Erectile dysfunction: Treatments and causes

They know your medical history and can help you figure out whether what’s occurring is normal or needs treatment.

Failure to undo priapism will lead to permanent penile damage and untreatable ED. One or more cruciate corporotomy incisions correct curvature. Since impotence can be a forewarning symptom of progressive coronary disease, doctors should be more direct when questioning patients about their health. We evaluated 67 patients 18 to 60 years old (mean age 28. )Understanding the relationship between testosterone and ED has been impaired by a lack of standardized measurement of this hormone and the cyclic nature of its release and consumption. 6%) vs those without (4. Within the muscle, nitric oxide activates a guanylyl cyclase that raises intracellular concentrations of cyclic guanosine monophosphate (GMP). Erectile dysfunction is particularly common among men with cardiovascular disease and/or diabetes.

ED is defined as the persistent “inability to achieve or maintain an erection sufficient for satisfactory sexual performance.

Therefore, a thorough history (medical, sexual and psychosocial), physical examination and appropriate laboratory tests aimed at detecting these diseases should be performed. Taking certain medications can also increase your risk for ED. In case you missed it, luckily, your testosterone levels are easy to check using a simple blood test. What is erectile dysfunction (ED)? Priapism may also result from the use of erectile function promoting agents that have a long duration of action. These improve blood flow to the penis to – with sexual stimulation – help with getting and maintaining an erection. PDE5 inhibitors improve on normal erectile responses helping blood flow into the penis. A physical exam will be done.

All patients commenced sexual intercourse successfully. 14 per 18-mg/dL [1-mmol/L] increase; 95% CI, 1. Another question asks, "During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse? "The end result is difficulty with maintain a firm erection (losing an erection too quickly) that is now believe to be an early manifestation of atherosclerosis and vascular disease.

  • Prosthesis implanted in a straight penis.
  • Especially since these conditions present no outwardly detectable symptoms in their early stages.

International Journal of Impotence Research

Priapism is defined as an erection that lasts more than 4 hours beyond sexual stimulation or that is not related to sexual stimulation [44]. This form of primary PE is psychogenic (as opposed to organic or physical) impotence. An estimated 10. If you choose to seek help, give your doctor as much information as you can about your symptoms including their frequency and severity as well as the onset. Intracavernosal injection, or ICI, is best used when the cause of erectile dysfunction is neurological (result of brain damage). If men already had ED at the onset of the study, the risk for cardiovascular disease was 45% higher than those with no ED.

  • In all four cases, curvature was fully corrected, and prosthesis was successfully implanted and followed for 6–8 months.
  • During penile prosthesis implantation, a significant intraoperative bleeding (1 liter) due to large scrotal venous malformations and profuse bleeding from both corpora was recorded.

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Many men who do not respond to oral PDE5 inhibitors can be ‘rescued' with ICI. If so, ED might be added to the list of risk factors known to precede cardiovascular disease. For the first month, men should limit their physical activity. It is secreted in a diurnal manner with a peak in the morning.

In cases where implantation of a penile prosthesis is intended, venous leakage is not a concern, and immobilization by the erect implant also works against graft contraction. The contrast agent provides for enhanced information regarding blood supply and vascular anomalies. Factors associated with ED were identified using univariate statistics including the χ2 test for categorical variables and the 2-tailed t test for continuous variables. In patients where ED proves to be of organic nature, it is difficult to judge straightness of the penis considering failure to attain the fully erect state, even with intracorporal injection of vasoactive drugs.

Mechanical vacuum devices induce erections by creating a partial vacuum, which draws blood into the penis, engorging and expanding it. To approximate the geographical distribution of men across the country, physicians who lived within a 30-km radius of 11 metropolitan centers were selected according to a randomization scheme based on postal code. Additional history, as outlined in Table 3, should clarify the duration, progression and severity of the erectile dysfunction, as well as any associated factors. – One of the more invasive treatments for erectile dysfunction, surgical options also exist. And lean on an overall healthy lifestyle to shed pounds, if you carry extra pounds. 3 On arousal, parasympathetic activity triggers a series of events starting with the release of nitric oxide and ending with increased levels of the intracellular mediator cyclic guanosine monophosphate (cGMP). The prevalence and severity of ED increases with age in parallel with many conditions such as ischemic heart disease and diabetes.

  • Viagra does not directly cause penile erection, but affects the response to sexual stimulation.
  • 6, indicating that participants, on average, were slightly overweight.


