Welcome to the 3rd step towards dealing with ED
ACT today

• A counsellor is a qualified health care professional to whom you can talk about ED and its possible causes. He or she may be able to suggest techniques that you may want to try to manage your symptoms. This is especially important if you are very anxious about being able to get or keep an erection.
• All men with sexual dysfunction would benefit from counselling
• Counselling should be an integral part of treatment
• Your doctor may provide counselling for you
• If your doctor feels you will benefit from specialist counselling, he or she will be able to recommend one

There are currently 3 different options available

• These medicines are called PDE-5 inhibitors
• They are now the most commonly-prescribed treatments for ED
• They are not all exactly the same, and their differences are important
• If your doctor decides to prescribe one of these for you, they may discuss those differences with you
• Depending on the treatment, they need to be taken between 25 minutes and 1 hour before sexual intercourse
• The period of time over which they work can vary from 4–5 hours up to 36 hours. i.e. during these time periods, providing you have sexual stimulation, an erection may be achieved
• In order for these medications to work, sexual stimulation is required
• Alcohol may affect erections
• Avoid excessive alcohol with oral treatments Some of these treatments may have their onset of effect delayed if taken after food

If your doctor thinks an oral treatment may be suitable for you, then they will discuss side effects and contraindications* with you as part of reaching a prescribing decision

The most common side effects include:

• headache
• indigestion
• flushing
• pounding heartbeat
• nausea
• nasal congestion
• effects on vision
• dizziness
• back pain
• muscle aches
• abdominal pain

* Contraindication: To advise against or indicate the possible danger of a drug or treatment

• These products contain alprostadil
• These are injected into the penis or inserted using a special applicator
• This usually takes place just before sexual intercourse to produce an erection
• They work approximately 5–15 minutes after administration

If your doctor thinks an injection or insertion may be suitable, they will discuss side effects and contraindications* with you as part of reaching a prescribing decision

• Side effects may include:
  • pain in the penis
  • urethral burning
  • the penis can become scarred, bent or kinked, particularly after long-term use
• Tell your doctor if this happens as you may need to stop using the product
• There are guidelines on how often you should use these products - your doctor should advise you
• If your penis is scarred, not straight, or abnormally formed, you should NOT use these products

*Contraindication: To advise against or indicate the possible danger of a drug or treatment

• These work by drawing blood into the penis, making it erect
• A constriction ring is then placed around the base of the penis to keep the blood in the penis and maintain the erection
• Vacuum pumps should be used just before sexual intercourse
• They take a few minutes to use
• The constriction ring should not be worn for longer than 30 minutes (remove ring)
• They may be used as often as required
• Some products advise a break of at least 60 minutes between each treatment

• Side effects may include:
  • discomfort
  • bruising of penis

• Some men with ED and low testosterone levels are prescribed testosterone hormone replacement as part of their treatment.

• Two types of surgery are available
• Surgery is usually only necessary if counselling or medical treatments haven't worked or are not suitable
• The most common surgical procedure is prosthetic implants
• This involves the insertion of artificial rods into the penis
• The second surgical technique involves repairing the blood vessels of the penis
• This happens in men who have had an injury that has caused poor blood flow
• Your doctor will advise you as to whether this is a suitable option for you