Erectile Dysfunction

Erectile dysfunction (ED), also called impotence, is the inability to get and keep an erection firm enough for sex. It is a common type of male sexual dysfunction. ED becomes more common as men get older, but it is not a natural part of aging.

Having erection trouble from time to time is not necessarily a cause for concern. If ED is an ongoing issue, however, it can cause stress, affect self-confidence, and contribute to relationship problems. Problems getting or keeping an erection also can be a sign of an underlying health condition that needs treatment and is a risk factor for heart disease.

Some people have trouble speaking with their doctors about sex. But if you have ED, you should tell your doctor. ED can be a sign of health problems. It may mean that blood vessels are clogged or nerves are damaged.

There are several new treatments for ED. For many men, the answer is as simple as taking a pill. Getting more exercise, losing weight, or stopping smoking may also help.

ED symptoms might include:

• Trouble getting an erection
• Trouble keeping an erection
• Reduced sexual desire

ED may be caused by a combination of physical and psychological issues. For instance, a minor physical condition that slows your sexual response might cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen erectile dysfunction.

In most cases, erectile dysfunction is caused by something physical. Common causes include:

• Heart disease
• Clogged blood vessels (atherosclerosis)
• High cholesterol
• High blood pressure
• Diabetes
• Obesity
• Metabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol
• Parkinson's disease
• Multiple sclerosis
• Peyronie's disease — development of scar tissue inside the penis
• Certain prescription medications
• Tobacco use
• Alcoholism and other forms of substance abuse
• Sleep disorders
• Treatments for prostate cancer or enlarged prostate
• Surgeries or injuries that affect the pelvic area or spinal cord

The brain plays a key role in sexual arousal and the physical events that cause an erection. A number of things can interfere with sexual feelings and cause or worsen ED. These include:

• Depression, anxiety or other mental health conditions
• Stress
• Relationship problems due to stress, poor communication or other concerns
• Various risk factors can contribute to ED, including:
• Medical conditions, particularly diabetes or heart conditions
• Tobacco use, which restricts blood flow to veins and arteries, can cause chronic health conditions that lead to erectile dysfunction
• Being overweight or obese
• Certain medical treatments, such as prostate surgery or radiation treatment for cancer
• Injuries, particularly if they damage the nerves or arteries that control erections
• Medications, including antidepressants, antihistamines and medications to treat high blood pressure, pain or prostate conditions
• Psychological conditions, such as stress, anxiety or depression
• Drug and alcohol use, especially if you're a long-term drug user or heavy drinker
• Prolonged bicycling, which can compress nerves and affect blood flow to the penis, may lead to temporary or permanent erectile dysfunction

Your doctor will conduct a physical exam and a medical history to diagnose ED and recommend a treatment. If you have chronic health conditions or your doctor suspects that an underlying condition might be involved, you might need further tests or a consultation with a specialist.

Tests for underlying conditions might include:

• Physical exam. This might include careful examination of your penis and testicles and checking your nerves for sensation.
• Blood tests. A sample of your blood might be sent to a lab to check for signs of heart disease, diabetes, low testosterone levels and other health conditions.
• Urine tests (urinalysis). Like blood tests, urine tests are used to look for signs of diabetes and other underlying health conditions.
• Ultrasound. This test is usually performed by a specialist in an office. It involves using a wandlike device held over the blood vessels that supply the penis. It creates a video image to let your doctor see if you have blood flow problems. This test is sometimes done in combination with an injection of medications into the penis to stimulate blood flow and produce an erection.
• Overnight erection test. Most men have erections during sleep without remembering them. This simple test involves wrapping a special device around your penis before you go to bed.This device measures the number and strength of erections that are achieved overnight. It can help to determine if your ED is related to psychological or physical causes.
• Psychological exam. Your doctor might ask questions to screen for depression and other possible psychological causes of ED.

Complications resulting from erectile dysfunction can include:

• An unsatisfactory sex life
• Stress or anxiety
• Embarrassment or low self-esteem
• Relationship problems
• The inability to get your partner pregnant

For many men, ED is caused or worsened by lifestyle choices. They can take steps and make choices that might help improve symptoms of ED.

• If you smoke, quit.
• Lose excess pounds. Being overweight can cause or worsen ED.
• Include physical activity in your daily routine. Exercise can help with underlying conditions that play a part in ED by reducing stress, helping you lose weight, and increasing blood flow.
• Get treatment for alcohol or drug problems. Drinking too much or taking certain illegal drugs can worsen ED directly or by causing long-term health problems.
• Work through relationship issues. Consider couples or marriage counseling if you are having trouble improving communication with your partner or working through problems on your own.

Oral medications are a successful ED treatment for many men. They include:

• Sildenafil (Viagra)
• Tadalafil (Cialis)
• Vardenafil (Levitra, Staxyn)
• Avanafil (Stendra)

These medications enhance the effects of nitric oxide — a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow and allows you to get an erection in response to sexual stimulation.

Taking one of these tablets will not automatically produce an erection. Sexual stimulation is needed first to cause the release of nitric oxide from your penile nerves. These medications amplify that signal, allowing men to function normally. Oral ED medications are not aphrodisiacs, will not cause excitement, and are not needed in men who get normal erections.

The medications vary in dosage, how long they work, and the possible side effects. Your doctor will consider your particular situation to determine which medication might work best. These medications might not fix your ED immediately. You might need to work with your doctor to find the right medication and dosage for you.

Before taking any medication for ED, including over-the-counter supplements and herbal remedies, check with your doctor. Medications for ED might not work or might be dangerous if you:

• Take nitrate drugs — commonly prescribed for chest pain (angina) — such as nitroglycerin (Minitran, Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Monoket) and isosorbide dinitrate (Dilatrate-SR, Isordil)
• Have very low blood pressure (hypotension) or uncontrolled high blood pressure (hypertension)
• Have severe liver disease
• Have kidney disease that requires dialysis