This suggests that exercise may increase testosterone in addition to reducing body fat. An individual receiving treatment for ED must be psychologically sexually stimulated to induce a NO releasing response from NANC nerve terminals initiating the sGC cascade, resulting in an increase in cGMP levels. The doctor will ask about your symptoms and health past. After correction of curvature, artificial erection is needed to judge whether or not correction is adequate, and this cannot be performed considering the corporotomies that leak saline used to induce artificial erection. Behavioral modification, including smoking cessation, nutritional counseling, and optimization of over the counter and prescription drugs that may be promoting erectile dysfunction should be the first line of treatment. The change in the blood vessels is controlled by nerves.

Many advances have occurred in both diagnosis and treatment of erectile dysfunction. A similar analysis for those individuals without cardiovascular disease or diabetes demonstrated that higher levels of cardiovascular risk or fasting blood glucose remained independently associated with ED after adjustment for age, past or present depression, marital status, and education. In addition, men should not take these medications if they have a history of heart attack or stroke, or if they have a bleeding disorder or stomach ulcers. In most cases, the side effects are linked to PDE5 inhibitor effects on other tissues in the body, meaning they are working to increase blood flow to your penis and at the same time impacting other vascular tissues in your body. 04), impaired fasting glucose (OR, 1. Before you start a new exercise plan, you should always discuss it with your doctor.

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2 Age was the variable most strongly associated with ED. Erectile dysfunction (ED) itself can be seen in 16% of all men, with as many as 7-8% of men below age 30 being affected (2)! However, the finding that ED patients—but not PE—scored higher in trait anxiety compared to healthy controls has interesting implications. Contraceptives, this can help lower your risk of hardening of the arteries (atherosclerosis). Nitric oxide released from nonadrenergic-noncholinergic neurotransmission and the endothelium is the principal neurotransmitter for penile erection. If a patient isn’t responding to the medication or is experiencing side effects that don’t allow him to continue taking them, a primary provider might refer him to a specialist. Some erectile dysfunction might indicate a disease of the nervous system, and a neurologist should be consulted. Collaborators in the Canadian Study of Erectile Dysfunction* G. On the contrary, patients with PE are less likely to experience depression symptoms, a finding that further supports the neurobiological nature of the disorder possibly influenced by hereditary factors [44, 59].

What Causes Erectile Dysfunction?

Infection is the most common cause of penile implant failure and occurs less that 2 percent of the time. After excluding those taking sildenafil citrate (n = 312), ED was rated as mild among 9. This drug works best when taken on an empty stomach and many men can get an erection 30 to 60 minutes after taking the medication. Increased systolic flow and reverse diastole 25 min after injection of prostaglandin. Blood pressure medicines. Circulatory problems could be indicated by an aneurysm.

This severity assessment is also important when monitoring how effective – or ineffective – treatment is in addressing ED. However, ED does not improve prediction of CVD beyond the traditional risk factors included in the Framingham risk score [27]. Drug-induced impotence. Researchers are hoping to have the treatment administered via injection only once or twice a year.

Subject Collections

These include intracavernous injection therapy, vacuum constriction devices, intraurethral therapy, and possible surgery. The user manually adjusts the position of the penis and, therefore, the rods. According to the NIH, erectile dysfunction is also a symptom that accompanies many disorders and diseases. Attempts to treat ED date back well over 1,000 years.

  • In some cases of medication-induced erectile dysfunction, changes in medication may improve erections.
  • ” Still in its preliminary testing, gene therapy offers a treatment for erectile dysfunction that is quick, convenient, and has few side effects.

Physical Exam

The presence of either condition is independently associated with a 3- to 4-fold increase in coronary events. If it is determined that ED is a problem, the patient evaluation should include a detailed sexual and medical history and a physical exam. Particular attention should be given to the cardiovascular, neurologic and genitourinary systems, as these systems are directly involved with erectile function. Dose-adjustment is recommended in patients with hepatic failure and with co-administration of drugs also metabolized by the cytochrome p450 enzymes. This involves implanting a device, like an inflatable cylinder. A man who scores 22 to 25 has no signs of ED. In men with spinal cord injuries, the degree of erectile function depends largely on the nature, location and extent of the lesion. Only after insertion of the rods the curvature is revealed.

Despite the successful use of PDE-5 inhibitors, there is still a significant population of patients that remain refractory to this therapy.

Two semi-rigid but bendable rods are placed within the erection chambers of the penis, which allows manipulation into an erect or nonerect position. 19 Table 1 summaries the oral PDE5 drugs approved by the U. This may include questions about the time of day, how rigid the erection is, and how long it lasts. The devices have three components: But it's not a natural part of aging. Some evidence exists to suggest that chronic inflammation associated with metabolic syndrome also plays a role in endothelial dysfunction and erectile function, possibly due to oxidative stress. 17 The basic screen consists of serum testosterone and prolactin measurements.

