Erektile Dysfunktion

Erectile dysfunction means not being able to get and keep an erection firm enough for sexual activity. It also is called impotence.

Having erection trouble from time to time isn’t always a cause for concern. But if erectile dysfunction is ongoing, it can cause stress, affect self-confidence and add to challenges with a partner. Problems getting or keeping an erection can be a sign of a health condition that needs treatment and a risk factor for heart disease.

If you’re worried about erectile dysfunction, talk to your healthcare professional, even if it’s awkward. Sometimes, treating an underlying condition can fix erectile dysfunction. Or you might need medicines or other direct treatments.

Having trouble getting an erection once in a while is common. Erectile dysfunction symptoms are ongoing and often get worse over time. They might include:

• Trouble getting an erection.
• Trouble keeping an erection.
• Wanting sex less.

When to see a doctor

Your main healthcare professional is a good place to start when you have erectile issues. See your healthcare professional if:

• You worry about your erections or you have other sexual problems, such as ejaculating sooner than you want. This is called premature ejaculation. Ejaculating later than you want is called delayed ejaculation.
• You have diabetes, heart disease or another health condition that might be linked to erectile dysfunction.
• You have other symptoms with erectile dysfunction.

Male sexual arousal is complex. It involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Also, stress and mental health concerns can cause erectile dysfunction or make it worse.

Sometimes the cause of erectile dysfunction is both physical and mental. For instance, a minor physical condition that slows your sexual response might cause worry about keeping an erection. The anxiety can add to erectile dysfunction.

Physical causes of erectile dysfunction

Common physical causes of erectile dysfunction include:

• Heart disease.
• Clogged blood vessels, also called atherosclerosis.
• High cholesterol.
• High blood pressure.
• Diabetes.
• Obesity.
• Metabolic syndrome, which involves higher blood pressure, high insulin levels, body fat around the waist and high cholesterol.
• Parkinson’s disease.
• Multiple sclerosis.
• Certain prescription medicines
• Tobacco use.
• Peyronie’s disease, which can cause pain during sex, a bent penis to bend, a penis that gets shorter with erection or a lump or bump in the penis.
• Overuse of alcohol and use of illicit drugs.
• Sleep conditions.
• Treatments for prostate cancer or enlarged prostate.
• Surgeries or injuries that affect the pelvic area or spinal cord.
• Low levels of the hormone testosterone.

Mental health causes of erectile dysfunction

The brain plays a key role in getting sexually excited, which starts an erection. Things that can get in the way of sexual feelings and cause or add to erectile dysfunction include:

• Depression, anxiety or other mental health conditions.
• Stress.
• Issues with a partner.

As you get older, erections might take longer to start and might not be as firm. You might need more direct touch to your penis to get and keep an erection. But erectile dysfunction is not a typical part of aging.

Risk factors that can add to erectile dysfunction include:

• Medical conditions. Diabetes or heart conditions are big risk factors.
• Tobacco use. This lowers blood flow to veins and arteries. Over time, tobacco use can cause ongoing health conditions that lead to erectile dysfunction.
• Being overweight. Being obese, especially, can lead to erectile dysfunction.
• Certain medical treatments. These include prostate surgery or radiation treatment for cancer.
• Injuries. This is especially true if injuries damage the nerves or arteries that control erections.
• Medicines. These include antidepressants, antihistamines, and medicines to treat high blood pressure, pain or prostate conditions.
• Mental health conditions. These include stress, anxiety and depression.
• Illicit drug and alcohol use. This is especially true for long-term drug use or heavy drinking.

Complications from erectile dysfunction can include:

• A poor sex life.
• Depression, stress or anxiety.
• Embarrassment or low self-esteem.
• Relationship issues.
• Not being able to get your partner pregnant.

The best way to prevent erectile dysfunction is to make healthy lifestyle choices and to manage any health conditions. For instance:

• Work with your healthcare professional to manage diabetes, heart disease or other ongoing health conditions.
• Get regular checkups and medical screening tests.
• Stop smoking, limit or don’t drink alcohol, and don’t use illicit drugs.
• Exercise regularly.
• Find ways to ease stress.
• Get help for anxiety, depression or other mental health issues.

