Erectile dysfunction (ED), sometimes referred to as impotence, is the inability of a man to achieve or maintain an erection hard enough for sexual intercourse. Millions of men in the U.S. have erectile dysfunction. It may be caused by diseases, complications from surgery, side effects of certain medications, lifestyle factors, and psychological factors.
Erectile dysfunction can be treated at any age. Treatment depends on your overall health and the underlying cause of the problem. If erectile dysfunction is a problem for you, talk to your doctor. Significant strides have been made in the last decade for treating erectile dysfunction. There are a number of therapies to choose from today. Your doctor can help you choose the best and safest one.
How Is Erectile Dysfunction Treated?
In some cases, simple lifestyle changes, such as losing weight, drinking less alcohol, or quitting smoking, may improve erectile dysfunction.
If the erectile dysfunction is caused by a certain medication, your doctor may suggest reducing the dose or trying an alternative drug. Certain blood pressure medications, allergy drugs, antidepressants, sedatives, appetite suppressants, and an ulcer drug called cimetidine may make it hard for a man to get a firm erection.
Most men with erectile dysfunction, however, will need further treatment. Treatment options for erectile dysfunction include:
- Psychotherapy (counseling)
- Medications (drug therapy)
- Vacuum devices (pumps)
Psychotherapy for Erectile Dysfunction
Talk therapy may be the initial treatment option for men with anxiety or stress-related erectile dysfunction. Relationship difficulties, work problems, financial woes, and other, everyday stressors can trigger erectile dysfunction. Talking about worries and stressors to a licensed therapist can ease sexual anxiety and provide strategies to boost intimacy. Usually only three to four sessions are needed. Including your partner in therapy can also be helpful.
Medications for Erectile Dysfunction
Men have different options in the types of drugs for ED. Medicines can be taken orally, inserted into the urethra, or injected into the penis.
The first medications usually prescribed to men with erectile dysfunction are called phosphodiesterase (PDE) type 5 inhibitors. These include:
- sildenafil (Viagra)
- tadalafil (Cialis)
- vardenafil hydrochloride (Levitra, Staxyn)
- avanafil (Stendra)
Medications for Erectile Dysfunction continued…
They are generally taken by mouth anywhere from 15 minutes to one hour before having sex — depending on the drug — and should not be used more than once a day. One medication, Cialis, may be taken up to 36 hours before sexual activity. Staxyn dissolves in the mouth, but the other medications are swallowed.
PDE-5 inhibitors relax smooth muscles in the penis, which increases blood flow to the area, helping the penis become erect during sexual activity. About 80% of men who take PDE-5 inhibitors have firmer and longer-lasting erections. However, if your erection lasts more than four hours, seek emergency medical help.
Side effects of PDE-5 inhibitors are usually mild but may include headache, stuffy nose, flushing, muscle aches, and rarely, a temporary blue-green shading of your vision.
You should not take PDE-5 inhibitors if you take nitrate drugs, such as nitroglycerin tablets for heart disease. Doing so can cause a dangerous drop in blood pressure. Men taking alpha-blockers for prostate problems or blood pressure should also be cautioned. Always make sure your doctor knows about all the medications you are taking, including over-the-counter drugs, herbs, and supplements.
Injections and Suppositories for Erectile Dysfunction
If the medications taken by mouth do not improve erection quality, or you cannot safely take such medications, your doctor may recommend a drug called alprostadil. It helps boost blood flow to the penis, automatically triggering an erection within minutes.
Alprostadil may be given in two ways:
Intracavernous drug injection. The medication is injected into the side of the penis. It involves sticking a needle directly into the penis, and it raises your risk for dangerously prolonged erections (called priaprism) and scarring.
Intraurethral suppositories. Pellets containing alprostadil are placed into the urethra at the tip of the penis. Such treatment is called MUSE (which means medicated urethral system for erections). This therapy may be less successful than injections
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Vacuum Devices for Erectile Dysfunction
A vacuum device improves firmness by increasing blood flow to the penis. About 80% of men who use the device correctly obtain an erection hard enough for sexual intercourse.
Vacuum erection devices (VED), also called vacuum constriction devices (VCD), are made of three parts:
- A clear, plastic tube (cylinder) that slides over the penis.
- A manual or battery-operated pump that sucks air out of the cylinder, sending more blood to the penis.
