Non-invasive treatments are often tried first. Most of the best-known treatments for ED work well and are safe. Still, it helps to ask your health care provider about side effects that could result from each option:
- Oral drugs or pills known as phosphodiesterase type-5 inhibitors are most often prescribed in the U.S. for ED (Viagra, Cialis, Levitra, Stendra)
- Testosterone Therapy (when low testosterone is detected in blood testing)
- Penile Injections (ICI, intracavernosal Alprostadil)
- Intraurethral medication (IU, Alprostadil)
- Vacuum Erection Devices
- Penile Implants
- Surgery to bypass penile artery damage for some younger men with a history of severe pelvic trauma. Penile vascular surgery is not recommended for older men with hardened arteries.
Oral Drugs (PDE5 inhibitors)
Drugs known as PDE type-5 inhibitors increase penile blood flow. These are the only oral agents approved in the U.S. by the Food and Drug Administration for the treatment of ED.
- Viagra ® (sildenafil citrate)
- Levitra ® (vardenafil HCl)
- Cialis ® (tadalafil)
- Stendra ® (avanafil)
For best results, men with ED take these pills about an hour or two before having sex. The drugs require normal nerve function to the penis. PDE5 inhibitors improve on normal erectile responses helping blood flow into the penis. Use these drugs as directed. About 7 out of 10 men do well and have better erections. Response rates are lower for Diabetics and cancer patients. If you are taking nitrates for your heart, you SHOULD NOT take any PDE5 inhibitors. Always speak with your health care provider before using a PDE5 inhibitor to learn how it might affect your health. Most often, the side effects of PDE5 inhibitors are mild and often last just a short time. The most common side effects are:
- Stuffy nose
- Facial flushing
- Muscle aches
In rare cases, the drug Viagra ® can cause blue-green shading to vision that lasts for a short time. In rare cases, the drug Cialis ® can cause or increase back pain or aching muscles in the back. In most cases, the side effects are linked to PDE5 inhibitor effects on other tissues in the body, meaning they are working to increase blood flow to your penis and at the same time impacting other vascular tissues in your body. These are not ‘allergic reactions’.
In those rare cases where a low sex drive and low blood levels of Testosterone are at fault for ED, Testosterone Therapy may fix normal erections or help when combined with ED drugs (PDE type 5 inhibitors).
Vacuum Erection Device
A vacuum erection device is a plastic tube that slips over the penis, making a seal with the skin of the body. A pump at the other end of the tube makes a low-pressure vacuum around the erectile tissue, which results in an erection. An elastic ring is then slipped onto the base of the penis. This holds the blood in the penis (and keeps it hard) for up to 30 minutes. With proper training, 75 out of 100 men can get a working erection using a vacuum erection device.
Intracavernosal (ICI) and Urethra (IU) Therapies
If oral drugs don’t work, the drug Alprostadil is approved for use in men with ED. This drug comes in two forms, based on how it is to be used: intracavernosal injection (called «ICI») or through the urethra (called «IU therapy»).
Alprostadil is injected into the side of penis with a very fine needle. It’s of great value to have the first shot in the doctor’s office before doing this on your own. Self-injection lessons should be given in your doctor’s office by an experienced professional. The success rate for getting an erection firm enough to have sex is as high as 85% with this treatment. Many men who do not respond to oral PDE5 inhibitors can be ‘rescued’ with ICI. ICI Alprostadil may be used as a mixture with two other drugs to treat ED. This combination therapy called «bimix or trimix» is stronger than alprostadil alone and has become standard treatment for ED. Only the Alprostadil ingredient is FDA approved for ED. The amount of each drug used can be changed based on the severity of your ED, by an experienced health professional. You will be trained by your health professional on how to inject, how much to inject and how to safely raise the drug’s dosage if necessary. ICI therapy often produces a reliable erection, which comes down after 20-30 minutes or with climax. Since the ICI erection is not regulated by your penile nerves, you should not be surprised if the erection lasts after orgasm. The most common side effect of ICI therapy is a prolonged erection. Prolonged erections (>1 hour) can be reversed by a second injection (antidote) in the office. Men who have penile erections lasting longer than two to four hours should seek Emergency Room care. Priapism is a prolonged erection, lasting longer than four hours. It is very painful. Failure to undo priapism will lead to permanent penile damage and untreatable ED.