Diagnosing erectile dysfunction involves having a physical exam and answering questions about your medical and sexual history. If you have ongoing health conditions that could be involved, you might need other tests. Or you might need to see a specialist.

Tests for underlying conditions might include:

• Physical exam. This might involve an exam of your penis and testicles and checking for nerve damage.
• Blood tests. A sample of your blood sent to a lab can check for signs of heart disease, diabetes, low testosterone levels and other health conditions.
• Urine tests, also called urinalysis. Like blood tests, urine tests can show signs of diabetes and other health conditions.

• Ultrasound. This test uses sound waves to look at the blood vessels that send blood to the penis. It involves using a wandlike device called a transducer held over the blood vessels. It makes a video image that can show if you have blood flow problems.

  Healthcare professionals sometimes do this test after putting a shot of medicine into the penis to stimulate blood flow and make an erection.

• Mental health exam. Your healthcare professional may ask questions to screen for depression and other mental issues that can cause erectile dysfunction.

Treatment for erectile dysfunction depends on the cause of your erectile dysfunction, how bad it is and whether you have underlying health conditions. You might have several treatment choices.

Your healthcare professional can tell you the pros and cons of each treatment. What you prefer matters. What your partner wants also might be part of your treatment choices.

Oral medicines

Medicines taken by mouth work for many people who have erectile dysfunction. They include:

• Sildenafil (Revatio, Viagra).
• Tadalafil (Adcirca, Cialis, others).
• Vardenafil.
• Avanafil (Stendra).

These medicines relax muscles in the penis. They increase blood flow in response to sexual stimulation. These pills alone don’t cause an erection. But they can make it easier for you to get an erection with sexual stimulation.

People who can get and keep erections without help don’t need erectile dysfunction medicines. These medicines won’t improve sex for them.

The medicines vary in dosage, how long they work and side effects. Possible side effects include flushing, stuffy nose, headache, vision changes, backache and stomach upset.

These medicines might not work right away. And they don’t work for everyone. They might work less well after prostate surgery and for people who have diabetes and other conditions. Work with your healthcare professional to find the right medicine and dosage for you.

Before taking any medicine for erectile dysfunction, get your healthcare professional’s OK. This includes supplements and herbal remedies you can get without a prescription.

Some erectile dysfunction medicines might cause you harm if you:

• Take nitrate drugs such as nitroglycerin (Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Monoket) and isosorbide dinitrate (Isordil, Bidil). These treat chest pain, called angina.
• Have heart disease or heart failure.
• Have very low blood pressure, called hypotension.

Other medicines

Other medicines for erectile dysfunction include:

• Self-injection therapy. You use a fine needle to put alprostadil (Caverject, Edex) into the base or side of your penis. The dose of each shot is for an erection lasting no longer than an hour.

  These shots may have one or two other medicines in them as well (BiMix,Tri-Mix). Side effects can include mild bleeding from the shot site and an erection that lasts too long, called priapism. Rarely, fibrous tissue may form where you give yourself the shot.

  A member of your healthcare team shows you how to give yourself the shot. Because you use a very fine needle, pain from the shot most often is minor.

• Intraurethral medicine. This involves placing medicine inside your penis into the tube that carries urine from the body, called the urethra. You use a special applicator to put the medicine into the tip of your penis. The medicine increases blood flow to cause an erection.

  The erection most often starts within 10 minutes and lasts between 30 and 60 minutes. Side effects can include a burning feeling in the penis and minor bleeding in the urethra.

• Testosterone replacement. For those who have low levels of the hormone testosterone, testosterone replacement might help with erectile dysfunction. More commonly, you might use this with other treatments for erectile dysfunction.

Penis pumps, surgery and implants

If medicines don’t work for you or aren’t right for you, your healthcare professional might suggest other treatment. Other treatments include:

• Penis pumps. A penis pump, also called a vacuum erection device, is a plastic tube that fits over the penis. A hand or battery-powered pump attaches to the tube. The pump sucks air out of the tube. This makes a vacuum that pulls blood into your penis.

  Once you get an erection, you put a rubber tension ring around the base of your penis. This holds in the blood and helps you keep the erection. You then remove the vacuum device.

  The erection most often lasts long enough to have sex. You remove the tension ring after sex. Your penis may bruise, and the band might weaken ejaculation. Your penis might feel cold to the touch.

