Erectile Dysfunction

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KEY POINTS

• Erectile dysfunction (ED) is trouble having an erection or keeping it firm enough for sex. Another term for this problem is impotence.
• Treatment of erectile dysfunction depends on the cause. Your healthcare provider may prescribe medicines, mechanical devices, surgery, or therapy.

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What is erectile dysfunction?

Erectile dysfunction (ED) is trouble having an erection or keeping it firm enough for sex. Another term for this problem is impotence.

Most men have trouble with erections from time to time. For example, it may be a problem when you are tired or nervous. When ED happens often or becomes a long-lasting problem, it can deeply affect you and your sex partner.

What is the cause?

An erection happens when more blood flows into the penis and the veins in the penis clamp down, trapping the blood. This makes the penis stiff. Nerves in the penis help the blood vessels open more, give feelings of pleasure, and help keep the erection until orgasm.

There are many possible causes of ED. They can be a mixture of physical or emotional causes.

Physical causes that can affect the blood flow to the penis, and the muscles and nerves of the penis include:

• Older age
• Diabetes
• High cholesterol
• Smoking
• Obesity
• Diseases or injuries of the nervous system, such as paralysis of the lower body or multiple sclerosis
• Alcohol or drug abuse
• Heart disease
• High blood pressure
• Side effects of medicines
• Problems after surgery for rectal or prostate cancer
• Low levels of male hormone (testosterone) can cause a decreased sex desire

Emotional causes may include:

• Being very tired or having jet lag
• Anger, anxiety, stress, and depression
• Fear of being rejected or of not performing well
• Loss of interest in sex

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you.

Tests may include:

• Urine and blood tests
• A test of the blood flow and pressure in your penis
• A snap gauge test to check the nighttime stiffness of your penis. For this test, you put a special band on your penis before you go to sleep. If you have an erection, the snap gauge will break.

You may be referred to a healthcare provider who specializes in erectile problems.

How is it treated?

Treatment of erectile dysfunction depends on the cause.

Medicines

Problems with blood flow or blood pressure to your penis may be treated with medicines such as Viagra, Levitra, and Cialis. During sexual stimulation, these medicines work by relaxing the blood vessels in the penis. More blood can enter the penis, which helps you get or keep an erection. Your provider may prescribe other medicines that you inject into your penis when you want to have an erection.

If your level of testosterone is low, hormone treatment may be prescribed. The hormone testosterone is available in the form of patches or gels that are put on the skin, or as monthly or bimonthly shots that can be given in the arm.

Mechanical Devices

Mechanical devices may be used to trap blood in the penis to cause an erection. They come with a vacuum chamber, a pump, connecting tubing, and elastic bands. Suction pulls blood into your penis, and you get an erection. The blood is kept in the penis by a tight band placed around the base of the penis. You should not keep the band in place longer than 30 minutes or fall asleep with it.

Surgery

If these treatments do not work, or if you have severe defects of the blood vessels in your penis, you may need surgery.

Surgery may be used to place an implant inside your penis. These devices are used only when other treatments don’t help.

• A semi-rigid implant uses rods to give firmness to the penis. It can be inserted during a 1-day surgery. It is always ready for use once it is in place because it is always at its full size.
• An inflatable implant has cylinders that can be inflated or deflated at will. It uses a pump tucked in the scrotum above your testicles and a fluid reservoir behind your pubic bone. The penis gets hard when you pump fluid from the reservoir, and gets soft when the fluid goes back into the reservoir.

Usually you can start using an implant 4 to 6 weeks after surgery. Penile implants do not change your sensation or ejaculation.

Therapy

Several kinds of therapy can help with erectile dysfunction caused by emotional problems:

• Couples therapy helps partners improve their ability to communicate with each other. It may help you decide what changes are needed in the relationship and in the behavior of each partner. Both partners then work to learn new behaviors.
• Sex therapy can help you learn about sexual behaviors and responses, and help reduce pressure to perform during sex. You may go to therapy every week or every other week.
• Cognitive behavior therapy (CBT) is a way to help you identify and change views you have of yourself, the world, and the future. CBT can make you aware of unhealthy ways of thinking. It can also help you learn new ways to think and act. Therapy may help you deal with anxieties, stress, or depression.

You can get more information from:

• Urology Care Foundation
  866-746-4282
  http://www.urologyhealth.org