Dr Rob King
Suite 805, Level 8
229 Macquarie Street
Sydney NSW 2000

Erection difficulties

The medical term used is erectile dysfunction (ED).

How common is ED?

It is very common, affecting about 8% of men younger than 40, and at least 50% of men between 40 and 70 years of age.

What causes ED?

There are many causes, and the older a man is, the more likely several concomitant causes of ED will be present.

Some of the causes include:

  • Blockage of the small arteries in the penis by build-up of fat (atherosclerotic plaque). If this is the cause of a man’s ED, he is at high risk of having a heart attack or stroke 3-5 years after the onset of his ED. This is why it is critical all men with ED have a comprehensive health assessment. We provide ED-focused health assessments at our clinic
  • Some medications, in particular benzodiazepines, some anti-depressants, beta-blockers, diuretics, finasteride (commonly used for hair loss)
  • Long-term regular use of alcohol
  • Regular or past heavy use of drugs (cannabis, ecstasy, cocaine and others)
  • Stress/anxiety of any cause
  • Emotional issues
  • Anxiety (including performance anxiety)
  • Low mood/depression
  • Low libido/sex drive
  • High blood pressure
  • High blood cholesterol
  • High blood sugar and diabetes
  • Smoking
  • Being overweight or obese
  • Obstructive sleep apnoea
  • An enlarged prostate (BPH)
  • After treatment for prostate cancer (surgery, radiation treatment)
  • Testosterone deficiency
  • Natural ageing process.

There are however up to 25 other possible causes of ED.

Treatment of ED

Understanding why a man has ED, rather than just treating his problem with medications or injections into the penis, is paramount. Unless the underlying cause of ED is addressed (eg high blood pressure, being overweight or obese), the problem will gradually worsen and eventually the ED will no longer respond to medications or injections.
While the causes of the man’s ED are being determined, the following treatment options can be initiated:


Tablets that improve erections very effectively (but don’t treat the underlying cause) include Cialis, Levitra and Viagra. All three form part of the class of pharmaceuticals known as PDE5 inhibitors.
There is a variety of ways in which these can be taken, and different people will require different approaches to maximise their erection-enhancing effect. Many men give up using these medications simply because the treatment was not tailored to their particular needs and therefore proved either ineffective or not practical.


In some men, the main cause of their ED is psychological, and counselling is therefore the main treatment. However ruling out a physical cause before initiating counselling is very important.


If the medications are no longer proving effective (particularly in those who have not had the underlying cause of their ED addressed, or because of long-standing diabetes), erections can be achieved by injecting certain compounds directly into the penis. These compounds include alprostadil (PGE1), phentolamine, papaverine and atropine. Injections into the penis are referred to as intra-cavernosal injections.
Although the idea of having to stick a needle into the penis is at first daunting, the vast majority of men who use injections are very happy with them.
Patients have the opportunity to try injections under our supervision in our rooms.


Men not wishing to take any pharmaceutical medications may respond to supplementation with arginine. Arginine is required for the production of nitric oxide, a compound essential for achieving erections. It should only be used under medical supervision as the initial amount required to achieve erections is reasonably high and will interact with some medications.

Vacuum pumps

Advantages of this treatment include ease of use and no on-going costs.

Penile implants

Indicated when penile injections are no longer effective. Current implants give excellent results.
This surgical procedure is performed by a urologist.

Pelvic floor exercises

These may be effective in some people with erection difficulties.

Read about low libido and sex drive here.