Erectile Dysfunction

What is Erectile Dysfunction? Statistics have conveyed that one-half of American men over age forty have erection troubles. You are not alone. There are over 3 million US cases of erectile dysfunction per year.

When a man has erectile dysfunction (ED), it is difficult to get or maintain an erection that is hard enough for sexual intercourse.

Erectile dysfunction may be a sign of a physical or psychological disorder. It can cause anxiety and possible relationship tension.

What causes Erectile Dysfunction? While ED is more prevalent in older men, age is not the basis of this issue. Conditions like heart disease, high blood pressure, and high blood sugar can engender ED because they can lead to an impaired response of the blood vessels responsible for controlling penile erection. Lifestyle choices like the use of drugs, alcohol, and tobacco, and lack of exercise can also restrict proper blood flow to the penis. Certain injuries, surgeries, low testosterone levels, medications, and/or radiation therapies to the pelvic area may also harm nerves in the penis which results to ED.

How do I lower my risk?

How is Erectile Dysfunction treated?

Do not lose hope because erectile dysfunction is treatable. Your urologist will need to investigate the root causes to properly treat this condition. In general, it never hurts to modify habits, such as the cessation of smoking or drug abuse, which may directly fix your ED. Emotional problems or performance anxiety can also be treated. Alternating or cutting back on certain medications can often improve ED. However, do not change your medications unless your provider advises this after an extensive review. There are numerous helping agents like the utilization of Viagra or Cialis which can prevent ED from occurring. Furthermore, there are also solutions like the erectile dysfunction pump and much more that your health care provider will further discuss with you at your consultation.

  • Cessation of recreational drugs, alcohol, and tobacco.

  • Exercising frequently

  • Talk to your provider about the medications you are taking. Changing some medications can prevent ED from occurring.

  • Maintain a healthy lifestyle

  • Testosterone level assessment after a certain age

Treatment Details

The simplest treatments include the use of a class of oral medications known as phosphodiesterase type 5 inhibitors (PDE5I, e.g. sildenafil, tadalafil, vardenafil, and avanafil). These drugs enhance the effects of nitric oxide, a natural molecule within the body that relaxes the smooth muscle of the penis, to enable increased blood flow and result in an erection. These medications are generally very safe and reliable. Men who use nitrates (found in certain heart medications and in some recreational drugs) should not use PDE5I. Optimal use of PDE5I requires advice on timing and proper use of these drugs for maximal effect.

Another relatively simple, non-invasive treatment for ED includes use of a vacuum erection device (‘penile pump’), to assist with achieving erection for intercourse. These devices work by pulling blood into the penis; a tight constrictive ring is then placed at the base of the penis. 

Self-injection therapy is another option for managing ED; in this approach, the man is taught how to inject vasodilator medications directly into the side of his penis, using a very small needle. These drugs increase penile blood flow which can lead to an erection. While not generally as convenient as oral medications, self-injection tends to be more powerful and can be used by men who are taking nitrate medications. The biggest risk of injections is the possibility of an erection that does not go away by itself (known as priapism). If you develop a prolonged (~4 hours or more), you should be seen emergently as the penis may otherwise be permanently damaged.

When the more conservative approaches fail to adequately improve erectile function, surgical options may be considered. A device known as a penile prosthesis may be inserted and often leads to high satisfaction. Benefits of this option include the avoidance of medications and injections, a very natural appearance and feel of the penis in both the flaccid and erect states, and, complete control over the onset and duration of the erection. Implant surgery generally does not interfere with penile sensation and orgasmic function.  Placement of a penile prosthesis carries the general risks of any operation, including the possibility of infection requiring device removal.  It is also important to recognize that the erect length of the penis after prosthesis surgery tends to be less than pre-ED length.