Erectile Dysfunction

Erectile dysfunction at a glance

• Erectile dysfunction (ED) is a man’s inability to get or sustain an erection in order to complete sexual intercourse (climax and ejaculation).
• Erectile dysfunction affects an estimated 10 million to 20 million men in the U.S., and another 10 million have partial ED.
• A man likely has erectile dysfunction if he has erection problems more than half the time in attempts to have sex.
• An erection requires proper nerve signals, blood flow and stimulus from the brain, and problems in any of these areas can result in erectile dysfunction.
• Urologists treat ED with medications, injections, vacuum devices, implanted devices, advice with lifestyle changes and possible referral for psychological therapy.

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What is erectile dysfunction?

Erectile dysfunction (ED, or impotence) is a man’s inability to get or sustain an erection in order to complete sexual intercourse. ED is becoming more common, affecting an estimated 10 million to 20 million men in the U.S., with another 10 million having partial ED.

Increased stress, poor lifestyle choices and use of medications are adding to the rise in ED.

Erectile dysfunction becomes more prevalent with age. About 40 percent of men in their 40s experience some degree of erectile dysfunction. At age 70, ED affects about 70 percent of men.

Many men occasionally have problems attaining and sustaining erections as a normal part of life. But a man likely has erectile dysfunction if this happens more than half the time he attempts to have sex.

An erection occurs when sexual arousal causes penile nerves to release nitric oxide, a substance that signals for the increase in blood flow into the penis. The blood fills sacks in the penis (sinusoids) that engorge spongy tissue so that it presses against the outer sheath of the penis and narrows the veins that usually allow blood to drain from the penis.

This trapped blood maintains the erection as long as sexual arousal continues the stimulation.

Causes of erectile dysfunction

Erectile dysfunction can be caused by illnesses (examples include diabetes and kidney disease), certain medical treatments, and/or psychological issues that cause a breakdown in the events that lead to an erection.

Erection failure can be due to low blood flow to the erectile tissue in the penis, faulty nerve function in the penis, or inadequate arousal stimulus from the brain to the penis.

Healthcare professionals once widely believed that most cases of erectile dysfunction were due to psychological issues. However, advances in research show that only a small percentage of ED cases are due to psychological issues and that most cases are in fact caused by medical problems.

Physical causes of erectile dysfunction

• Medical conditions:
  • Heart disease, diabetes, clogged blood vessels, kidney disease, high cholesterol and/or blood pressure, metabolic syndrome, Parkinson’s disease, Peyronie’s disease, multiple sclerosis, sleep disorders
• Lifestyle factors:
  • Obesity, alcoholism, tobacco use
• Medication interactions
• Surgeries or treatments in the pelvic or spinal area (e.g. treatments for prostate cancer)
• Injuries to the penis or testicles

Psychological causes of erectile dysfunction

Anything that interferes with a man’s sexual feelings and thoughts can cause ED. That’s because the brain has to trigger feelings of sexual arousal and send other signals that cause the physical events that lead to an erection, followed by ejaculation. Psychological issues causing ED may include:

• Stress
• Relationship problems with the sexual partner
• Depression

Diagnosis & treatment of erectile dysfunction

To diagnose the cause of erectile dysfunction, sometimes a urologist needs only to talk to a man about his sexual and medical history and conduct a physical exam. Medical and sexual history may indicate an underlying medical condition. The physical exam involves an evaluation of the genitalia.

In other instances, additional diagnostic tests may be needed, such as:

• Blood test to check for underlying medical conditions and low testosterone
• Ultrasound that creates a video of blood flow to the penis
• Urine tests for underlying medical conditions

Treatment for ED varies depending on the patient and the extent of his dysfunction.

Medications to treat erectile dysfunction

Medications such as Viagra (sildenafil), Cialis (tadalafil) and others are the most commonly known treatments for ED. These medications heighten the effects of naturally occurring nitric oxide that relaxes muscles in the penis when a man is sexually aroused.

The increased blood flow to the penis results in a sustained erection. But if nitric oxide is not created by arousal, these medications will not work.

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Other treatments for ED

• Medicated pellets (alprostadil intraurethral) are self-inserted into the urethra at the tip of the penis. An erection generally begins within 10 minutes and lasts 30-60 minutes.
• Intracavernosal injections in the penis with a very fine needle deliver the same type of medications that increase blood flow and cause an erection lasting about an hour.
• Penile prosthesis surgery implants an inflatable device into the penis that can be pumped up to create an erection. Semi-rigid rods also can be implanted on both sides of the penis, keeping it firm but bendable.
• A penis pump is a vacuum device involving a tube placed around the penis that is pumped up (by hand or battery-power) to vacuum air out of the tube, in turn pulling blood into the penis for an erection. The man places a tension ring around the base of his penis to maintain the erection.
• Surgery, used in rare cases, corrects blood vessel problems causing ED
• Psychotherapy may be helpful to address sexual performance issues that can be caused by anxiety, stress and depression.
• Lifestyle changes to maintain a healthy weight, stop smoking, exercise regularly, reduce alcohol intake, manage stress, and address psychological issues are often effective.

Risks of treatments

The surgical procedures above carry the same risks as any surgery including infection, blood loss and issues with anesthesia. Men may have allergic reactions to medications and/or side effects of a troubling nature.