Erectile dysfunction is trouble having an erection or not being able to keep an erection long enough to finish having sex. Another term for this problem is impotence.
It is normal for most men to have trouble having an erection sometimes when they are tired or nervous. When erectile dysfunction becomes a pattern or a long-lasting problem, however, it can deeply affect the emotional lives of men and their sex partners.
Erectile dysfunction affects older men more than younger men. Midlife and the later years bring changes in circulation that may affect the sex organs. Couples need to be more open and understanding with each other about sexual problems such as erectile dysfunction.
Fortunately, there are many effective treatments for erectile dysfunction.
An erection is caused when there is increased blood flow into the penis. Penile veins then clamp down to trap blood there, causing stiffness. Nerves in the penis provide feelings of pleasure and help maintain the erection until ejaculation.
There are many possible physical and nonphysical causes of erectile dysfunction, including:
If erectile dysfunction lasts longer than 2 months or is a recurring problem, see your health care provider for a physical exam. You may be referred to a doctor who specializes in erectile problems.
The exam will include urine and blood sugar tests so that the doctor can rule out diabetes. In addition, the doctor may want to measure the level of testosterone, a male hormone in your blood.
The doctor may want to test penile blood flow and pressure. He or she may also want to measure the nighttime stiffness of the penis by the snap gauge test or stamp test.
In the snap gauge test, a band is placed around the penis before you go to sleep. If there is an erection, the snap gauge will break.
For the stamp test, you take a strip of stamps (such as Easter Seals) and make a ring around the nonerect shaft of the penis. Moisten and seal the stamp overlap before going to sleep. Do not use postage stamps because the glue is too strong. If you have an erection during sleep, the stamp ring will break. This will wake you up and allow you to feel the degree of erection. Awakening the next morning with the ring intact means you did not have an erection while you were asleep. Repeat the test the next two nights. If the stamp ring is intact three times, you probably have impaired blood flow in your penis.
If the doctor has ruled out physical problems as a cause of erectile dysfunction, he or she may refer you and your partner to a psychotherapist or family counselor.
Psychological problems causing erectile dysfunction are varied but most can be helped. Therapy often leads to improved function in other areas of life as well as in sexual function. Psychotherapists often like to work with both partners. Therapy, like other treatments, can be uncomfortable but worthwhile. If you have concerns about your referral, discuss them with your primary doctor.
If you have problems with blood flow or blood pressure to your penis, you may have several options.
Drug Treatment
Medicines called PDE-5 inhibitors are often used to treat erectile dysfunction. These medicines include Viagra, Levitra, and Cialis. After sexual stimulation, these medicines work by relaxing the blood vessels in the penis. More blood can enter the penis, which helps you get or keep an erection.
These pills should not be used by men who are taking nitrates. The combination of drugs could cause a dangerously low blood pressure. Erythromycin and some antifungal medicines can also interact with these pills. Men taking these medicines may need a different dose to prevent side effects. PDE-5 inhibitors can cause side effects such as flushing, headache, and indigestion.
Other drugs can be self-injected into the penis when an erection is desired. A possible problem with these shots is priapism (painful erections that last more than 4 hours). This requires emergency treatment. Because of this risk, the shots must be used only with a health care provider's prescription. A man will usually become erect in 3 to 5 minutes after having a shot. Erections resulting from these shots usually last as long as an hour.
If a man's level of testosterone is low, he may be prescribed hormone treatment. Testosterone is available in the form of patches or gels that are used on the skin or as monthly shots in the arm.
External Mechanical Devices
There are mechanical devices that trap blood in the penis to cause an erection. They come with a vacuum chamber, a pump, connecting tubing, and elastic bands. The system requires time and dedication on the part of the couple to become comfortable with it. There are a number of such devices on the market. They may be covered by Medicare when the problem is related to blood flow and the device is prescribed by a doctor.
You insert the soft penis into the vacuum chamber tube connected to a pump by a piece of tubing. You then apply suction by using the small hand pump. Suction pulls blood into the penis, producing an erection. The blood is held in the penis by placing a tight band, similar to a rubber band, around the base of the erect penis. You should not keep the band in place longer than 30 minutes or fall asleep with it on.
Advantages of these devices include:
Surgery
Men who have defects of penile arteries or veins may choose surgery to correct the defects.
Invasive Mechanical Devices or Implants
These are mechanical devices actually placed inside the body.
Invasive devices are used only when:
Treatment involves inserting a mechanical device or prosthesis into the area where the blood normally collects to stiffen the penis.
Although the overall success rate of the penile prosthesis is greater than 95%, many doctors urge couples to consider simpler, less expensive choices before surgery.
The doctor will discuss the pros and cons of each type of device and help couples select the proper one for them. The implant has rods or cylinders that can be inflated or deflated at will. Most prostheses can be inserted during a one-day surgery and require no overnight hospital stay.
Semi-rigid or rigid implants:
Advantages of a semi-rigid or rigid implant are:
Disadvantages of a semi-rigid or rigid implant are:
Inflatable Implants:
Advantages of an inflatable implant are:
Disadvantages of an inflatable implant are:
You can contact:
American Foundation for Urologic Disease
1128 North Charles Street
Baltimore, MD 21201
Phone: 800-242-2383
Web sites: http://www.afud.org or
http://www.impotence.org
Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.
HIA File MEN4601F.HTM Release 9.0/2006
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