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Erectile Dysfunction

Overview

Erectile dysfunction is a man’s consistent inability to get or maintain an erection. This condition is not considered normal and is different from other problems that interfere with sexual intercourse, such as lack of sexual desire and problems with ejaculation and orgasm. Frequent erectile dysfunction can cause emotional and relationship problems and often leads to diminished self-esteem. Erectile dysfunction has many causes, most of which are treatable, and is not an inevitable consequence of aging.

Approximately 5 percent of 40-year-old men, and between 15 percent and 25 percent of 65-year-old men, experience erectile dysfunction on a long-term basis. A much more common problem that affects the majority of men at some point in their life is the occasional failure to achieve an erection, which can occur for a variety of reasons, such as from drinking too much alcohol or from being extremely tired.

Education/General Information

Failure to achieve an erection less than 20 percent of the time is not unusual, and treatment is rarely needed. Failure to achieve an erection more than 50 percent of the time, however, generally indicates that there is a problem requiring treatment.

Erectile dysfunction can occur at any age, and a number of factors may contribute to the problem. The cause of erectile dysfunction may be either physical or psychological, or a combination of the two. Physical causes include vascular problems, neurological problems, problems with the structure of the penis, hormonal problems or medical conditions such as diabetes, high blood pressure, high cholesterol, atherosclerosis, multiple sclerosis, stroke and Parkinson’s disease. Physical factors that can be controlled include alcohol consumption, smoking and drug use.

Medications being taken for other conditions may also be a factor. Injury to the penis or pelvic region, injury to the spinal cord and pelvic surgery can also result in erectile dysfunction. Psychological causes of erectile dysfunction include anxiety, depression, stress, grief or relationship issues.

Symptoms of erectile dysfunction include inability to have an erection at any time, inability to maintain a firm erection or inability to maintain an erection long enough to complete intercourse.

Diagnosis

If you suspect you may have erectile dysfunction, see your doctor. He or she can perform a variety of tests to identify what is causing your problem. For most patients, the diagnosis will require a simple medical history, physical examination and a few routine blood tests. Most patients do not require extensive testing before beginning treatment. The choice of testing and treatment depends on the goals of the individual. If erection returns with simple treatment such as oral medication and the patient is satisfied, no further diagnosis and treatment are necessary. If the initial treatment response is inadequate or the patient is not satisfied, then further steps may be taken. In general, as more invasive treatment options are chosen, testing may be more complex.

Treatment

Treatment for erectile dysfunction depends on the cause of the problem. If the problem is due to psychological issues, counseling is usually appropriate. Oftentimes, counseling is coupled with medication. Medication may be used to treat erectile dysfunction caused by vascular, hormonal, neurological or psychological problems.

Several prescription drugs are prescribed to treat this condition. They work by relaxing the blood vessels that supply blood to the penis. Research has shown that nearly 70 percent of men with erectile dysfunction improve with the use of prescription drugs. Other medications to treat erectile dysfunction are injected medications such as Caverject, Pavabid and Regitine; intra-urethral alprostadil; Yohimbine; and hormonal therapy.

In rare cases, surgery may be an option for treating erectile dysfunction. Penile implants and penile blood vessel surgery are two surgical options. Penile implants replace the penis tissue that fills with blood during an erection. The implants cause an erection when pumped with a solution that is stored in the lower abdomen. With penile blood vessel surgery, a portion of another blood vessel is used to bypass the artery that sends blood to the penis.

Other treatment options for erectile dysfunction are vacuum devices and external penile splints. Vacuum devices are plastic tubes that fit around the penis. The air can be pumped out of the tube, producing an erection. A band is then placed at the bottom of the penis to keep the erection, and the tube is removed. External penile splints provide mechanical support and work by holding up the penis.

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