  If a penis pump works well for you, your healthcare professional might suggest or prescribe a certain model. That way you can be sure it’s right for you and made by a company you can trust.

• Penile implants. This treatment involves surgery to place an implant into the penis. You can inflate some of these devices, which lets you control when and how long you have an erection. A semirigid rod keeps your penis firm. But you can bend it away from the body for sex and toward the body when you don’t want it to show.

  Healthcare professionals don’t often suggest penile implants until you’ve tried other erectile dysfunction treatments first. People who have tried other therapies without success tend to be happy with their implants.

  As with any surgery, there’s a risk of complications, such as infection. Your healthcare professional might delay surgery if you have a urinary tract or other type of infection.

Beratung

Maybe stress, anxiety or depression causes your erectile dysfunction or the condition makes stress and issues with your partner. Then your healthcare professional may suggest that you, or you and your partner, see a counselor.

For many people, lifestyle choices cause erectile dysfunction or make it worse. Here are some tips that might help:

• If you smoke, quit. If you have trouble quitting, get help. Try nicotine replacement, such as over-the-counter gum or lozenges. Or ask your healthcare professional about a prescription medicine that can help you quit.
• Lose excess weight. Being overweight can cause erectile dysfunction or make it worse.
• Be more physically active. Exercise can help with underlying conditions that play a part in erectile dysfunction by easing stress, helping you lose weight and increasing blood flow.
• Get treatment for alcohol or drug overuse. Drinking too much or taking certain illicit drugs can make erectile dysfunction worse. And overuse can cause long-term health problems that make erectile dysfunction worse.
• Work through issues with your partner. Think about couples counseling for help working through problems with your partner.

Before using any supplement, check with your healthcare professional to make sure it’s safe for you, especially if you have ongoing health conditions. Some alternative products that claim to work for erectile dysfunction can cause harm.

The Food and Drug Administration has issued warnings about some types of “herbal viagra” because they may have harmful ingredients not listed on the package. You might not know the dosages. Or they might have been tainted while being made.

Some of these supplements can interact with prescription medicines and cause very low blood pressure. These products are a special danger for anyone who takes nitrates.

No matter what causes erectile dysfunction, it can be a source of stress for you and your partner. Here are some steps you can take:

• Don’t assume the issue will last. It’s common to have erection problems sometimes. Thinking you’ll have it again or that it’s a sign of something wrong with you can cause stress. Stress can make erectile dysfunction worse.
• Involve your sexual partner. Your partner might think not being able to have an erection is a sign that you have less desire for sex. Assure your partner that this isn’t true. Talk openly about your condition. Treatment can work better for you when you involve your partner.
• Don’t ignore stress, anxiety or other mental health concerns. Talk to your healthcare professional or a mental health professional to deal with these issues.

You’re likely to start by seeing your main healthcare professional. Your healthcare professional may send you to a specialist. This could be a doctor who specializes in male genital problems, called a urologist, or a doctor who specializes in the hormonal systems, called an endocrinologist.

Here’s some information to help you get ready for your appointment.

What you can do

Take your partner with you, if you can. Your partner can help inform your healthcare professional and remember the information you get.

Make a list of:

• Your symptoms, including any that may not seem linked to erectile dysfunction, and when they began.
• Key personal information, including any major stresses or recent life changes.
• All medicines, vitamins, herbal remedies and supplements you take, including dosages.
• Questions to ask your healthcare team.

For erectile dysfunction, some questions to ask include:

• What’s the most likely cause of my erection troubles?
• What are other possible causes?
• What tests do I need?
• Is my erectile dysfunction most likely to go away or to last?
• What are the treatments and which do you suggest?
• Are there any brochures or other printed material that I can have? What websites do you suggest?

Be sure to ask all the questions you have.

What to expect from your doctor

Your healthcare professional is likely to ask questions, such as:

• What other health concerns or ongoing conditions do you have?
• Do your erectile problems happen sometimes, often or all the time?
• Do you want sex less than you used to?
• Do you get erections during masturbation, with a partner or while you sleep?
• Does your partner have sexual problems?
• Are you anxious, depressed or under stress?
• Do you drink alcohol? If so, how much?
• Do you use illicit drugs?
• What seems to help with your erectile dysfunction?
• What seems to make your erectile dysfunction worse?