Erectile Dysfunction & Treatments

What is erectile dysfunction?
Erectile dysfunction (ED), also known as impotence, is the inability to achieve or sustain an erection for satisfactory sexual activity. Erectile dysfunction is different from other conditions that interfere with male sexual intercourse, such as lack of sexual desire (decreased libido) and problems with ejaculation and orgasm (ejaculatory dysfunction). This article focuses on the evaluation and treatment of erectile dysfunction.




How common is erectile dysfunction?

Erectile dysfunction (ED, impotence) varies in severity; some men have a total inability to achieve an erection, others have an inconsistent ability to achieve an erection, and still others can sustain only brief erections. The variations in severity of erectile dysfunction make estimating its frequency difficult. Many men also are reluctant to discuss erectile dysfunction with their doctors due to embarrassment, and thus the condition is underdiagnosed. Nevertheless, experts have estimated that erectile dysfunction affects 30 million men in the United States.

While erectile dysfunction can occur at any age, it is uncommon among young men and more common in the elderly. By age 45, most men have experienced erectile dysfunction at least some of the time. According to the Massachusetts Male Aging Study, complete impotence increases from 5% among men 40 years of age to 15% among men 70 years and older. Population studies conducted in the Netherlands found that some degree of erectile dysfunction occurred in 20% of men between ages 50-54, and in 50% of men between ages 70-78. In 1999, the National Ambulatory Medical Care Survey counted 1,520,000 doctor-office visits for erectile dysfunction. Other studies have noted that approximately 35% of men 40-70 years of age suffer from moderate to severe ED, and an additional 15% may have milder forms.

Treatment of Erectile Dysfunction

The first thing your doctor will do is to make sure you're getting the right treatment for any health problems that could be causing or worsening your erectile dysfunction.

A variety of options exist for treating erectile dysfunction. The cause and severity of your condition, and underlying health problems, are important factors in your doctor's recommending the best treatment or treatments for you. Your doctor can explain the risks and benefits of each treatment and will consider your preferences. Your partner's preferences also may play a role in treatment choices.

Oral medications 

Oral medications are a successful erectile dysfunction treatment for many men. They include:

1. Sildenafil (Viagra)
2. Tadalafil (Cialis)
3. Vardenafil (Levitra, Staxyn)

All three medications work in much the same way. These drugs enhance the effects of nitric oxide, a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow and allows you to get an erection in response to sexual stimulation. These medications vary in dosage, how long they work and their side effects. Your doctor will take into account your particular situation to determine which medication may work best.

Possible side effects include flushing, nasal congestion, headache, visual changes and stomach upset.

These medications may not fix your erectile dysfunction immediately. You may need to work with your doctor to find the right medication and dose for you.

Before taking any prescription erectile dysfunction medication (including over-the-counter supplements or herbal remedies), get your doctor's OK. Although these medications can help many people, not all men should take them to treat erectile dysfunction. These medications may not work or may be dangerous for you if you:

Take nitrate drugs — commonly prescribed for chest pain (angina) — such as nitroglycerin (Nitro-Bid, Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Imdur, Monoket) and isosorbide dinitrate (Dilatrate, Isordil)

Take a blood-thinning (anticoagulant) medication, alpha blockers for enlarged prostate (benign prostatic hyperplasia) or high blood pressure medications

Have heart disease or heart failure

Have had a stroke

Have very low blood pressure (hypotension) or uncontrolled high blood pressure (hypertension)

Have uncontrolled diabetes

Other medications 

Other medications for erectile dysfunction include:

Alprostadil self-injection. With this method, you use a fine needle to inject alprostadil (Caverject Impulse, Edex) into the base or side of your penis. In some cases, medications generally used for other conditions are used for penile injections on their own or in combination. Examples include papaverine, alprostadil and phentolamine. Each injection generally produces an erection that lasts about an hour. Because the needle used is very fine, pain from the injection site is usually minor. Side effects can include bleeding from the injection, prolonged erection and formation of fibrous tissue at the injection site.

Alprostadil penis suppository. Alprostadil intraurethral (Muse) therapy involves placing a tiny alprostadil suppository inside your penis in the penile urethra. You use a special applicator to insert the suppository into your penile urethra. The erection usually starts within 10 minutes and lasts between 30 and 60 minutes. Side effects can include pain, minor bleeding in the urethra, and formation of fibrous tissue inside your penis.

Testosterone replacement. Some men have erectile dysfunction caused by low levels of the hormone testosterone, and may need testosterone replacement therapy.

Penis pumps, surgery and implants 

Medications may not work or may not be a good choice for you. If this is the case, your doctor may recommend a different treatment. Other treatments include:

Penis pumps. A penis pump (vacuum erection device) is a hollow tube with a hand-powered or battery-powered pump. The tube is placed over your penis, and then the pump is used to suck out the air inside the tube. This creates a vacuum that pulls blood into your penis. Once you get an erection, you slip a tension ring around the base of your penis to hold in the blood and keep it firm. You then remove the vacuum device. The erection typically lasts long enough for a couple to have sex. You remove the tension ring after intercourse. Bruising of the penis is a possible side effect, and ejaculation may not be as forceful. If a penis pump is a good treatment choice for you, your doctor may recommend or prescribe a specific model. That way you can be sure it suits your needs and that it's made by a reputable manufacturer. Penis pumps available in magazines and sex ads may not be safe or effective.

Penile implants. This treatment involves surgically placing devices into the two sides of the penis. These implants consist of either inflatable or semirigid rods. The inflatable devices allow you to control when and how long you have an erection. The semirigid rods keep the penis firm but bendable. This treatment is usually not recommended until other methods have been tried first. As with any surgery, there is a risk of complications such as infection.

Blood vessel surgery. In rare cases, leaking or obstructed blood vessels can cause erectile dysfunction and surgery is necessary to repair them.

Psychological counseling 

If your erectile dysfunction is caused by stress, anxiety or depression, your doctor may suggest that you, or you and your partner, visit a psychologist or counselor. Even if it is caused by something physical, erectile dysfunction can create stress and relationship tension.