysfunction Treatments

Erectile dysfunction is treatable and in some cases curable, irrespective of the age.

Improving erectile dysfunction treatments are now available for men seeking a return to normal sexual activity.

After first being assessed for any underlying physical and psychological conditions, there are a number of treatment options. All treatments are subject to pre-existing conditions and medications.

Non-Surgical Treatment for Erectile Dysfunction

Conservative treatment measures to treat erectile dysfunction are always considered before invasive measures such as surgery.

Common less invasive non-surgical treatments can include:

  • Lifestyle Changes
  • Medications
  • Devices

Erectile Dysfunction Treatment by Lifestyle Change

For some men, making a few healthy lifestyle changes may solve the problem.

Abstinence from smoking, weight loss, and increased physical activity may help some men regain sexual function.

Erectile Dysfunction Treatment by Medication Change

The next step is cutting back on any drugs with harmful side effects.

For example, drugs for high blood pressure work in different ways. If you think a particular drug is causing problems with erection, tell your doctor and ask whether you can try a different class of antihypertensive medicine.

Stopping prescribed medication is not advised unless guided by your doctor. Our doctor can assess and discuss your specific options.

Erectile Dysfunction Treatment using Drug Therapy:

Drugs for treating Erectile dysfunction can be

  • Oral Medication or
  • Penile Injection Therapy

A/Prof Katz will discuss the pros and cons of each of these treatments to see if they are suitable.

Oral Medications for ED

There are currently 4 commonly used types of oral erectile dysfunction agents

  1. Viagra
  2. Cialis
  3. Levitra
  4. Spedra

At Men's Health Melbourne, we do not believe in a "one size fits all" approach. Each of these drugs has specific reasons why they should be given and we take a very personalised approach to prescribing these drugs. Some drugs may be better suited to certain individuals compared to others for various reasons.

Before we prescribe any drug, we go through the pros and cons of each of these drugs including the reasons for prescribing it. Furthermore, most of these drugs come in different dosages and can be prescribed in different ways to achieve specific results and goals.

Some of these drugs can be quite expensive and therefore at Men's Health Melbourne we can help you source cheaper prescription medications such as generics or compounded formulations.

At Men's Health Melbourne we will endeavour to try and ensure that patients are given the most efficacious, affordable and best treatment for the erectile dysfunction which ideally should be conservative with medical therapy, without needing injectables or surgery.

Penile Injection therapy

Click on the link for Penile Injection therapy to find out more about the Men’s Health Melbourne Penile Injection Program.

Erectile Dysfunction Treatment using a Vacuum Pump

Pumps are mechanical vacuum devices that can cause erection by creating a partial vacuum, which draws blood into the penis, engorging and expanding it.

The devices have three components:

  • a plastic cylinder, into which the penis is placed;
  • a pump, which draws air out of the cylinder; and
  • an elastic band, which is placed around the base of the penis to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back into the body.

One variation of the vacuum device involves a semi-rigid rubber sheath that is placed on the penis and remains there after erection is attained and during intercourse.

Surgical Treatment for Erectile Dysfunction

Where conservative treatment measures are unsuccessful surgery may be considered. The most common surgery performed for erectile dysfunction is Penile Implant surgery.

Implanted devices, known as prostheses, can restore erections in many men with severe ED.

For more information about surgical therapy, please click here.