Erectile Dysfunction

Erectile dysfunction, also known as ED, is a common condition in which a man is unable to achieve and sustain an erection.

What is Erectile Dysfunction?

ED is defined as trouble getting or keeping an erection. ED is also damage to the erectile tissue. Although it isn’t rare for men to have problems with erections from time to time, ED that comes on slowly or happens regularly with sex is not normal and should be treated.

How common is Erectile Dysfunction?

ED is the most common sexual problem men report to their doctor. As many as 1 in 2 men over the age of 50 will have some degree of ED.

What causes ED?

A urologist will find the cause(s) of your ED and will help to treat the problem. It can result from health problems, emotional issues, or from both.Some known risk factors for ED are:

• Injury to the pelvis
• Surgery for cancers of the prostate, colon, rectum or bladder
• Heart disease
• Peripheral artery disease (narrowed arteries slowing blood flow)
• High blood pressure
• High blood sugar (diabetes)
• Alcohol use
• Drug use
• Smoking or vaping
• Some medication
• Emotional stress from depression, anxiety, or relationship problems.

Even though ED becomes more common as men age, growing old does not always cause ED. Some men are sexually functional into their 80s.

Physical causes of ED include:

Factors that affect vessels or nerves and restrict blood flow to the penis.

• The penis cannot trap blood during an erection.
• Certain diseases, spinal cord injury or radiation or surgery in the pelvic area can harm and prevent nerves from the brain reaching the penis.
• Cancer treatments near the pelvis (such as surgery and/or radiation for prostate, colorectal or bladder cancer) can affect how the penis functions.
• Drugs used to treat other health problems may negatively impact erections.

Emotional causes of ED include:

• Anxiety
• Depression
• Relationship conflicts
• Stress at home or work
• Stress from social, cultural, or religious conflicts
• Worry about sexual performance.

What are the symptoms of ED?

Symptoms of ED may include:

• Getting an erection, but it not lasting long
• Getting a partial erection that is not firm enough
• Not being able to get an erection at all

When ED causes problems, a urologist can help.

Treatment for ED

If ED is causing you problems, a urologist can offer treatment that will fix or improve it, support your circulatory health and help improve the quality of your life.

Lifestyle changes

Treatment for ED starts with taking care of your overall health. Your doctor will highlight risk factors that can be changed or improved, such as diet, exercise, quitting smoking, and getting more sleep.

Your doctor may also adjust any prescribed medication you are taking (never stop or change prescription medication without talking to your doctor first).

Emotional care

Your doctor might suggest seeking treatment for your emotional wellbeing. This may include a referral to a counselor or therapist.

Medication

Your doctor will usually offer medication treatment first, which often works well. Always ask about possible side effects.

Oral drugs known as PDE type-5 inhibitors increase penile blood flow to create a strong erection. About 70% of men respond well to these drugs. PDE type-5 inhibitors include Viagra® (sildenafil citrate), Levitra® (vardenafil HCl), Cialis® (tadalafil), and Stendra® (avanafil).

Vacuum Erection Device

A vacuum erection device is a plastic tube that slips over the penis, making a seal with your skin. A pump at the other end of the tube makes a low-pressure vacuum around the erectile tissue which results in an erection. Around 75% of men can get a working erection using a vacuum erection device.

Dietary Supplements

The effectiveness of dietary or herbal supplements isn’t clear. Always talk to your doctor before you take any supplements to self-treat ED.

Testosterone Therapy

If low levels of testosterone are found in the blood, testosterone therapy may be combined with ED drugs (PDE-5 inhibitors) to help with erections.

Intracavernosal (ICI) and Intraurethral (IU) Therapies

If oral medications aren’t effective, a drug called Alprostadil can be taken which is given as an injection in the penis (intracavernosal injection or ICI) or through a medicated pellet placed in the urethra (called intraurethral or IU therapy).

Surgical treatment

If other treatments have not been effective, surgery can be performed which involves a penile implant or prosthesis , and offers a permanent solution to ED. They don’t affect sensation and have a very high success and satisfaction rate. There are two types of penile implants:

Semi-rigid implant (bendable)

Made from two bendable silicone and metal rods, they provide the firmness needed for intercourse and can be bent down for urination.

Inflatable Implant

Fluid-filled cylinders are placed in the penis which are joined to a pump in the scrotum (between the testicles). When pumped, the cylinders inflate and make the penis stiff.