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Erectile Dysfunction


Video

John H. Jurige Jr., M.D. on Erectile Dysfunction

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Erectile dysfunction (ED, and sometimes referred to as impotence) means being unable to achieve or maintain an erection sufficient for sexual intercourse. The condition is not uncommon. According to the American Foundation for Urologic Disorders, ED affects nearly 20 million men in the U.S. Although most common in older men, ED is not an inevitable part of the aging process. Medical advances have made ED treatable in men of any age, so men who experience this problem should discuss it with their urologist. ED may be the first sign of significant underlying conditions, such as cardiovascular disease.

Causes

ED most often results from an injury or a disease that damages the nerves or restricts blood flow to the penis. This includes diabetes, kidney disease, multiple sclerosis (MS), atherosclerosis, vascular disease and neurologic disease. A hormonal abnormality, such as low testosterone, can cause ED as well. Erectile dysfunction can also be a side effect of some common medications, such as antihistamines, tranquilizers, appetite suppressants, antidepressants and drugs for ulcers or high blood pressure.

Other factors, including relationship problems, fatigue and use of alcohol and tobacco, can contribute to the problem.  n addition, psychological issues such as stress, anxiety, depression, guilt and poor self-esteem must be considered, especially in younger men.

Diagnosis

A frank discussion of your sexual activity is a first step that will help your doctor understand your problem and be better able to pinpoint the cause. Your doctor will also ask about your medical history and perform a physical exam to help identify any disease or medical condition that can cause ED. 

If a disease or hormonal imbalance is suspected, laboratory tests of blood and urine may provide information for a definite diagnosis. An interview and questionnaire, possibly including your partner, may be used to determine psychological factors.

Treatment

For ED resulting from physical causes, a variety of treatment methods are available with success rates as high as 90 percent, depending on the severity of the problem. If psychological issues play a part, counseling or therapy is often recommended to help relieve the anxiety or other underlying emotional obstacle.

Medications
Oral drugs, such as Viagra, Levitra and Cialis, work to relax the muscles and increase blood flow to the penis, but these can have adverse reactions when combined with other medications and should be used only according to your doctor’s instructions.

Other drugs act directly to enlarge blood vessels, and may be injected into the penis or inserted into the urethra. Your doctor will also consider any drugs you already take and may cut back or change any medication that can have an effect on ED.

Vacuum devices
Considered the safest treatment for erectile dysfunction, these mechanical devices are also highly effective. A plastic cylinder is placed over the penis and a pump removes the air inside causing a partial vacuum, which draws blood into the penis. An elastic ring over the base of the penis traps the blood and helps maintain the erection during intercourse.

Surgery
Surgery can correct some causes of erectile dysfunction, such as obstruction of an artery that blocks the flow of blood to the penis. A surgeon can also implant a device called a prosthesis that uses mechanical means to cause an erection. Several types are available, so you and your doctor can decide which is best for you.

FAQ

What are some of the risk factors for erectile dysfunction?
One of the most common causes is nerve damage or restricted blood flow to the penis caused by disease or injury. ED can also be a side effect of certain medications, low testosterone or another hormonal abnormality. Other contributing factors can include relationship problems, fatigue, alcohol and tobacco use as well as psychological issues, such as depression or stress.

What are some steps I can take to help prevent erectile dysfunction?
Actions that contribute to heart and circulatory health can also help reduce risk of ED. For example:

  • Maintain a healthy weight
  • Stop smoking
  • Get regular moderate exercise

In addition, you should:

  • Limit use of alcohol
  • Cut back or change any drug that may affect ED
  • Get enough sleep
  • Reduce stress
  • Find ways of coping with anxiety or depression
  • Have regular checkups and screenings

Why can’t I just take Viagra?
Drugs, such as Viagra, Levitra and Cialis, can be helpful to many men with ED, but they are not recommended for everyone. Men who have had heart problems or who are taking heart medications should not take these drugs. Ask your doctor what treatment is right for you.