What are the side effects? The muscles you can feel working during this process are the pelvic floor muscles, and they will be the focus of Kegel exercises. Some antidepressant medications cause erectile failure. The cost of intra-urethral suppositories is high with respect to the overall success and therefore should be used judiciously. The first is that people with diabetes "typically have poor vasculature. "Our results on state anxiety, indicating that all clinical groups (ED, PE, and AD) had significantly higher state anxiety compared to healthy controls, are in agreement with previous research findings. An initial trial dose of intra-urethral alprostadil should be administered under healthcare provider supervision due to the risk of fainting. Even after adjustment for age, the presence of ED was significantly associated with undiagnosed hyperglycemia (OR, 1. )

The cut is either above the penis where it joins the belly, or under the penis where it joins the scrotum.

Role Of Testosterone

Prospective results from the Massachusetts Male Aging Study also confirmed that increased coronary risk precedes the development of ED. Maybe you can get an erection, but you quickly find it doesn’t last long enough to complete sex or truly enjoy it. In young men, one study has shown a preference for Cialis over sildenafil. – Medications like sildenafil (Viagra®), tadalafil (Cialis®) and vardenafil (Levitra®) stimulate blood flow to the penis, enabling you to achieve an erection. Prostate disease and ED Prostate cancer does not cause ED. After excluding subjects who had prostate surgery (n = 28), the impact of cardiovascular disease or diabetes was greatest for those aged 40 to 49 years, among whom the probability of ED in the absence of cardiovascular disease or diabetes was 31%, with increases to 52% in the presence of cardiovascular disease alone, 57% in the presence of diabetes alone, and 73% when both conditions were present.

Clinical studies have suggested that these devices are effective and acceptable to a large number of patients with ED of varying causes, including psychogenic erectile failure. Recommended laboratory tests include urinalysis, complete blood count, and measurement of fasting blood glucose, creatinine, and in select instances augmented by laboratory evaluation of cholesterol and triglycerides, and testosterone. Human clinical trials have recently been performed using SAR407899, a Rho-kinase inhibitor four times more potent than fasudil, for the treatment of mild to moderate ED (Rhoket trials—Aventis). Go easy on alcohol, especially in excess, since that can also cause erectile dysfunction. Treatment involves addressing the underlying causes, lifestyle modifications, and addressing psychosocial issues. Drug status, 8811801Nielsen FH. Sexual dysfunction in the United States:

Difficulty or inability to achieve an erection. For the vast majority, such testing is unlikely to change management strategy. To evaluate the robustness of these results, all multivariate analyses were repeated comparing men with at least moderate ED (EF score, ≤21) and those without ED.

Erectile dysfunction (ED), also known as impotence, is a type of sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual activity.

Risk Factors

24 Head-to-head comparison suggested that tadalafil outperforms sildenafil on validated measures of erectile dysfunction, including the international index of erectile function and sexual encounter profile-2 and -3. Patients are hospitalized overnight for closed suction drainage, and sent home on seven days of post-operative antibiotics. The good news is that many healthcare providers and urologists are equipped to discuss and treat ED. Three types of implants are used to treat ED, including:

Primary premature ejaculation. Penile implants can also be used to treat patients who have a curved or bent penis, a condition known as Peyronie’s disease. The vascular processes that produce an erection are controlled by the nervous system and certain prescription medications may have the side effect of interfering with necessary nerve signals.

Symptom-based definitions are rapidly replacing the routine use of physiologic measures of erectile function such as penile tumescence. The second Princeton consensus on sexual dysfunction and cardiac risk: Erectile dysfunction is a common, age related and very treatable urologic condition that can have psychogenic, arterial, venous neurogenic and hormonal causes. Correction of curvature before implantation (in the same session) can help implanting the suitable length of prosthesis in a straight penis, without undue complexity and risk of infection. Causes of enlarged prostate, these effects include:. The primary reason for seeking out the advice of a qualified healthcare professional is because there are a variety of options available to treat ED.

Classification of Erectile Dysfunction

In addition to discussing any concerns related to sexual function, a clinician should also get your full medical history. Another option involves injecting a medication directly into the base of the penis before sex with a small needle – like that used for insulin injections. Although generally safe, including for men with heart disease, PDE5 inhibitors can cause side effects such as headaches and upset stomach. 5-9 However, diabetes is also a major risk factor for cardiovascular disease and may confound the association between cardiovascular disease and ED. Penile implants are most often placed under anesthesia. Not surprisingly, trait anxiety was found to be significantly higher among individuals with anxiety disorders compared to all three other groups. Erectile dysfunction wikipedia, , & Howell, R. 4 The way to combat these negative associations with sex is to change them to positive ones. Always speak with your health care provider before using a PDE5 inhibitor to learn how it might affect your health.

It is performed by placing a finger in the rectum and noting contraction of the anal sphincter and bulbocavernosus muscle when the glans penis is squeezed. Keywords, eDT in Hall C. Importantly, PDE5 inhibitors are contraindicated in those taking nitrate medication and also in men for whom sexual intercourse is inadvisable due to cardiovascular risk factors. Men with erectile dysfunction and their partners often lack a full understanding of sexual processes or have unrealistic expectations regarding sexual performance and satisfaction.

Another study compared the response of surgically and medically castrated rabbits to vardenafil with that of control rabbits. This would be non-arteritic anterior ischemic optic neuropathy (NAION). There are treatment options available to you. Personal information is not protected.

Article Info

The aim of this paper is to discuss 3 types of new pharmacotherapies that have surfaced in the last decade and may provide an alternative to current options for treatment of ED in the future. Virtually all men of all ages and with all types of erectile dysfunction can have successful intercourse with a vacuum constriction device. Sometimes, treating an underlying condition is enough to reverse erectile dysfunction. Cigarette smoking may induce vasoconstriction and penile venous leakage because of its contractile effect on the cavernous smooth muscle. Obesity and metabolic syndrome can cause changes in blood pressure, body composition and cholesterol, which may lead to ED.

The straightened corpora cavernosa are different in length from the presized cylinders, longer or shorter according to the technique used to correct curvature.

Beta-adrenergic blocking drugs may cause erectile dysfunction by potentiating alpha-1 adrenergic activity in the penis. If you are taking nitrates for your heart, you SHOULD NOT take any PDE5 inhibitors. The least favorable option then is to ignore the problem with the consequent compromised esthetics and functionality, with the exception of cases of mild curvature, where the shortening that occurs by the default implantation procedure may mask the curvature. There are two types of penile implants. Don’t wait to talk to your doctor about what you’re experiencing. The normal penile erection involves relaxation of cavernous arteries, filling of venous sinusoidal spaces within the corpora cavernosal bodies and constriction of the subtunical venous plexus system. Another study found that castrated rats had erections if given testosterone alone or dihydrotestosterone (DHT) and 5-alpha reductase inhibitors but not if given testosterone and 5-alpha reductase inhibitors.

However, there is little information regarding the prevalence of ED among patients seen in this clinical setting. Quick overview, this test showed that the mean O 2 saturation of corporal blood immediately after VED-induced erection was 79. Patients with a ventral curvature of 30° and above requested correction of curvature along with implantation. Non-invasive treatments are often tried first. After these men were given testosterone transdermally for 6 months, the number of NPTs increased, as did the maximum rigidity with sildenafil. Problems with the veins that drain the penis can also contribute to erectile dysfunction. It has been shown to work well in men of all ages, in men with diabetes, and in men who have had the surgical procedure called radical prostatectomy. Users also should be patient while relying on these devices, since they can diminish spontaneity of sexual intercourse.

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Diagnosis of Erectile Dysfunction

Erectile dysfunction (ED) is defined as the recurrent inability, of three months’ duration or longer, to attain or maintain an erection sufficient for satisfactory sexual performance. ED can occur because of problems at any stage of the erection process. The autonomic nervous system is involved in erection, orgasm, and tumescence. To do this, stop peeing midstream. The following are some of the different types and possible causes of erectile dysfunction: For all participants, the crude odds ratios (ORs) associated with the presence of cardiovascular disease or diabetes are presented in Table 2, along with ORs associated with each condition after adjustment for age. This tissue damage will reduce the use of other treatments, such as any oral medication or external vacuum constricting devices.

However, erectile dysfunction (ED) is only considered a concern if satisfactory sexual performance has been impossible on a number of occasions for some time.

Since ED can be a forewarning symptom of progressive coronary disease, doctors should be more direct when questioning patients about their health. 13; 95% CI, 2. Psychological impotence is where erection or penetration fails due to thoughts or feelings; this is somewhat less frequent, on the order of about 10% of cases.

One of the largest current studies of ED, the Massachusetts Male Aging Study, found that ED may be present in up to half of the male population between 40 and 70 years old [1]. Because arousal starts in the brain, psychological issues can be a significant contributing factor to erectile dysfunction. The accumulation of these intracellular messengers facilitates the release of Ca2+ from store and the opening of calcium channels on the cell membrane. Surgical implantation of a penile prosthesis represents the only well-accepted surgical therapy for the treatment of ED.

