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Erectile Dysfunction

Erectile dysfunction (ED) is the inability to develop or maintain an erection of the penis sufficient for satisfactory sexual performance. An estimated 30 million American men suffer from ED. While the problem is more common in older men, it affects men of all ages. It is important to understand that erectile dysfunction is different from other sexual problems, such as loss of sexual desire (decreased libido) and problems with ejaculation and orgasm (e.g., delayed ejaculation and anorgasmia).

Although erectile dysfunction can have a negative impact on sex life, it is a treatable condition. The first step is to see a healthcare provider to find out what is causing the problem. There are many potential causes of ED, and they can be divided into two categories: physical and psychological. Physical causes of ED include:

  • Diseases of the blood vessels (vascular diseases), such as hardening of the arteries
  • Diseases of the nerves that control the blood flow to the penis (neurological diseases)
  • Hormonal problems
  • Injury to the penis, bladder, pelvis, or spinal cord
  • Medications
  • Peyronie’s disease (a condition of the penis in which it is bent or curved when erect)
  • Structural problems with the penis

Psychological causes of ED include:

  • Anxiety
  • Depression
  • Guilt
  • Low self-esteem
  • Relationship problems

Treatment of ED depends on the underlying cause. In some cases, such as with psychological causes, counseling may be effective. In other cases, medication or surgery may be necessary. Some of the common medications used to treat ED include:

  • Phosphodiesterase type 5 inhibitors. These are the most commonly prescribed medications for ED. They include sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). They work by inhibiting the enzyme phosphodiesterase type 5, which is involved in the breakdown of cGMP (a substance that relaxes smooth muscle).
  • Alprostadil. This is a synthetic version of prostaglandin E1, a substance that is naturally produced in the body. It is injected into the side of the penis. In some men, it produces an erection. It can also be used as a cream (alprostadil cream) that is applied to the penis.
  • Vacuum devices. These devices are effective in 60-80% of men. They are consists of a plastic cylinder, a pump, and a constriction ring. The cylinder is placed over the penis, and the pump is used to create a vacuum that pulls blood into the penis. The constriction ring is then placed at the base of the penis to maintain the erection. The vacuum device can be used with or without sildenafil (Viagra).
  • Penile implants. This is a surgical procedure that is used in men who are not candidates for other treatments. It is a permanent solution, but it has a high risk of complications. The implants can be either inflatable or semirigid.
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