Causes of and Treatments for Erectile Dysfunction (ED)

Erectile Dysfunction (ED) can happen to men of all ages and represents the inability to achieve or maintain an erection sufficient for sexual intercourse. It is important to repeat that while most think of erectile dysfunction as “not being able to get it up,” that is only part of the problem. Many men also suffer from not being able to maintain a firm erection throughout intercourse. It is especially common after age 40, with Cleveland Clinic estimating that it affects up to 52% of men during their lives. It is so common that the American Urological Association estimates that 30 million men in the U.S. and 150 million men worldwide suffer from ED. But ED is not a normal part of aging. As a man, having this psychological or physiological condition can cause stress, relationship strain, and low self-confidence.

Today, thanks to widespread awareness about ED and the knowledge of available treatments, more and more men are comfortable with going to their doctors about problems with erectile dysfunction. There are several effective treatments for ED that are now widely available. Yet many men wait months or even years to bring it up to their doctors, and some never seek treatment at all. It may seem embarrassing, but your doctor will refer you to a urologist, or men’s health specialist, who can identify the underlying cause of erectile dysfunction.

How We Determine the Cause

Patients suffering from ED should first be evaluated for any underlying physical and psychological conditions. ED can occur because of problems at any stage of the erection process. For example, the penile arteries may be damaged and not open properly to allow blood through. While this can be a very personal problem, it may result from a more serious health concern, so seeing a doctor is essential.

• Cardiovascular disease – Heart conditions can influence your heart’s ability to pump blood to the rest of your body. If the genital area doesn’t get strong-enough blood flow, it becomes difficult to maintain an erection. Similarly, ED may also be predictive of heart disease. As such, seeing a urologist for a checkup is a good idea.
• High cholesterol is another potentially life-threatening systemic condition causing plaque build-up in the arteries. This can impede blood flow through the narrowed passageways and, in addition to raising blood pressure, reduce the amount of blood to the penis.
• Diabetes: Diabetes comes with a slew of complications, including nerve damage. When this happens, you may feel less sensation, thereby causing impotence. Similarly, diabetes complications such as changes in hormones and impaired blood flow can also cause ED.
• Obesity: When a man is overweight, his body may start to produce less testosterone and more estrogen instead. Your T-levels (testosterone levels) are vital to maintaining an erection for sexual intercourse. If your ED problem is caused by obesity, the good news is that it is reversible. Adopting a healthier lifestyle and losing weight can improve your condition.
• Depression – in addition to causing some people to lose interest in many formerly-pleasurable activities (like sex), depression can cause men to self-medicate with alcohol or smoking cigarettes, which can, in turn, increase their risk of ED. Those who get treated for depression with medication also may struggle with side effects, including ED.
• Damage from cancer or surgery
• Injuries
• Stress – Stress can lead to anxiety and depression. