Urology Center of Englewood

Erectile Dysfunction

Overview

Erectile dysfunction (ED) affects an estimated 30 million men in the United States,1 making it the most common sexual problem in men. ED is the inability to get or keep an erection that’s firm enough for sexual intercourse. Although the frequency of ED increases with age, the condition should not be viewed as an inevitable part of aging. Effective treatments are available.

Why does ED occur?

From a physiological standpoint, an erection is the result of a complex sequence of events that involves the brain and spinal column, the endocrine system, and the nerves, blood vessels, muscles, and other tissues in and around the penis. A problem at any point in this sequence can contribute to ED.

Health conditions that can contribute to ED include diabetes, high blood pressure, nerve damage, multiple sclerosis, atherosclerosis (hardening of the arteries), heart disease, and hormonal abnormalities. Surgery or radiation therapy to the pelvis can also contribute to ED by damaging nerves and blood vessels near the penis.

Several types of medications may cause ED, including certain blood pressure drugs, antihistamines, and antidepressants. You should not stop taking any medications, however, without first consulting your doctor.

Lifestyle factors that contribute to ED include smoking, excessive alcohol use, obesity, and physical inactivity. Psychological factors such as stress and anxiety can also cause ED or make ED worse.

How is ED diagnosed?

The most important first step in managing ED is telling your doctor about the problem. This is not something to be embarrassed about; ED is a common and treatable medical condition.

To diagnose the condition and determine the best course of treatment, your doctor will collect information about your medical history and your current sexual problems, and will also perform a physical examination. Laboratory tests may be performed in order to evaluate underlying health conditions that could be causing the ED.

How is ED treated?

Several ED treatments are available, and it’s likely that at least one of them will be effective for you.

Behavioral changes: A few basic lifestyle changes may be enough to improve your ED, or may improve the effectiveness of other ED treatments that you receive: avoid smoking and excessive alcohol consumption, achieve or maintain a healthy body weight, and engage in regular physical activity. If medications are contributing to your ED, your doctor may be able to make some adjustments to your medications.

Oral drug therapy: Drugs known as PDE5 (phosphodiesterase type 5) inhibitors are commonly used for the initial treatment of ED. These drugs are taken orally (by mouth), and include Viagra® (sildenafil), Levitra® (vardenafil), Staxyn® (vardenafil), and Cialis® (tadalafil). They work by increasing blood flow to the penis, and are used in combination with sexual stimulation to achieve an erection. Men taking certain other drugs should not use PDE5 inhibitors, so be sure that your doctor knows about all of the other drugs that you are taking.

Drugs administered directly to the penis: Another ED medication—alprostadil—comes in forms that are injected directly into the penis (Caverject®, Edex®) or placed inside the urethra (MUSE®). These drugs can be quite effective at producing an erection, but are not safe for men with certain medical conditions.

Vacuum devices: Vacuum devices offer another option for achieving an erection. With these devices (also known as penis pumps), a cylinder is placed over the penis. As a pump draws air out of the cylinder, blood is drawn into the penis. Once the penis is erect, an elastic ring is slid onto the base of the penis. The ring helps to maintain the erection by preventing blood from leaving the penis. The ring should not be left on the penis for more than 30 minutes. Once again, this treatment may not be safe for men with certain medical conditions, so talk with your doctor.

Penile implants: Penile implants (also known as penile prostheses) can also be used to produce an erection. Surgery is required to place the implants inside the penis. The most commonly used type of implant is inflatable: it includes a fluid reservoir and pump. When an erection is desired, the implant is inflated by pressing on the pump, which is located under the skin. Another type of implant is malleable (bendable): to have an erection, the penis is simply moved into an erect position.

Psychotherapy: If stress and anxiety are contributing to your ED (or if you’re experiencing stress and anxiety as a result of your ED), counseling can give you tools to manage these feelings.

Live your life

For many of us, healthy sexual experiences are an important part of life. When physical or psychological problems interfere with these experiences, medical attention and treatment can help to resolve the problem. Don’t hesitate to seek care.

Reference:


1 National Institutes of Health, National Kidney and Urologic Diseases Information Clearinghouse. Erectile Dysfunction. NIH Publication No. 09-3923. June 2009.