Erectile Dysfunction (ED)
Difficulty getting and maintaining an erection is a problem that more than 40 million men in the United States face today. So, you’re not alone. The key is understanding the diagnosis so that the problem can be corrected. Treatment of erectile dysfunction is relatively easy and straightforward. In addition, almost 100% of men with ED can be successfully treated. Also, we now understand ED might signify other underlying medical issues and men with this problem might be at a higher risk of heart attack or stroke. Recent research has demonstrated that ED, in many instances, is a vascular disease just like heart disease is a vascular disease. So, talking about this issue with your doctor might just save your life.
Erectile Dysfunction (ED): Also known as impotence, ED happens when you cannot get and keep an erection firm enough for sex. Having erection trouble from time to time shouldn’t be alarming. However, if ED is ongoing, it may lead to stress, relationship problems and/or affect your self-confidence. Beyond the emotional and relationship concerns, ED may be a sign of an underlying health problem.
- Trouble keeping an erection
- Reduced sexual desires
- Medical conditions, particularly diabetes or heart problems
- Being overweight
- Medications, including antidepressants, antihistamines and medications to treat high blood pressure, pain or prostate cancer
- Tobacco use restricts blood flow to veins and arteries. Over time, tobacco use can cause chronic health problems that lead to ED.
- Drug and alcohol use, especially if you’re a long-term drug user or heavy drinker
- Certain medical treatments, such as prostate surgery or radiation for cancer
- Injuries, particularly damage to the nerves that control erections
- Psychological conditions, such as stress, anxiety or depression
- Prolonged bicycling can compress nerves, affecting blood flow to the penis and leading to temporary ED
- Physical causes – In most cases, physical issues cause ED. Common causes include:
- Heart disease
- High blood pressure
- Clogged blood vessels (atherosclerosis)
- Metabolic syndrome — a condition that includes increased blood pressure, high insulin levels, body fat around the waist and high cholesterol
- Parkinson’s disease
- Multiple sclerosis
- Low testosterone
- Scar tissue inside the penis
- Certain prescription medications
- Tobacco use
- Alcoholism and other substance abuse
- Treatments for prostate cancer or enlarged prostate
- Surgeries or injuries affecting the pelvic area or spinal cord
- Psychological causes – The brain triggers physical responses that cause erections. The responses are generated by feelings. Various psychological issues can interfere with sexual feelings and cause or worsen ED.
- Depression, anxiety or other mental health conditions
- Relationship problems due to stress, poor communication or other concerns
We may consider using one more of the following tests to better understand the reason for your ED.
- Physical exam of your penis and testicles, nerve function and vascular supply.
- Blood tests to check for signs of heart disease, diabetes, low testosterone levels and other health problems
- Urine tests (urinalysis) to look for signs of diabetes and other underlying health conditions
- Ultrasound to check blood flow to your penis. We hold a wand-like device (transducer) over the blood vessels that supply the penis. A video image shows if you have blood flow problems.
- Overnight erection test — Most men have erections during sleep without realizing them. This test involves wrapping special tape around your penis before going to sleep. If the tape is separated when you wake, your penis was erect at some time during your sleep. This may indicate your ED is psychological rather than physical in nature.
Many times, men with ED respond well to oral medications, which can include:
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Levitra)
These medications enhance the effects of nitric oxide, a natural chemical your body produces to relax muscles in the penis. This increases blood flow and allows you to get an erection from sexual stimulation. These medications vary in dosage, how long they work and side effects. We will consider your particular situation to determine which medication may work best.
- A vacuum constriction device is an external pump with a band on it that you can use to get and keep an erection.
- A penile implant may be used if the ED is due to a medical cause that is unlikely to resolve or improve on its own or with other medical treatments.
- Vascular reconstructive surgery may help improve the blood supply of the penis to improve your ability to get and maintain an erection.