Erectile dysfunction
Erectile dysfunction, or ED, is the most common sex problem that men report to their doctor. It affects as many as 30 million men.
Symptoms
Erectile dysfunction symptoms might include persistent:
Trouble getting an erection
Trouble keeping an erection
Reduced sexual desire
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Causes
Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Likewise, stress and mental health concerns can cause or worsen erectile dysfunction.
Sometimes a combination of physical and psychological issues causes erectile dysfunction. For instance, a minor physical condition that slows your sexual response might cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen erectile dysfunction.
Physical causes of erectile dysfunction
In many cases, erectile dysfunction is caused by something physical. Common causes include:
Heart disease
Clogged blood vessels (atherosclerosis)
High cholesterol
High blood pressure
Diabetes
Obesity
Certain prescription medications
Tobacco use
Alcoholism and other forms of substance abuse
Sleep disorders
Psychological causes of erectile dysfunction
The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:
Depression, anxiety or other mental health conditions
Stress
Relationship problems due to stress, poor communication or other concerns
Complications can include:
An unsatisfactory sex life
Stress or anxiety
Embarrassment or low self-esteem
Relationship problems
Diagnosis
Medical consultation including history taking and physical exam may be sufficient for the diagnosis of erectile dysfunction, establishing possible causes, and recommend a treatment. In many cases you might need further tests
Treatment
Depending on the cause and severity of your erectile dysfunction and any underlying health conditions, you might have various treatment options. Your doctor can explain the risks and benefits of each treatment and will consider your preferences.
Oral medications
Oral medications are a successful erectile dysfunction treatment for many men. They include:
Sildenafil (Viagra)
Tadalafil (Adcirca, Cialis)
Vardenafil (Levitra, Staxyn)
Avanafil (Stendra)
All four medications enhance the effects of nitric oxide — a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow and allows you to get an erection in response to sexual stimulation.
The medications vary in dosage, how long they work and side effects. Possible side effects include flushing, nasal congestion, headache, visual changes, backache and stomach upset. They can have serious
Interactions with other medications, especially Nitrates, a medication
Prescribed for heart disease and angina.
Your particular situation will determine which medication might work best. These medications might not treat your erectile dysfunction immediately. You might need to work with your doctor to find the right medication and dosage for you.
Before taking any medication for erectile dysfunction, including over-the-counter supplements and herbal remedies, get your doctor’s OK.
Other medications for erectile dysfunction include:
Alprostadil urethral suppository. Alprostadil (Muse) intraurethral therapy involves placing a tiny alprostadil suppository inside your penis in the penile urethra. You use a special applicator to insert the suppository into your penile urethra. The erection usually starts within 10 minutes and, when effective, lasts between 30 and 60 minutes. Side effects can include a burning feeling in the penis, minor bleeding in the urethra and formation of fibrous tissue inside your penis.
Testosterone replacement.
Some people have erectile dysfunction that might be complicated by low levels of the hormone testosterone. In this case, testosterone replacement therapy might be recommended
Pumps
If a penis pump is a good treatment choice for you, your doctor might recommend or prescribe a specific model. That way, you can be sure it suits your needs and that it’s made by a reputable manufacturer.
Penile implants.
This treatment involves surgically placing devices into both sides of the penis. These implants consist of either inflatable or malleable (bendable) rods. Inflatable devices allow you to control when and how long you have an erection. The malleable rods keep your penis firm but bendable.
Penile implants are usually not recommended until other methods have been tried first. Implants have a high degree of satisfaction among those who have tried and failed more-conservative therapies. As with any surgery, there’s a risk of complications, such as infection. Penile implant surgery is not recommended if you currently have a urinary tract infection.
Exercise
Recent studies have found that exercise, especially moderate to vigorous aerobic activity, can improve erectile dysfunction.
Even less strenuous, regular exercise might reduce the risk of erectile dysfunction. Increasing your level of activity might also further reduce your risk.
Psychological counseling
If your erectile dysfunction is caused by stress, anxiety or depression — or the condition is creating stress and relationship tension — your doctor might suggest that you, or you and your partner, visit a psychologist or counselor.
Alternative medicine
Before using any supplement, check with your doctor to make sure it’s safe for you — especially if you have chronic health conditions. Some alternative products that claim to work for erectile dysfunction can be dangerous.
The Food and Drug Administration (FDA) has issued warnings about several types of “herbal viagra” because they contain potentially harmful drugs not listed on the label. The dosages might also be unknown, or they might have been contaminated during formulation.
Some of these drugs can interact with prescription drugs and cause dangerously low blood pressure. These products are especially dangerous for anyone who takes nitrates.
Coping and support
Whether the cause is physical, psychological or a combination of both, erectile dysfunction can become a source of mental and emotional stress for you and your partner. Here are some steps you can take:
Don’t assume you have a long-term problem. Don’t view occasional erection problems as a reflection on your health or masculinity, and don’t automatically expect to have erection trouble again during your next sexual encounter. This can cause anxiety, which might make erectile dysfunction worse.
Involve your sexual partner. Your partner might see your inability to have an erection as a sign of diminished sexual interest. Your reassurance that this isn’t the case can help. Communicate openly and honestly about your condition. Treatment can be more successful for you when you involve your partner.
Don’t ignore stress, anxiety or other mental health concerns. Talk to your doctor or consult a mental health provider to address these issues.
Before your appointment
Ask what you need to do ahead of time. When you make the appointment, be sure to ask if there’s anything you need to do in advance.Write down any symptoms you’ve had, including any that might seem unrelated to erectile dysfunction.
Write down key personal information, including any major stresses or recent life changes.
Make a list of all medications, vitamins, herbal remedies and supplements you take.
Write down questions to ask your doctor.
For erectile dysfunction, some basic questions to ask your doctor include:
What’s the most likely cause of my erection problems?
What are other possible causes?
What kinds of tests do I need?
Is my erectile dysfunction most likely temporary or chronic?
What’s the best treatment?
How can I best manage other health conditions with my erectile dysfunction?
Should I see a specialist? What will that cost, and will the visit be covered by my insurance?
If medication is prescribed, is there a generic alternative?
In addition to your prepared questions, don’t hesitate to ask additional questions.
