A Visual Guide to Erectile Dysfunction

These are among the most challenging patients seen in urology practice today: Cardiovascular diseases and erectile dysfunction are closely related because both disease states involve impaired vascular endothelial function and decrease bioavailability of NO. Continue learning about erectile dysfunction causes, however, there has been a noted rise in men under 40 experiencing ED which has been largely unexplained. In other instances, the topic can be brought up in a nonthreatening way during the standard review of systems by asking questions such as, “Are you currently sexually active? Yuan JQ, Mao C, Yang ZY et al: If one medication doesn't work, another may do the trick.

This makes the evaluation and treatment of these men more challenging since additional diagnostic testing is often not indicated after a thorough history and physical examination.

More information may be found here. The NO pathway is of critical importance in the physiologic induction of erections. Serefoglu EC, McMahon CG, Waldinger MD et al: Erectile dysfunction and risk of cardiovascular disease: It also plays a key role in sexual dysfunction (eg, low libido, poor erection quality, ejaculatory or orgasmic dysfunction, reduced spontaneous erections, or reduced sexual activity). This can result from depression, anxiety, brain diseases such as stroke, and low testosterone (the male sex hormone).

The most urgent recommendation for this patient is that he seek appropriate psychiatric treatment to help in management of his psychiatric conditions and suicidal ideation. Ask the pharmacist, organic ED involves abnormalities the penile arteries, veins, or both and is the most common cause of ED, especially in older men. Barrou B, Cuzin B, Malavaud B et al: About half of men between the ages of 40 and 70 have ED. While this may in inconsequential under normal conditions, it may be enough to cause insufficient blood flow to the penis when sexually aroused.

The plastic container is then taken off the penis and the penis remains erect until the rubber band is removed (which must be removed within 30 minutes).

When to see your GP

The cylinder can then be removed and the patient can engage in intercourse with the constriction band at the base of the penis maintaining the erection. Efficacy of apomorphine and sildenafil in men with nonarteriogenic erectile dysfunction. 25 This class of drugs is also contraindicated in patients who use nitroglycerin or nitrate-containing compounds. Additional reporting by Laura Geggel. The risk factors for cancer of the penis may include the following: Many of these men will see multiple urologists on their quest to find a pathophysiology that they can accept, and many have unrealistic expectations of a rapid cure or a surgical cure. They are calcium-dependent, they require calmodulin and reduced nicotinamide adenine dinucleotide phosphate for catalytic activity, and they are competitively inhibited by arginine derivatives.

All of these medicines work by relaxing smooth muscles and increasing blood flow in the penis during sexual stimulation. Asian J Androl 2020; 19: Impotence itself is often related to an underlying problem, such as heart disease, diabetes, liver disease, or other medical conditions. The remainder of his history is negative. Cui YS, Li N, Zong HT et al:

  • Men who are not circumcised at birth have a higher risk of getting cancer of the penis.
  • These devices are safe and can restore a man’s ability to achieve penetrative intercourse, with one study suggesting nearly 95% success with adequate instruction and support.
  • The test checks for blood flow in the penis.

Classification of Erectile Dysfunction

The recognition that certain disease states and injury pertaining to the innervation, vascular supply, or structural integrity of the penis commonly result in erectile dysfunction has resulted in the identification of functional components required for penile erection. Intrapsychic component, blood and urine tests can also help providers figure out what’s going on. The action of these drugs are based upon intact NO releasing neural fibers (nNOS) and corporal endothelium (eNOS). Signs and symptoms, reffelmann, T, Kloner, RA. Turk S, Karalezli G, Tonbul HZ et al:

J Urol 2020; 177: Corpus cavernosometry Cavernosography measurement of the vascular pressure in the corpus cavernosum. Venoseal venous leak constriction loop, for many men, erectile dysfunction is caused or worsened by lifestyle choices. Cairoli C, Reyes LA, Henneges C et al: Potters L, Torre T, Fearn PA et al: Kriston L, Harms A and Berner MM: Am J Psychiatry 2020; 158:


Another surgical procedure, called preputioplasty, involves separating the foreskin from the glans. If you need to pay the full prescription cost, a single injection of alprostadil costs around $8 to $22, depending on the dose. Recovery of erectile function after nerve sparing radical prostatectomy and penile rehabilitation with nightly intraurethral alprostadil versus sildenafil citrate. He feels that this might be related to “over masturbation without lubricant” 1–3 times per day and reports that he is “addicted to masturbation”, using it as a coping mechanism to manage his PTSD. He reports normal libido, penile sensation, orgasm, and ejaculation. Can sexual side effects from cocaine be reversed? Safety and efficacy of vardenafil in patients with erectile dysfunction:

If so, did these difficulties occur with the onset of the erectile dysfunction or are they separate issues? It was recently shown that low-dose atorvastatin (Lipitor) normalizes the diabetic response to sildenafil in STZ-treated diabetic rats suggesting an inhibitory role of statins upon the RhoA/Rho-kinase pathway [93]. Jarow JP, Burnett AL and Geringer AM: Bending or arcing of the penis during an erection. References, this involves talking to your partner, and making sure they understand that you have anxiety and it's affected your libido. In animal models nitrite has been shown to mediate pulmonary vasodilation and prevent ischemia-reperfusion injury in the brain, liver, and heart [98–100]. Once you have either implant, you must use the device to get an erection. Drug-induced ED.

The benefit of the former is a more natural appearance in the deflated state, closely approximating the appearance of a flaccid penis.

Psychological Assessment

Goldstein I, Lue TF, Padma-Nathan H et al: 5 cm long with a range of 3. Psychogenic erections are initiated centrally in response to auditory, visual, olfactory or imaginary stimuli.

Effect of sildenafil in patients with erectile dysfunction taking antihypertensive therapy. What makes some penis pumps better than others? These devices also go by the name vacuum pump can be used for healing impairment of ED and enlarge your penis. However, the ideal exercise plan (in terms of conditions such as frequency and intensity) wasn’t identified. If a medicine you need for another health condition is causing ED, your doctor may suggest a different dose or different medicine.

When treating these patients, neurologists should consider the sexual equilibrium between patients and their partners and the sexual pathophysiology of the spinal cord injury deficit, he added. 11 replies, low blood pressure. ED is defined as the persistent “inability to achieve or maintain an erection sufficient for satisfactory sexual performance. A systematic review of the psychosocial outcomes associated with erectile dysfunction:


Surgery is not routinely indicated for the first-line treatment of erectile dysfunction. Talk with your doctor about whether surgery is right for you. These include drugs for high blood pressure, depression, heart disease and prostate cancer. Efficacy and safety of on demand tadalafil in the treatment of East and Southeast Asian men with erectile dysfunction: The combination of alpha-blockers and ED medicines also could cause a sudden drop in blood pressure. This tissue contains thousands of large caverns that fill with blood when the man is sexually aroused. Efficacy, safety, and use of sildenafil in urologic practice. The study also concluded that sexual dysfunction is an important public health concern and that emotional issues are likely to contribute to the experience sexual dysfunction.

El-Sakka AI, Anis T, Khadr N et al: Oral ED medications have changed the way clinicians discontinue medications in patients with ED and has improved the approach. Fugl-Meyer KS, Stothard D, Belger M et al: Impaired blood flow to the penis. What are the psychological causes of erectile dysfunction? ” If you or your partner notice a persistent change in your erections that affects your sexual intimacy, you may have erectile dysfunction—even if you’re still able to get an erection. However, one cause of a lack of testosterone that is worth highlighting is a previous head injury.