Erectile dysfunction (ED) also known as impotence is when men are unable to get and keep an erection firm enough for sexual intercourse. Men experiencing ED occasionally may not necessarily have a cause for concern. However, if not treated appropriately, ED will typically worsen over time possibly progressing from mild to complete impotence.
Causes of Erectile Dysfunction
Erectile dysfunction is more common than most people realize. As men age, ED affects up to 50 percent of men over the age of 40 who experience it and more than 80 percent of men age 70 and older. Some of the main contributing causes of ED include:
- Type 2 diabetes – Poor long-term blood glucose control damages nerves and blood vessels leading to the penis and is the main contributor to ED
- Low testosterone – low levels of this hormone can reduce interest in sex and difficulties in achieving and maintaining an erection
- Peripheral vascular disease – This causes the narrowing of blood vessels which lowers blood flow to organs such as the penis. This disease may be the cause of ED in as many as 50% to 70% of men who have it
- Obesity – Excess weight and fat tissue damages blood vessels, reduces testosterone and causes a state of inflammation in the body
- Psychosocial stress – Stress and anxiety about ED can interrupt how a man’s brain sends messages to the penis to allow extra blood flow
- Smoking – An erection is only possible when blood vessels in the penis enlarge and fill with blood. Smoking disrupts blood vessels in that area of the body resulting in erectile dysfunction
While men are often hesitant to discuss this with their doctor, they will not be the first or the last man to bring it up to them. Unfortunately, this is an area of a man’s health that is often ignored or not talked about because of the sensitive nature. Doctors, however, should also make the attempt to bring up the topic when seeing men at annual physicals or when seen for other medical appointments.
Important questions a man’s doctor should ask are the following:
- Do you have trouble getting an erection when desired?
- Does the erection last long enough for satisfactory performance?
- Is the erection too soft for penetration?
Men answering “yes” to any of the questions necessitates the need to seek further help of finding the best-individualized treatment for their ED.
Treatments for Erectile Dysfunction
Because there are a variety of reasons why men develop ED, there are, fortunately, a variety of effective ED treatments to personalize what works best for each individual man. As with most medical treatments, there are pros and cons of each to take into consideration. Here are treatment options for men to evaluate with the advice of their doctor:
- Medications for ED: Cialis, Viagra, Levitra, and Stendra are medications called phosphodiesterase inhibitors. They are a common first-line attempt most doctors will offer men with ED. They work by blocking an enzyme called phosphodiesterase type 5 while boosting nitric oxide. Nitric oxide encourages muscles in the penis to relax allowing blood flow to get and keep an erection long enough for sex. These medications are not suitable for every man; men who should not take phosphodiesterase inhibitors include men who have heart failure or heart disease or are on nitrates drugs commonly prescribed for chest pain such as nitroglycerin and men who have very low blood pressure or hypotension.
- Review of Medications: ED can be a side effect of many medicines, including those to treat high blood pressure, anxiety, heartburn, allergies, pain, seizures, and cancer. If a prescription or over-the-counter medication is the cause of ED, changing the dose or switching to another medication may resolve the problem.
- Make Lifestyle Changes: Unhealthy habits can affect ED. Men can adopt healthier habits starting with losing extra weight, eating health-promoting foods, exercising regularly, not smoking, drinking less, and not abusing illicit substances.
- Hormone Replacement Therapy: Men with low testosterone may be recommended to replace what their body is not producing sufficient levels of. Testosterone can be delivered via injection, patch, gel, gum and cheek (buccal cavity), intranasal, subcutaneous pellet, or oral medication. While hormone replacement therapy can be effective, side effects can occur which may include acne, enlarged prostate, and enlarged breast tissue. It may also lead to heart disease and a higher risk of prostate cancer growing faster. Men should discuss with the doctor of their personal preferences and possible side effects.
- Psychological Counseling: If ED is caused by stress, anxiety, or depression, a man, along with his partner, maybe referred by his doctor to visit with a psychologist or counselor. Even if a man’s ED is caused by something physical, ED can still create stress and relationship tension.
- Vacuum Erection Device: This is a hollow tube with a hand-powered or battery-powered pump. The tube is placed over the penis and the pump is used to pull blood into the penis. Once a man gets an erection, a tension ring is placed at the base of the penis to hold in the blood to keep the penis firm and erect. The vacuum device is removed in order to have sex and after the intercourse, the tension ring is removed also. Men who are on blood thinners should not use this device.
- Penile Injections: Several medications are commonly injected directly into the penis to achieve an erection. Commonly used medications for this purpose include alprostadil, papaverine, and phentolamine. A fine needle is used to inject the medication into the base or side of the penis. The goal of injection therapy is to produce an erection lasting about 20 to 40 minutes. If an erection lasts longer than one hour, the medication or dose will need to be adjusted to avoid potentially long-term complications. Because the needle is very fine, pain from the injection site is usually minor.
- Penile Implants: This treatment involves surgically placing devices into the two sides of the penis. These implants consist of either inflatable or semi-rigid rods made from silicone or polyurethane. The inflatable devices allow men to control when and how long he has an erection. The semi-rigid rods keep the penis firm but bendable. This treatment can be expensive and is usually not recommended until other methods have been tried first. As with any surgery, there is a risk of complications such as infection.