- An elastic ring that is placed around the base of the penis after an erection is obtained. The rubber band-like ring helps maintain firmness by preventing blood from leaking out of the penis. The ring comes in different sizes for an individual fit.
A vacuum device can be cumbersome and interfere with a man’s ability for sexual spontaneity. The elastic ring may lead to skin irritation, bruising, loss of feeling or sensitivity, or pain.
Vacuum devices are available with or without a prescription. Talk to your doctor before buying or using a vacuum device purchased without a prescription.
Surgery for Erectile Dysfunction
If all other treatments for erectile dysfunction have failed, your doctor may recommend surgery. Surgery is usually only done if you have severe erectile dysfunction and no response from nonsurgical treatments.
Erectile dysfunction surgery falls into two categories:
- Placement of an implant (prosthesis) in the penis.
- Vascular reconstruction surgery to improve blood flow to or reduce blood leakage from the penis and surrounding structures.
Implants, or prostheses, help restore firmness for many men with erectile dysfunction. There are two types of implants: malleable and inflatable.
- Malleable implants are a pair of adjustable rods placed inside the penis. You manually move your penis, and therefore rods, into a position suitable for intercourse. Such implants do not affect penis size.
- Inflatable implants are a pair of tubes placed in the penis connected to a squeezable pump inside the scrotum. You squeeze the pump to get an erection. Inflatable implants can also help slightly increase length and width.
Once you have a penile implant, you must always use it to get an erection. Implants may cause infection in some men. Men who have a urinary tract infection, skin infection, or systemic (body-wide) infection should not get a penile implant. Other problems with implants may include auto-inflation, mechanical breakdown of the device, and shifting of the pump.
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Vascular reconstruction surgery may be done to:
- Repair blood vessel blockages to improve blood flow to the penis.
- Block veins to prevent blood from leaking out of the penis and surrounding tissues.
Blood vessel repair is best done in younger men who have a subtle blockage due to an injury. This type of surgery usually is not successful in older men, who tend to have more widespread blood flow blockages.
Vein blockage, called ligation, is the opposite of penile blood vessel repair. A vein is intentionally blocked to reduce blood loss from the penis and surrounding tissues. Blood loss from the penis can lead to a decrease in firmness. This procedure is rarely used, however, because its long-term effectiveness is unclear.
Future Treatments for Erectile Dysfunction
Advances in erectile dysfunction treatment are being made every day. Gene therapy for erectile dysfunction is being widely studied and could provide a longer-lasting treatment for men with erectile dysfunction.
Scientists are also researching whether a substance made from spider venom could lead to the development of new drugs for erectile dysfunction. Certain poisonous spider bites can trigger priapism, which is a dangerously prolonged erection.
Not Recommended for Erectile Dysfunction
These therapies are not recommended for the treatment of ED:
Testosterone. Testosterone is a male hormone, or androgen. It is not recommended as a treatment for erectile dysfunction when blood tests reveal the man has a normal testosterone level.
Trazodone. Trazodone is an antidepressant. Some studies report slightly better sexual function in men who took the drug. But follow-up trials yield conflicting or unconvincing results. Current guidelines do not recommend trazodone for the treatment of erectile dysfunction.
Yohimbine. Yohimbine is obtained from the bark of certain evergreen trees. It is not recommended for the treatment of erectile dysfunction. Well-conducted studies have not been done to determine how well it improves sexual function in men.
Supplements for Erectile Dysfunction
Various over-the-counter products have been promoted as all-natural ways to enhance a man’s sexual performance or promote erections. Yet clinical evidence suggesting that herbs and supplements effectively treat erectile dysfunction is lacking. Herbal therapies, including yohimbine bark and L-arginine, are not recommended as a treatment for erectile dysfunction, according to the most recent treatment guidelines by the American Urological Association.
The FDA warns that some products may contain unlisted and harmful substances or the active ingredient in some prescription medications. Some of the so-called over-the-counter dietary supplements for ED have been found to contain sildenafil (the active ingredient in Viagra) or a substance similar to that prescription or another called vardenafil (the active ingredient in Levitra and Staxyn). These FDA-approved prescriptions can be dangerous for patients who take nitrates to treat chest pain or heart disease.
In recent years, the FDA has seized many over-the-counter products for male sexual dysfunction because they contained dangerous or undeclared ingredients.
The FDA says you should AVOID the following products: