|Erectile dysfunction (impotence) occurs when a man can no longer get or keep an erection firm enough for sexual intercourse. Having erection trouble from time to time isn't necessarily a cause for concern. But if erectile dysfunction is an ongoing problem, it may cause stress, cause relationship problems or affect your self-confidence.
Even though it may seem awkward to talk with your doctor about erectile dysfunction, go in for an evaluation. Problems getting or keeping an erection can be a sign of a health condition that needs treatment, such as heart disease or poorly controlled diabetes. Treating an underlying problem may be enough to reverse your erectile dysfunction.
If treating an underlying condition doesn't help your erectile dysfunction, medications or other direct treatments may work.
|Erectile dysfunction symptoms may include persistent:
A Urologist is a good place to start when you have erectile problems. See Dr. HajMurad if:
- Trouble getting an erection
- Trouble keeping an erection
- Reduced sexual desire
- Erectile or other sexual problems are an issue for you or your partner
- You have diabetes, heart disease or another known health problem that may be linked to erectile dysfunction
- You have other symptoms along with erectile dysfunction that may not seem related
|Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Likewise, stress and mental health problems can cause or worsen erectile dysfunction. Sometimes a combination of physical and psychological issues causes erectile dysfunction. For instance, a minor physical problem that slows your sexual response may cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen erectile dysfunction.
Physical causes of erectile dysfunction
In most cases, erectile dysfunction is caused by something physical. Common causes include:
Psychological causes of erectile dysfunction
- Heart disease
- Clogged blood vessels
- High cholesterol
- High blood pressure
- Metabolic syndrome, a condition
involving increased blood pressure, high insulin levels, body fat
around the waist and high cholesterol
- Parkinson's disease
- Multiple sclerosis
- Low testosterone
- Peyronie's disease, development of
scar tissue inside the penis
- Certain prescription medications
- Tobacco use
- Alcoholism and other forms of
- Treatments for prostate cancer or
- Surgeries or injuries that affect
the pelvic area or spinal cord
The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:
- Depression, anxiety or other mental health conditions
- Relationship problems due to stress, poor communication or other concerns
|As you get older, erections may take longer to develop and may not be as firm. You may need more direct touch to your penis to get and keep an erection. This isn't a direct consequence of getting older. Usually it's a result of underlying health problems or taking medications, which is more common as men age.
A variety of risk factors can contribute to erectile dysfunction. They include:
- Medical conditions, particularly
diabetes or heart problems.
- Using tobacco, which
restricts blood flow to veins and arteries. Over time tobacco use
can cause chronic health problems that lead to erectile dysfunction.
- Being overweight, especially
if you're very overweight (obese).
- Certain medical treatments, such
as prostate surgery or radiation treatment for cancer.
- Injuries, particularly
if they damage the nerves that control erections.
- Medications, including
antidepressants, antihistamines and medications to treat high blood
pressure, pain or prostate cancer.
- Psychological conditions, such
as stress, anxiety or depression.
- Drug and alcohol use, especially
if you're a long-term drug user or heavy drinker.
- Prolonged bicycling, which
may compress nerves and affect blood flow to the penis, can lead to
temporary erectile dysfunction.
|Tests and diagnosis
|For many men, a physical exam and answering questions (medical history) are all that's needed before a doctor is ready to recommend a treatment. Tests for underlying problems may include:
- Physical exam.
may include careful examination of your penis and testicles and
checking your nerves for feeling.
- Blood tests.
sample of your blood may be sent to a lab to check for signs of
heart disease, diabetes, low testosterone levels and other health
- Urine tests (urinalysis).
blood tests, urine tests are used to look for signs of diabetes and
other underlying health conditions.
test can check blood flow to your penis. It involves using a
wand-like device (transducer) held over the blood vessels that
supply the penis. It creates a video image to let your doctor see if
you have blood flow problems. This test is sometimes done in
combination with an injection of medications into the penis to
determine if blood flow increases normally.
- Overnight erection test.
men have erections during sleep without remembering them. This
simple test involves wrapping special tape around your penis before
you go to bed. If the tape is separated in the morning, your penis
was erect at some time during the night. This indicates the cause of
your erectile dysfunction is most likely psychological and not
- Psychological exam.
doctor may ask you questions to screen for depression and other
possible psychological causes of erectile dysfunction.
|Treatments and drugs
|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 are a successful erectile dysfunction treatment for many men. They include:
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.
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Levitra, Staxyn)
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 for erectile dysfunction include:
Penis pumps, surgery and implants
- 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.
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.
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.