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Erectile Dysfunction Overview:

What is Erectile Dysfunction?

Erectile dysfunction (ED) is the inability to get and keep an erection firm enough to engage in sexual intercourse. ED is not considered normal at any age. In most cases, ED is a symptom of another, underlying condition that can include a lack of desire and problems with orgasm and ejaculation.

How common is ED?

Approximately 1 in 10 adult males will suffer from ED on a long-term basis and many men experience occasional ED symptoms, which occur for a variety of reasons, such as drinking too much alcohol, stress, relationship problems, or from being extremely tired.

The failure to get an erection less than 20% of the time is not unusual and typically does not require treatment. However, the failure to achieve an erection more than 50% of the time generally means there is a problem that treatment can address.

ED does not have to be a part of getting older. While it is true that some older men may need more stimulation to achieve an erection, they should still be able to enjoy intercourse.

What causes ED?

ED can be caused by many factors, which include:

  • Vascular disease: Blood supply to the penis becomes blocked or restricted due to vascular disease such as atherosclerosis
  • Neurological disorders: Nerves to the penis become damaged by stroke, diabetes, or other causes
  • Psychological issues: Stress, depression, lack of stimulus, and performance anxiety
  • Trauma: An injury could contribute to symptoms

Chronic illness, certain medications, and a condition called Peyronie’s disease can also cause ED. Surgical operations for prostate, bladder, and colon cancer may also contribute.

Medications that may cause ED

ED is a common side effect of many prescription drugs. While these medications treat a disease or condition, in doing so they can affect a man’s hormones, nerves, or blood circulation resulting in an increased risk of ED.

If you experience ED and think that it may be a result of the medication you are using, contact your doctor and he or she may be able to prescribe a different medication. Common medications that may have ED as a potential side effect include:

  • Diuretics (pills that increase urine flow)
  • Antihypertensives (high blood pressure drugs)
  • Antihistamines
  • Antidepressants
  • Parkinson’s disease drugs
  • Antiarrhythmics (a drug for irregular heart action)
  • Tranquilizers
  • Muscle relaxants
  • Nonsteroidal anti-inflammatory drugs
  • Histamine H2-receptor antagonists
  • Hormones
  • Chemotherapy medications
  • Prostate cancer drugs
  • Anti-seizure medications

Other substances that can cause ED include:

  • Alcohol
  • Amphetamines
  • Barbiturates
  • Cocaine
  • Marijuana
  • Methadone
  • Nicotine
  • Opiates

These drugs not only affect the central nervous system but can also cause serious damage to the blood vessels, leading to permanent ED.

Management and Treatment:

What doctors treat ED?

The type of medical specialist who treats ED will depend on the cause of the problem. Based on your family’s medical history, as well as your own medical history and current health, your doctor may treat you with oral medications.

If these options fail, you may be referred to a urologist who can assist with other non-surgical options such as a vacuum device or injections or surgical treatment options. If needed, your doctor may also refer you to a psychologist specializing in sexual dysfunction.

How is erectile dysfunction treated?

ED can be treated by the following:

  • Oral medications
  • Sex therapy
  • Penile injections
  • Vacuum devices
  • Intraurethral medication
  • Surgery (penile implant)

Each has its own pros and cons. Discuss your options with your doctor to determine the suitable treatment for you. The first step will always be identifying the underlying cause.

What non-surgical treatments exist?

Education and communication:

Education about sex, sexual behaviors, and sexual responses may help a man overcome anxieties about sexual dysfunction. Talking honestly with your partner about your needs and concerns may also help to overcome many barriers to a healthy sex life.

Medication:

Medications such as sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis) may help improve sexual function in men by increasing blood flow to the penis. Men who are on medicines that contain nitrates such as nitroglycerine should not take oral ED medications. The combination of nitrates and these specific medications can cause low blood pressure (hypotension).

The most common side effects of these medications are indigestion, nasal congestion, flushing, headaches, and a temporary visual disturbance.

Mechanical aids:

Aids such as vacuum devices and penile constriction rings serve as erectile aids for some men. A vacuum constriction device is a cylinder that is placed over the penis. The air is pumped out of the cylinder, which draws blood into the penis and causes an erection. The erection is maintained by slipping a band off of the base of the cylinder and onto the base of the penis. The band can stay in place for up to 30 minutes. The vacuum device can be safely used to treat most causes of erectile failure. Lack of spontaneity, discomfort, and cumbersomeness of the device seem to be the biggest concerns of patients.

Penile injection therapy (intracavernosal injection therapy):

Men are taught how to inject medications directly into the erection chambers of the penis to relax the blood vessels, allowing blood to flow into the penis and create an erection. Injection therapy is effective in treating a wide variety of erection issues caused by blood vessel, nerve, and psychological conditions. The most common side effects are pain and penile scarring (fibrosis).

Psychology and sex therapies:

Therapy with a trained counselor can help a person address feelings of anxiety, fear, or guilt that may have an impact on sexual function. Sex therapy also helps a man’s partner accept and cope with the problems.

Hormone:

Hormone replacement in the form of topical gels, creams, patches, injections, and pellets can be prescribed by a physician to treat ED.

What are the surgical treatment options?

Penile prosthesis surgery:

Inflatable penile prostheses are implanted in an outpatient surgical procedure. Once they are in place they enable a man to have an erection whenever he desires. The use of a prosthesis preserves penile sensation, orgasm, and ejaculation for most men.

The most commonly used penile implant consists of a pair of inflatable cylinders that are surgically implanted in the erection chambers of the penis. The cylinders are connected through tubing to a reservoir of fluid under the lower abdominal muscles, and to a pump inside the scrotal sac.

To inflate the penile prosthesis, the man compresses the pump a number of times to transfer fluid from the reservoir to the cylinders. When inflated, the prosthesis makes the penis stiff and thick similar to a natural erection.

Prevention:

Can ED be prevented?

For people who are at risk of developing ED due to personal behavior, steps can be taken to try to prevent its occurrence. However, other causes may not be preventable.

A number of studies now suggest a link between ED and obesity, high cholesterol, hypertension, diabetes, and heart disease.

The following recommendations may help prevent ED or improve the problem if it is already present:

  • Eat a healthy diet that limits saturated fats and includes several portions of fruits, vegetables, and whole grains.
  • Reduce cholesterol. High cholesterol can harden, narrow, or block the arteries leading to the penis. Men can lower cholesterol through diet, exercise, and medication.
  • Maintain a healthy weight
  • Exercise regularly. In addition to reducing the risk of ED, exercise will help you manage stress.

Living With:

What should I do if I am having problems achieving/keeping an erection?

If you suspect you have ED, please see your primary care physician or a urologist. He or she can perform tests to find out what is causing your problem and refer you to a specialist if needed.

Does insurance cover erectile dysfunction (ED) treatment?

Insurance coverage for ED depends on the type of treatment prescribed and whether your insurance covers sexual dysfunction. Speak with your insurance provider to determine if the option you are considering will be covered.

References:

  • National Kidney and Urologic Diseases Information Clearinghouse. Erectile Dysfunction Accessed 3/24/2016.
  • National Kidney and Urologic Diseases Information Clearinghouse. What I need to know about Erectile Dysfunction Accessed 3/24/2016.
  • Urology Care Foundation. What is Erectile Dysfunction? Accessed 3/24/2016.