  • Most causes of erectile dysfunction were once considered to be psychogenic, but current evidence suggests that up to 80 percent of cases have an organic cause.
  • It is defined as the "persistent or recurrent inability to achieve and maintain a penile erection of sufficient rigidity to permit satisfactory sexual activity for at least 3 months."
  • One of the first steps is to distinguish between physiological and psychological ED.

What Are The Risk Factors For Erectile Dysfunction?

Hormones such as adrenocorticotropic hormone, oxytocin, prolactin, and androgens, especially testosterone, have been implicated in the modulation of erectile function [8]. Erectile dysfunction exercises Certain exercises can also help with ED. Many antidepressant pharmacotherapies report ED as a common side effect [8]. 45; 95% confidence interval [CI], 1.

High levels of stress can also affect a person by decreasing blood flow to the penis. In some cases, the infected implant must be replaced by a new implant. Defining erectile dysfunction, in a meta-analysis, these investigators examined serum Hcy levels in subjects with ED compared to controls in order to clarify the role of Hcy in the pathogenesis of ED. A variety of additional testing modalities to assess erectile function are available (e. )Penile biothesiometry This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis. People who use these need to understand that vacuum pumps may be difficult for some people to use and may cause penile trauma if used improperly.


Erectile ability is just one aspect of normal male sexual function. However, erection in response to visual sexual stimulation is preserved in men with hypogonadism, suggesting that androgen is not essential for erection. The success rate for getting an erection firm enough to have sex is as high as 85% with this treatment. Calcium channel antagonists and ACE inhibitors have fewer detrimental effects on sexual function than diuretics, centrally acting-agents and beta-blocking therapies [34]. RhoA is a small, monomeric G protein that activates Rho-kinase. Of note, the average number of life events involving economic problems and the average number of all other life events did not differ significantly among the four groups. One month later, the day after the first prosthesis training session, the patient returned with swelling in the penoscrotal region. In cases of complete erectile dysfunction, in which tissue damage or other physiological problems prevent other solutions (such as Viagra) from being effective, penile implants may be the method of choice.

Talk to your doctor if you have any side effect that bothers you.

Diagnosis of Male Pattern Baldness

There are two types of procedures that may be used: Because there is a triad relationship between depression, ED and cardiovascular disease, men with depression should be fully evaluated for medical illness as well as psychological factors. The value of routine endocrinologic testing remains controversial2,15–17 because the incidence of endocrinopathy presenting as erectile dysfunction is low. Once questions related to the specific erectile complaint have been reviewed, additional questions relating to medical history and psychosocial factors need to be evaluated. One patient was diabetic. An erection is then achieved by creating a vacuum inside the cylinder with a pump connected to the cylinder. Eligible participants included men 40 years or older who were visiting their physician on a scheduled visit for any medical problem. One study examined the role of testosterone supplementation in hypogonadal men with ED.

Responding to COVID-19

Any causal relationships between anxiety and sexual dysfunctions must be explored in prospective studies. Its mechanism of action is believed to be the promotion of intracellular accumulation of cyclic adenosine monophosphate, thereby causing decreased intracellular accumulation of calcium and resulting smooth muscle relaxation. Similarly, in men with a history of arterial trauma, surgical intervention can restore erectile dysfunction. Standardized, validated survey instruments such as the Sexual Health Inventory for Men (SHIM) are valuable to assess erectile dysfunction in affected individuals and track response to therapy (Figure 2). The combination of increased inflow and decreased outflow rapidly raises intracavernosal pressure resulting in progressive penile rigidity and full erection (Figure 2).

This finding has also been reported in other studies. However, ED is now well understood, and there are various treatments available. In addition, three more cases exhibited mild ventral curvature of less than 30°, and two cases exhibited lateral curvature of approximately 10°. Crossover trials have shown that men with ED prefer tadalafil to sildenafil by up to a 9 : Laumann EO, Paik A, Rosen RC.

Inflatable implants make a normal looking erection and are natural feeling for your partner.

Detailed biochemical and hormonal analyses, 12-lead electrocardiography and EST (Treadmill) were performed in all participants. How should I take ED medications? As the patient may have never experienced a rigid erection, he is unable to report on the possibly existing congenital penile curvature (without hypospadias), which afflicts approximately 4–10% of men [2]. You may be offered alternatives to the drugs you take.


Alprostadil (also known as prostaglandin E1 [PGE1]) is the prominent known smooth-muscle dilator of the corpus cavernosum. 1016/s0022-5347(05)67363-6. Two semi-rigid but bendable rods are placed within the erection chambers of the penis, which allows manipulation into an erect or non-erect position.