Intraurethral (IU) Therapy
For IU therapy, a tiny medicated pellet of the drug, Alprostadil, is placed in the urethra (the tube that carries urine out of your body). Using the drug this way means you don’t have to give yourself a shot, unfortunately it may not work as well as ICI. Like ICI therapy, IU Alprostadil should be tested in the office, before home usage. The most common side effects of IU alprostadil are a burning feeling in the penis. If an erection lasts for over four hours, it will need medical attention to make it go down.
The main surgical treatment of ED involves insertion of a penile implant (also called penile prostheses). Because penile vascular surgery is not recommended for aging males who have failed oral PDE5 inhibitors, ICI or IU therapies, implants are the next step for these patients. Although placement of a penile implant is a surgery which carries risks, they have the highest rates of success and satisfaction among ED treatment options. Penile implants are devices that are placed fully inside your body. They make a stiff penis that lets you have normal sex. This is an excellent choice to improve uninterupted intimacy and makes relations more spontaneous. There are two types of penile implants.
Semi rigid Implant (Bendable)
The simplest kind of implant is made from two easy-to-bend rods that are most often made of silicone. These silicone rods give the man’s penis the firmness needed for sexual penetration. The implant can be bent downward for peeing or upward for sex.
With an inflatable implant , fluid-filled cylinders are placed lengthwise in the penis. Tubing joins these cylinders to a pump placed inside the scrotum (between the testicles). When the pump is engaged, pressure in the cylinders inflate the penis and makes it stiff. Inflatable implants make a normal looking erection and are natural feeling for your partner. Your surgeon may suggest a lubricant for your partner. With the implant, men can control firmness and, sometimes, the size of the erection. Implants allows a couple to be spontaneously intimate. There is generally no change to a man’s feeling or orgasm.
What is the Surgery Like?
Penile implants are most often placed under anesthesia. If a patient has a systemic, skin, or urinary tract infection, this surgery should be postponed until all infections are treated. If a man is on blood thinners, then he may need to talk with a medical expert about stopping the medications for elective surgery and healing. Most often, one small surgical cut is made. The cut is either above the penis where it joins the belly, or under the penis where it joins the scrotum. No tissue is removed. Blood loss is typically small. A patient will either go home on the same day or spend one night in the hospital. Recovery Time after Penile Implants:
- Most men will feel pain and will feel better with a narcotic pain-relief drug for one to two weeks. After the first week, over- the-counter pain drugs (such as acetaminophen or ibuprofen) may be substituted for narcotic pain drugs.
- Discomfort, bruising and swelling after the surgery will last for a few weeks.
- For the first month, men should limit their physical activity. The surgeon will explain when and how much exercise to do during the healing period.
- Men most often start having sex with their penile implants by eight weeks after surgery. If there is persisting swelling or pain, the use of the implant may be delayed. The surgeon or health care expert in the surgeon’s office will talk about how to inflate and deflate the implant.
There are risks to prosthetic surgery and patients are counselled before the procedure. If there is a post-operative infection, the implant will likely be removed. The devices are reliable, but in the case of mechanical malfunction, the device or a part of the device will need to be replaced surgically. If a penile prosthesis is removed, other non-surgical treatments may no longer work. Most men with penile implants and their partners say that they’re satisfied with the results, and they return to more spontaneous intimacy.
Several restorative or regenerative treatments are under investigation for the future treatment of ED:
- Extracorporeal shock wave therapy (ESWT) — low-intensity shock waves that aim to fix the erectile tissues and help restore natural erections.
- Intracavernosal injection of stem cells — to help cavernous tissue regrowth
- Intracavernosal injection autologous platelet rich plasma (APRP) — to help cavernous tissue regrowth
These are not currently approved by the FDA for ED management, but they may be offered through research studies (clinical trials). Patients who are interested should discuss the risks and benefits (informed consent) of each, as well as costs before starting any clinical trials. Most therapies not approved by the FDA are not covered by government or private insurance benefits.
Supplements are popular and often cheaper than prescription drugs for ED. However, supplements have not been tested to see how well they work or if they are a safe treatment for ED. Patients should know that many over-the-counter drugs have been found on drug testing to have ‘bootlegged’ PDE 5 Inhibitors as their main ingredient. The amounts of Viagra, Cialis, Levitra or Stendra that may be in these supplements is not under quality control and may differ from pill to pill. The FDA has issued consumer warnings and alerts. More information may be found here. Updated June 2018 If you think you have ED, a good first step is to talk with your doctor. The treatment you need – ranging from lifestyle changes to medication to surgery — will depend on what’s causing it.
- ED Tests: What to Expect at the DoctorWith so many possible causes for ED, your doctor has a number of tests they can use to figure out the best treatment for you.
- ED Treatment OverviewErectile dysfunction can be treated at any age. Treatment depends on your overall health and the underlying cause of the problem.
- What to Ask Your Doctor About EDIt can be embarrassing to discuss sexual matters with your doctor. Yet a doctor’s appointment is neccessary if you want to get treatment for ED. Here’s how to prepare for your doctor visit.
- ED Vacuum DevicesA vacuum constriction device (VCD) is an external pump with a band on it that a man with erectile dysfunction can use to get and maintain an erection.
- Penile Implants for EDA penile prosthesis or implant is an effective treatment for erectile dysfunction. Penile implant surgeries take about an hour and are typically done in an outpatient center.
- ED SurgeryVascular reconstructive surgery is one way to improve blood flow to the penis to help a man with erectile dysfunction get and keep an erection.
- Cialis, Levitra, Staxyn, and Viagra to Treat EDYou may already know most of the names: Cialis, Levitra, Staxyn, Stendra, Viagra. Learn more about these medications that can help men with erectile dysfunction.
- Alprostadil for EDAlprostadil, available as an injection or a suppository, is a drug that makes the blood vessels expand. That boosts blood flow throughout the body, including the penis, so it helps men with ED have an erection.
- New ED TreatmentsFuture treatments for erectile dysfunction focus on providing medications that are more effective, work rapidly, and have fewer, if any, side effects than currently available treatments.
- Testosterone Replacement Therapy for EDInadequate production of testosterone is not a common cause of erectile dysfunction. But, when ED does occur due to decreased testosterone production, testosterone replacement therapy may improve the problem.
- Alternative Remedies for EDIf you have erectile dysfunction, there are many ways your doctor can help you treat it. But you may want to consider complementary or alternative therapies, such as nutritional supplements, herbal remedies, acupuncture, and talk therapy. Just be sure to talk to your doctor first.
- Yohimbe Bark Supplements for EDYou can buy extract of the bark of the yohimbe tree – long used as an aphrodisiac in western Africa — as a dietary supplement. Its promoters claim it can help erectile dysfunction. But the science shows mixed results.
- Horny Goat Weed (Epimedium) and EDHorny goat weed is an herb that has been used in China for centuries to treat low libido, erectile dysfunction, fatigue, and other conditions. Learn how its extract may help increase blood flow to the penis.
- Quit Smoking to Help EDMen who smoke are about twice as likely to develop ED as nonsmokers. Smoking hampers circulation to all areas of the body, including the genitals, making it tougher to get and keep an erection.
Erection problems (impotence) are very common, particularly in men over 40. It’s usually nothing to worry about, but you should see a GP if it keeps happening. It could be the sign of a more serious problem.
Causes of erection problems
Most men occasionally fail to get or keep an erection. This is usually caused by stress, tiredness, anxiety or drinking too much alcohol, and it’s nothing to worry about. If it happens more often, it may be caused by physical health or emotional problems.
