Dr James Thompson is an experienced robotic, laparoscopic, endoscopic and open urological surgeon. He has sub-specialty training in (and passion for) the treatment of prostate, bladder and kidney cancer using the latest robotic surgery techniques and for high-impact cancer research that has the ability to immediately improve quality of life and cancer cure rates for the community.
Erectile Dysfunction
Difficulties with getting or maintaining erections or reAching orgasm are common
Dr Thompson sees men of all ages for issues of sexual function, from those in their twenties right up to those in their eighties.
Common reasons men seek a consult with Dr Thompson include:
a drop in libido (sex drive, interest in sex)
difficulty getting an initial rigid erection
difficulty maintaining an erection during sex
difficulty reaching climax (orgasm)
retrograde ejaculation (semen goes up into bladder and passes out in urine)
anejaculation (achieve climax but no semen comes out)
premature ejaculation (difficulty delaying climax, which occurs soon after start of sex)
Painful ejaculation
Blood in the semen (haematospermia / haemospermia)
low semen volume
infertility due to semen abnormalities.
The most common issue men encounter is difficulty getting or maintaining erections. This can happen due to one (or often more than one) of the following causes:
Age: it is common for erections to slowly weaken with older age due to hardening and narrowing of the small arteries to the penis and weakening of the nerves that stimulate erections.
Arterial (vascular) erectile weakness: as above, the tiny arteries responsible for erections are extremely vulnerable to atherosclerosis, which causes narrowing and blockage of the arteries similar to what occurs elsewhere in the body causing strokes, heart attacks, etc. the main factors causing vascular erection problems are high blood pressure (hypertension), high cholesterol (hyperlipidaemia), Diabetes (type 1 and 2), smoking, being overweight and a family history of ‘vascular problems’ eg strokes, heart attacks, high cholesterol.
nerve (neurological) erectile weakness: any condition that damages the tiny nerves in the body (called peripheral neuropathy, most commonly due to diabetes, alcohol or HIV), any surgery or radiation to the pelvis, any medications that affect nerves (eg antidepressants) or any condition affecting the spinal cord or brain (trauma, tumours, Parkinson’s, MS, dementia etc) can cause erectile diffiultues
Stress (eg work/ family/ relationship), Anxiety, depression and poor sleep are all common causes of erectile difficulties, even in the absence of any ‘physical’ or medical cause.
Alcohol is a major cause of erectile weakness, both at the time of alcohol consumption and after long term moderate or high intake or binge drinking over years, can even cause erectile difficulty at times when not consuming alcohol, due to effects on the tiny erectile nerves, blood vessels, blood pressure and brain.
Medications can cause or worsen the situation, particularly those used for blood pressure (eg beta blockers), anxiety, depression, chronic pain, hair loss (finasteride aka ‘Proprecia’) and in urology those used for prostate enlargement (finasteride aka ‘Proscar’ and dutasteride aka ‘Duodart / Avodart’).
hormonal imbalances most commonly hypogonadism ie low testosterone levels due to ageing, the ‘metabolic syndrome’, testicular conditions or brain/ pituitary conditions.
The treatment of erectile dysfunction is complex and requires first making a detailed history and examination plus investigations to establish the cause, followed by tailoring an individual treatment plan based on the unique causes, other medical conditions and weighing the pros and cons to identify the treatment preference of the individual. Examples of common treatments (in order of preference and simplicity) include:
Reversing the underlying cause is the first step, and often the most simple and effective, eg changing a medication, replacing low testosterone levels, reducing stress, smoking and/ or alcohol
tablets ie pde5i’s which include viagra, cialis, Levitra and recently spedra
vacuum erectile device (penile pumps)
Intracavernosal injections (ICIs eg bi-mix, tri-mix, caverject)
Intra-urethral suppositories (MUSE/ alprostadil, not currently available in Australia)
Penile Prosthesis (surgically implanted pump).
Dr Thompson has training and experience in all these treatments so can guide you through the process of diagnosis and selecting the ideal treatment for your situation. He also works with a multi-disciplinary team of sexual health specialist nurses, sexual health physicians and psychologists who can each help in certain situations, depending on the cause and treatment plan.