Erectile dysfunction is the inability to achieve or maintain an erection that is sufficiently rigid for sexual intercourse. Sexual drive and the ability to have an orgasm are not necessarily affected. Because all men have erection problems from time to time, doctors diagnose erectile dysfunction if a man fails to maintain an erection satisfactory for intercourse on at least 25% of attempts. Worldwide, erectile dysfunction occurs in close to 20% of men.
Erectile dysfunction is not new in either medicine or human experience, but it is often not easily or openly discussed. Cultural expectations of male sexuality inhibit many men from seeking help for a disorder that can usually benefit from medical treatment.
Causes of Erectile Dysfunction
In the past, erectile dysfunction was considered to be a psychological issue about 90 percent of the time. But as physicians learned more about erectile dysfunction — and as effective treatments were developed — today, only about 10 percent of cases are considered to have psychological causes.
The major cause of erectile dysfunction is restricted blood flow to the penis because of narrowed blood vessels. In fact, because the vessels in the penis are very small compared to other parts of the body, problems with erectile dysfunction can be a warning sign that other vessels, such as those leading to the heart, may eventually be affected. Diabetes, which also can affect the blood vessels, also is linked to erectile dysfunction.
Medications, such as treatment for high blood pressure, can also play a role. These drugs reduce blood pressure by reducing blood flow, which can affect erections. It is not recommended that men stop their blood pressure medications, of course. But some patients can eliminate their need for the treatment through changes in diet and exercise.
A small percentage of erectile dysfunction cases are related to surgery for prostate cancer. After the operation to remove the prostate, 15 percent to 60 percent of men can have erectile dysfunction, even when newer “nerve sparing” surgery is performed. Often, this side effect is temporary, and improvement can be seen up to one year after surgery.
Erectile Dysfunction Treatment
Not all men with erectile dysfunction want to be treated - it is a personal decision. For those who do, there are many options. The best-known treatment is medication. Viagra®, Levitra® and Cialis® all increase blood flow to the penis.
These drugs work in response to sexual stimulation and must be taken at least half an hour to two hours before sexual activity. Drawbacks include a loss of spontaneity and cost. In addition, high-fat meals can delay the onset of action.
Other non-surgical options include:
- A vacuum erection device
- Urethral suppositories
- Penile injections
The vacuum device is placed over the penis and draws blood into the sponge-like chambers of tissue that make up a majority of the penis. While effective, this option is dependent on body build and can be painful.
With urethral suppositories, a small medicated pellet, about the size of a grain of rice, is inserted into the urine passage. While fast and relatively easy, it is only about 30 percent to 65 percent effective. Known as MUSE (medicated urethral system for erection), this option takes five to 20 minutes to achieve an erection and is often used in men who take blood thinners and who cannot use the self-injection option.
With self-injection, a medication is injected directly into the penis to increase blood flow. It is very effective (about 75 percent to 85 percent) and works whether the nerve that controls erections is intact or not. It can be more costly than oral therapies and results in scarring in 5 percent to 30 percent of users (depending on the drug used). To ensure proper dosing, the first dose is generally administered in the doctor’s office.
A penile implant is often recommended for men who have tried other treatments without success. This device, on the market for 30 years, basically gives men an erection at their discretion but does not affect the ability to ejaculate or feel orgasm.
During an outpatient procedure, the device is implanted entirely in the body and is not visible. The device consists of two cylinders that replace the spongelike tissue in the penis, a pump and a reservoir that is placed in the abdomen.
To initiate an erection, the patient squeezes the pump (located in scrotum) to release fluid into the penis. When the erection is no longer needed, squeezing the pump returns the fluid to the reservoir. In addition to this model, there is a non-fluid device that consists of a pair of cylinders with metal coils that can be bent. Disadvantages of the prosthetic devices include that implantation requires a surgical procedure that is not reversible.