Non-urgent advice: See a GP or go to a sexual health clinic if:
- erection problems keep happening
It could be a sign of an underlying health condition such as diabetes. Information:
How sexual health clinics can help with erection problems
Sexual health clinics treat problems with sexual health. They can provide the same treatment you would get at your GP surgery. Many sexual health clinics offer a walk-in service, where you do not need an appointment. They’ll often get test results quicker than GP practices. Find a sexual health clinic near you
What happens at your appointment
The doctor or nurse will ask about your lifestyle and relationships, and any problems you might be having. They’ll carry out basic health checks, such as taking your blood pressure. They’ll also examine your genitals to rule out any obvious physical cause. If you have symptoms like needing to pee more often, you may also need to have an examination of your prostate.
Treatment for erection problems depends on the cause
Treatments for erectile dysfunction are usually effective and the problem often goes away. There are also specific treatments for some of the causes of erectile dysfunction.
|Narrowing of penis blood vessels, high blood pressure, high cholesterol||Medicine to lower blood pressure, statins to lower cholesterol|
|Hormone problems||Hormone replacement (for example, testosterone)|
|Side effects of prescribed medicine||Change to medicine after discussion with GP|
Medicine such as sildenafil (sold as Viagra) is also often used by doctors to treat erectile dysfunction. It’s also available from pharmacies. Because of changes in regulations, you no longer need a prescription to get sildenafil. But you’ll have to have a consultation with the pharmacist to make sure it’s safe for you to take it. There are other similar medicines called tadalafil (Cialis), vardenafil (Levitra) and avanafil (Spedra) that work in a similar way. You’ll still need a prescription to get these medicines.
Buying Viagra online
You can buy sildenafil (Viagra) over the internet. Be very careful if you do this as many websites sell fake medicines. Online medicines are not always regulated and the ingredients in them can vary from one pack to another. They can cause unpleasant side effects, or may not be suitable for you. It’s best to see a doctor before buying medicines online. They know your medical history and can discuss whether you might benefit from treatment. If you choose to buy sildenafil (Viagra) on the internet, make sure:
- any online pharmacy is registered with the General Pharmaceutical Council (GPhC)
- any online doctor service is registered with the Care Quality Commission (CQC)
- all doctors are registered with the General Medical Council (GMC)
Important Never buy off-prescription Viagra tablets online. Make sure they’re prescribed by a doctor or come from a UK pharmacy.
Things you can do to help with erectile dysfunction
Healthy lifestyle changes can sometimes help erectile dysfunction.
- lose weight if you’re overweight
- stop smoking
- eat a healthy diet
- exercise daily
- try to reduce stress and anxiety
- do not cycle for a while (if you cycle for more than 3 hours a week)
- do not drink more than 14 units of alcohol a week
The Sexual Advice Association has factsheets on medicines and other treatments for erectile dysfunction.
Do vacuum pumps work?
Vacuum pumps encourage blood to flow to the penis, causing an erection. They work for most men and can be used if medicine is not suitable or does not work. They’re not always available on the NHS. Speak to a doctor about where to get a vacuum pump.
Emotional (psychological) problems
It’s more likely to be an emotional problem if you only have erection problems some of the time. For example, you get an erection when waking up in the morning, but not during sexual activity. Anxiety and depression can be treated with counselling and cognitive behavioural therapy (CBT). A GP might recommend sex therapy, either on its own or in combination with other psychotherapy. There’s usually a long wait for these services on the NHS. You can also pay to see someone privately. Information:
Finding private counsellors or sex therapists
Counsellors and psychotherapists should be a member of the:
- British Association of Counselling and Psychotherapy
Sex therapists should be a member of the:
- College of Sexual and Relationship Therapists (COSRT)
- Institute of Psychosexual Medicine
Relate also offers sex therapy for a fee. Advice and support is also available from the Sexual Advice Association. Page last reviewed: 26 August 2020
Next review due: 26 August 2023
Dr. Drogo Montague discusses treatment options for erectile dysfunction.
What is erectile dysfunction (ED)?
Erectile dysfunction (ED) is the inability to get and keep an erection firm enough for sexual intercourse. Estimates suggest that one of every 10 men will suffer from ED at some point during his lifetime. It is important to understand that in most cases, ED is a symptom of another, underlying problem. ED is not considered normal at any age, and may be associated with other problems that interfere with sexual intercourse, such as lack of desire and problems with orgasm and ejaculation.
How common is erectile dysfunction?
