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Erectile Dysfunction

Erectile Dysfunction: What You Need to Know

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Updated January 26, 2009

What Is an Erection?

An erection can occur when sexual stimulation triggers your brain to send nerve signals to your penis. These signals cause the muscles within the arteries of your penis to relax resulting in more blood flow through the penis, which causes your penis to get hard. Normally, blood stays trapped in the penis until the completion of sexual activity.

What Is Erectile Dysfunction?

When you have erectile dysfunction (ED), also known as impotence, you have a problem getting or maintaining an erection long enough for sex. ED happens when not enough blood flows to your penis when you are sexually stimulated.

ED may not be the same for all men. Some men are not able to get an erection at all. Some men can get an erection, but it’s not hard enough for sex, and other men get a firm erection but lose it before or during sexual activity.

What Causes Erectile Dysfunction?

ED is a medical condition that can occur at any age, but is more common in men older than 65. ED may be caused by a health condition, lifestyle issue or psychological problem.

Health conditions and ED:

High blood pressure can cause damage to your blood vessels resulting in decreased blood flow to your penis.

Diabetes can increase your risk of having ED. If not controlled well enough, high blood sugar can damage blood vessels and nerves in your penis.

High blood cholesterol can cause blood vessels in your penis to narrow.

Nervous system disorders, such as stroke, Parkinson’s disease, multiple sclerosis and spinal-cord injuries, can increase your risk of having ED. These conditions may interfere with nerve signals between the brain and the penis.

Pelvic area injury or surgery can damage nerves and blood vessels that go to your penis. This happens most often following certain types of prostate surgery.

Low levels of the male hormone testosterone can decrease your desire for sex and affect your ability to get an erection. Low testosterone levels are common in men with type 2 diabetes.

Certain medications may cause ED as a side effect. In fact, between 10% and 25% of erectile dysfunction in the United States is caused by medications. Drugs that often cause erectile dysfunction include:

  • Cancer chemotherapies, such as Cytoxan (cyclophosphamide)
  • Medications used to treat high blood pressure, particularly diuretics such as Hydrodiuril (hydrochlorothiazide) and beta-blockers such as Inderal (propranolol)
  • Most drugs used to treat psychological disorders, including anti-anxiety drugs, such as Paxil (paroxetine); antidepressants, such as Zoloft (sertraline) and antischizophrenia drugs, such as Seroquel (quetiapine)
  • Tranquilizers, such as Valium (diazepam)
  • Hormonal medications used to treat prostate cancer, such as Lupron (leuprolide)
  • Propecia (finasteride) used to treat an enlarged prostate (BPH) and certain types of male hair loss

Lifestyle issues and ED

Certain lifestyle issues may increase your risk for having ED, including:

  • Smoking
  • Being overweight
  • Drinking too much alcohol
  • Not being physically active
  • Using recreational drugs, such as marijuana, cocaine or heroin

Psychological problems and ED

Some men with ED may have an emotional or personal issue, such as:

  • Feeling depressed
  • Feeling stress due to work or home situations
  • Anxiety about sexual performance, possibly because of a bad sexual experience or because of a previous occurrence of ED
  • Having relationship problems

How Is Erectile Dysfunction Diagnosed?

Your doctor will most likely ask you questions about your health and do a physical exam. You also may need to have some blood and urine tests to determine if you have a health condition that may be causing your ED.

How Is Erectile Dysfunction Treated?

Ask your doctor about treatment, since most men who have ED can significantly improve their ability to get and maintain an erection. Your doctor will recommend treatment for your ED depending on what is causing it.

If you have a chronic health condition, such as diabetes, high blood pressure or high cholesterol, your doctor will want to make sure that you are receiving proper treatment. Keeping your blood sugar, blood pressure and cholesterol at normal levels will help prevent further damage to nerves and blood vessels in your penis.

Your doctor will also determine if any medications are causing your ED. Changing medication doses or switching to a different medication may help.

Specific treatments for ED include:

Oral prescription medications, which belong to a class of drugs known as PDE-5 inhibitors, are the most commonly used medical treatment for ED. These medications have a high success rate and are easy to use.

The PDE-5 inhibitors - Viagra (Sildenafil), Cialis (tadalafil) and Levitra (vardenafil) - relax smooth muscle around arteries, allowing your penis to fill with blood.

Other Prescription Medications - For most men, oral medicines work well to treat ED. If they do not, there are several other prescription drug options:

  • Medications you inject in to your penis using a tiny needle, such as Caverject (alprostadil)
  • MUSE (alprostadil), a small pellet that is inserted inside the opening at the end of your penis

If your blood tests show that you have low testosterone for your age, your doctor may prescribe a testosterone gel (Androgel) or a testosterone skin patch (Androderm).

Lifestyle Changes- To help treat ED, your doctor may suggest that you make some changes to your lifestyle, such as:

  • Eat properly to maintain a healthy weight
  • Exercise regularly
  • Quit smoking
  • Limit your intake of alcohol
  • Stop using recreational drugs

Counseling - In some men, ED is related to emotional or relationship problems. Although medications may help, satisfying sexual experiences may require that you and your sexual partner talk with a counselor trained in issues of sexual intimacy.

The best results may be a combination of couseling and medications.

Other ED Treatment Options- If medications, counseling, change in lifestyle and management of chronic health conditions do not help, there are other options to help you manage your ED, such as:

  • Surgery to place a semi-rigid or inflatable implant in your penis
  • Using a vacuum device that is placed around your penis. You pump the device to create a vacuum that leads to an erection.
About 80 percent of men have success with an ED treatment.
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