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Erectile Dysfunction

Erectile Dysfunction

Alternate Names

  • impotence
  • Male reproductive organs

Definition

Male erectile dysfunction is a condition in which a man cannot get or keep a normal erection.

What is going on in the body?

Erectile dysfunction can be caused by mental or physical problems, or a combination of both. Men who are depressedor have some other emotional problem may have no interest in having sex. There may also be physical problems with how blood flows into the penis and is kept there during an erection.

Risks

What are the causes and risks of the condition?

Erectile dysfunction is a common problem. It is a problem whose frequency increases with age, but it is not necessarily a consequence of aging. Roughly 25% of men over the age of 65 have some degree of ED. Erectile dysfunction is considered a medical problem if it lasts more than 3 months.
Causes of erectile dysfunction can include:
Conditions that cause changes in the way blood flows to the penis, such as:
  • hardening of the arteries, or atherosclerosis
  • high blood pressure
  • high cholesterol
Conditions that affect the nervous system, such as:
  • multiple sclerosis
  • Alzheimer's disease
Psychological conditions and social problems, such as:
  • depression
  • stress
  • difficulties in the relationship with the man's sexual partner
Endocrine and hormone imbalances, such as:
  • diabetes, caused by abnormalities in the production or use of insulin in the body
  • hyperthyroidism, a high level of thyroid hormones
  • hypothyroidism, a low level of thyroid hormones
  • hypogonadism, a low level of testosterone
Habits that make blood flow worse, such as:
  • smoking cigarettes
  • abusing alcohol
  • using illegal drugs
Trauma or injury to the pelvis, such as:
  • spinal cord injury
  • prostate surgery, such as a transurethral resection of the prostate, simple prostatectomy, or radical prostatectomy
Some prescription medications, such as:
  • blood pressure medications including beta blockers, calcium channel blockers, or hydrochlorothiazide
  • some antidepressants

Prevention

What can be done to prevent the condition?

The best way to prevent erectile dysfunction is to reduce the risks. For instance, a man with diabetes should try to control his blood glucose, blood pressure, and cholesterol as well as possible. It is also helpful to limit alcohol intake and stop smoking.

Diagnosed

How is the condition diagnosed?

A medical evaluation is done when a man expresses concerns about erectile dysfunction to his healthcare professional. The evaluation may include a physical and psychological exam, and a written questionnaire on past sexual experiences. Lab tests are done to rule out certain diseases - especially diabetes, high blood pressure, high cholesterol and low testosterone levels. A test known as color phase ultrasonography may be done to evaluate blood flow to the penis.

Long Term Effects

What are the long-term effects of the condition?

Ignoring the physical causes of erectile dysfunction may result in a permanent inability to achieve an erection as well as other medical problems.

Other Risks

What are the risks to others?

Erectile dysfunction can affect the relationship between the man and his partner, especially if the couple do not talk about it. A man should discuss the issue with his partner and seek out solutions with her.

Treatments

What are the treatments for the condition?

First, any underlying conditions that may cause the erectile dysfunction should be treated. Treatment may include counseling or sex therapy for men whose erectile dysfunction stems from emotional problems. Treatments for physical causes of erectile dysfunction should progress from less to more invasive.
Treatment may include:
  • counseling
  • using oral prescription medications such as tadalafil (i.e., Cialis), vardenafil (i.e., Levitra), or sildenafil (i.e., Viagra)
  • using oral bromocriptine (i.e., Parlodel) in men with hyperprolactinemia
  • using a vacuum pump device to draw blood into the penis
  • inserting a suppository containing prostaglandin into the urethra (such as alprostadil i.e., Muse)
  • injecting testosterone (i.e., Depo-Testosterone) into a muscle, or using a testosterone patch or gel (i.e., AndroGel, Testim), in men who have a testosterone defficiency
  • injecting the medication prostaglandin E1 (such as alprostadil i.e., Caverject) into the penis
  • having surgery to improve blood flow to the penis
  • implanting an inflatable prosthesis into the penis
The Natural Medicines Comprehensive Database has reviewed the studies examining the use of natural medications (herbs, vitamins and supplements) in erectile dysfunction and has concluded that following are possibly effective:
  • DHEA
  • Panax Ginseng
  • L-arginine
  • Melanotan-II
  • Propionyl-L-carnitine
  • Yohimbe
The Natural Medicines Comprehensive Database has concluded that there is insufficient evidence for the use of pycnogenol for erectile dysfunction.

Side Effects

What are the side effects of the treatments?

Each treatment has its own set of advantages and side effects. The vacuum pump is very safe. But one drawback is that the constriction band, which keeps the erection, cannot be left on for more than 30 minutes.
Tadalafil (i.e., Cialis), vardenafil (i.e., Levitra), or sildenafil (i.e., Viagra) cannot be used in people who take nitroglycerine because the combination may cause severe low blood pressure and heart attack. A type of blood pressure medicine called an alpha-blocker cannot be used with Cialis or with Levitra. Injections are relatively painless, but require careful dose adjustments by a healthcare professional.
Pain or burning can occur when prostaglandin is placed into the urethra. Surgery is an option that should be discussed with a healthcare professional. Surgery can be complicated by bleeding, infection, or an allergic reaction to the medications used to control pain.

After Treatment

What happens after treatment for the condition?

Most treatments for erectile dysfunction are taken right before planned intercourse. Successful treatment restores sexual function to a satisfactory level for the man and his partner.

Monitor

How is the condition monitored?

A man should follow up with his primary healthcare professional or with his urologist concerning the treatment.

Sources

Benet AE, et al. Urol Clin North Am. 1995;22(4):699-709.

Krane RJ, et al. N Engl J Med. 1989;321(24):1648-1659.

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