Approximately one in 10 adult males will suffer from ED on a long-term basis. Many men do experience occasional failure to achieve erection, which can 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 that there is a problem and treatment is needed. ED does not have to be a part of getting older. While it is true that some older men may need more stimulation, they should still be able to achieve an erection and enjoy intercourse.
Symptoms and Causes
What causes erectile dysfunction (ED)?
ED can be caused by a number of factors, including:
- Vascular disease: Blood supply to the penis can become blocked or narrowed as a result of vascular disease such as atherosclerosis (hardening of the arteries).
- Neurological disorders (such as multiple sclerosis): Nerves that send impulses to the penis can become damaged from stroke, diabetes, or other causes.
- Psychological states: These include stress, depression, lack of stimulus from the brain and performance anxiety.
- Trauma: An injury could contribute to symptoms of ED.
Chronic illness, certain medications, and a condition called Peyronie’s disease can also cause ED. Operations for the prostate, bladder, and colon cancer may also be contributing factors.
What medications could cause erectile dysfunction (ED)?
Erectile dysfunction (ED) is a common side effect of a number of prescription drugs. While these medications may treat a disease or condition, in doing so they can affect a man’s hormones, nerves or blood circulation, resulting in ED or increasing the risk of ED. If you experience ED and think that it may be a result of the medication you are using, do not stop taking the medication. If the problem persists, contact your doctor and he or she may be able to prescribe a different medication. Common medications that may list ED as a potential side effect include:
- Diuretics (pills that cause increase urine flow).
- Antihypertensives (high blood pressure drugs).
- Parkinson’s disease drugs.
- Antiarrhythmics (drug for irregular heart action).
- Muscle relaxants.
- Nonsteroidal anti-inflammatory drugs.
- Histamine H2-receptor antagonists.
- Chemotherapy medications.
- Prostate cancer drugs.
- Anti-seizure medications.
Other substances or drugs that can cause or lead to ED include these recreational and frequently abused drugs:
These drugs not only affect and often suppress the central nervous system, but can also cause serious damage to the blood vessels, leading to permanent ED.
What prescription drugs may cause erectile dysfunction?
Erectile dysfunction (ED) is a common side effect of a number of prescription drugs. While these medications may treat a disease or condition, in doing so they can affect a man’s hormones, nerves or blood circulation. The result may be ED or an increase in the risk of ED. If you have ED and think that it may be a result of the medication you are using, do not stop taking the medication. If the problem persists, contact your doctor and he or she may be able to prescribe a different medication. Common medications that may list ED as a potential side effect include:
- Diuretics (pills that cause an increase in urine flow).
- Antihypertensives (medication for high blood pressure).
- Parkinson’s disease drugs.
- Antiarrhythmics (medication for irregular heart action).
- Muscle relaxants.
- Non-steroidal anti-inflammatory drugs.
- Histamine H2-receptor antagonists.
- Chemotherapy medications.
- Prostate cancer drugs.
- Anti-seizure medications.
What other substances or drugs may cause erectile dysfunction?
Other substances or drugs that can cause or lead to ED include these recreational and frequently abused drugs:
Aside from the well-known complications that the use and abuse of these drugs can cause, ED is not often mentioned. However, use of these drugs is a risk factor for ED. These drugs not only affect and often times slow down the central nervous system, but can also cause serious damage to the blood vessels, leading to permanent ED.
How are depression and erectile dysfunction related?
For some men, depression can accompany the condition of erectile dysfunction (ED). It is common for men with ED to feel angry, frustrated, sad, unsure of themselves, or even less “manly.” Such feelings may lead to a lack of self-esteem and, in severe cases, to depression. Depression that accompanies ED is treatable. The first step in addressing your concerns about ED-related depression is to be honest with yourself, your partner, and your doctor. After depression has been brought out into the open, coping with it will be easier and less stressful.
Diagnosis and Tests
How is erectile dysfunction (ED) diagnosed?
Because there are a variety of causes for ED, there are several different tests your doctor may use to diagnose the condition and determine its cause. Only after the cause of ED is determined can it be effectively treated. Before ordering any tests, your doctor will review your medical history and perform a thorough physical examination. The doctor will also «interview» you about your personal and sexual history. Some of these questions will be very personal and may feel intrusive. However, it is important that you answer these questions honestly. The questions asked may include:
- What medications or drugs are you currently using? This includes prescription drugs, over-the-counter drugs, herbals, dietary supplements and illegal drugs.
- Have you had any psychological problems such as stress, anxiety and depression?
- When did you first notice symptoms of ED?
- What are the frequency, quality and duration of any erections you have had?
- What are the specifics of the circumstances under which ED first occurred?
- Do/did you experience erections at night or during the morning?
- What sexual techniques do you use?
- Are there problems in your current relationship?
The doctor may also wish to interview your sexual partner since your partner may be able to offer in sight about the underlying causes. After your physical examination and discussion, your doctor may then order any one of the following tests to further diagnose your condition:
- Complete blood count (CBC): This is a set of blood tests that, among other things, can detect the presence of anemia. Anemia is caused by a low red blood cell count and can cause fatigue, which in turn can cause ED.
- Liver and kidney function tests: These blood tests may indicate whether ED may be due to your kidneys or liver functioning improperly.
- Lipid profile: This blood test measures the level of lipids (fats), like cholesterol. High levels may indicate atherosclerosis (hardening of the arteries), which can affect blood circulation in the penis.
- Thyroid function test: One of the thyroid hormones’ functions is to regulate the production of sex hormones, and a deficiency in these hormones may contribute to or cause ED.
- Blood hormone studies: Testosterone and/or prolactin levels in the blood may be measured to see if abnormalities in either of these sex hormones are present.
- Urinalysis: Analysis of urine can provide a wealth of information, including information on protein, sugar and testosterone levels. Abnormal measurements of these substances can indicate diabetes, kidney disease or a testosterone deficiency, all which can cause ED.
- Duplex ultrasound: This is perhaps the best test for evaluating ED. An ultrasound uses high-frequency sound waves to take «pictures» of the body’s tissues. For people with ED, an ultrasound may be used to evaluate blood flow and check for signs of a venous leak, atherosclerosis (hardening of arteries) or tissue scarring. This test is performed both while the penis is erect (usually induced by an injection of a drug that stimulates erection) and also while it is soft.
- Bulbocavernosus reflex: This test evaluates nerve sensation in the penis. During the test, your doctor will squeeze the head of your penis, which should immediately cause your anus to contract. If nerve function is abnormal, there will be a delay in response time.
- Nocturnal penile tumescence (NPT): This test measures a man’s erectile function while he is sleeping. Normally, a man will have five or six erections while asleep. A lack of these erections may indicate there is a problem with nerve function or circulation to the penis. The test uses two methods, the snap gauge method and the strain gauge method. The snap gauge method is performed by wrapping three plastic bands of varying strength around the penis. Erectile function is then measured based on which of the three bands breaks. The strain gauge method works by placing elastic bands around the tip and base of the penis. If the penis becomes erect during the night, the bands stretch, measuring the changes in penile circumference.
- Penile biothesiometry: This test involves the use of electromagnetic vibration to determine sensitivity and nerve function. A decreased sensitivity to these vibrations may indicate nerve damage.
- Vasoactive injection: During this test, an erection is produced by injecting special solutions that cause the blood vessels to dilate (enlarge) allowing blood to enter the penis.
- Dynamic infusion cavernosometry: This test is used for men with ED who have a venous leak. During this test, fluid is pumped into the penis at a predetermined rate. By measuring the rate at which fluid must be pumped to attain a rigid erection, doctors can determine the severity of the venous leak.
- Cavernosography: Used in conjunction with the dynamic infusion cavernosometry, this test involves injecting a dye into the penis. The penis is then X-rayed so that the venous leak can be seen.
- Arteriography: This test is given to people who are candidates for vascular reconstructive surgery. A dye is injected into the artery believed to be damaged and X-rays will be taken.
Before you are given any of these tests, your doctor will explain what is involved. If you have any questions, do not hesitate to ask your doctor.
Management and Treatment
What doctors treat erectile dysfunction?
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 (Viagra®, Levitra®, Cialis®). If these options fail, you may be referred to a urologist who can assist with other non-surgical options such as 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 in many ways, including:
- Oral medications.
- Sex therapy.
- Penile injections.
- Vacuum devices.
- Intraurethral medication.
- Surgery (penile implant).
Each type has its own pros and cons. Discuss your options with your doctor to determine the best treatment for you. The first step to treating ED is to find the underlying cause. Then the appropriate treatment can begin. There are a number of non-surgical and surgical options that can help a man regain normal sexual function.
What non-surgical treatments are there for erectile dysfunction (ED)?
Education and communication Education about sex, sexual behaviors, and sexual responses may help a man overcome his 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 (above) 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 create an erection. Injection therapy is effective in treating a wide variety of erection issues caused by blood vessel, nerve and psychological conditions. Using a tiny needle and syringe, the man injects a small amount of medicine into the side of his penis. The medicine relaxes the blood vessels, allowing blood to flow into the penis. This treatment has been widely used and accepted since the early 1980s. The three most common medicines are prostaglandin E1 (alprostadil), papaverine (Papacon®), and phentolamine (Regitine®). The most common side effects are pain and penile scarring (fibrosis). In extremely rare cases, patients with cerebral and vascular disease or severe cardiovascular diseases might not be able to tolerate the dizziness and high blood pressure occasionally caused by injection therapy. A painful erection that lasts longer than two to three hours is called priapism and may occur with injection therapy. This can be lessened with proper dosing and by following the treatment guidelines. Psychology and sex therapies Psychological causes may contribute to erectile failure even when there is a clear organic cause. Therapy with a trained counselor can help a person address feelings of anxiety, fear or guilt that may have an impact on sexual dysfunction. Sex therapy can be beneficial to most men when counseling is provided by a skilled sex therapist. Sex therapy also helps a man’s partner accept and cope with the problems. A patient whose ED has a clear psychological cause should receive sex therapy counseling before any invasive treatments are pursued. Hormone Low hormone levels may play a role in ED. Hormone replacement in the form of topical gels, creams, patches, injections and pellets are only used after physician evaluation.
What are surgical treatment options for erectile dysfunction (ED)?
Penile prosthesis surgery Inflatable penile prostheses are implanted during outpatient surgery. Once they are part of a man’s body, they enable him 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. This causes the penis to become erect. When inflated, the prosthesis makes the penis stiff and thick, which is very similar to a natural erection. A penile prosthesis does not change the sensation on the skin of the penis or a man’s ability to achieve orgasm or ejaculate. Pressing on a deflation valve attached to the pump returns the fluid to the reservoir, which returns the penis to a flaccid state. The surgical procedure is performed through one or two small incisions that are generally well hidden. Other people will be unable to tell that a man has an inflatable penile prosthesis. Complications following surgery are not common, but primarily include infection and mechanical device failure. Approximately 95% of penile implant surgeries are successful in producing erections that enable men to have sexual intercourse. Moreover, patient satisfaction questionnaires show that up to 90% of men who have undergone penile implants say they would choose the surgery again, and overall satisfaction ratings are higher than those reported by men using oral medication or penile injection therapy.
Can erectile dysfunction (ED) be prevented?
For people who are at risk of developing ED due to personal behavior, steps may 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. A diet that limits saturated fat intake and includes several portions of fruits, vegetables and whole grains can benefit men with ED.
- Reduce cholesterol. High cholesterol can harden, narrow or block the arteries (atherosclerosis) leading to the penis. Men can lower cholesterol through diet, exercise and medication.
- Maintain a healthy weight.
- Exercise regularly. Regular exercise may reduce the risk of ED. Choose exercises that you enjoy and will make a regular part of your day. In addition to reducing the risk of ED, exercise also can help you manage stress. Check with your doctor before starting any exercise program.
What should I do if I am having problems achieving/keeping an erection?
If you suspect you have erectile dysfunction, 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. Once the cause is identified, there are several treatment options to choose from.
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 at all. Speak with your insurance provider to determine if the option you are considering will be covered.
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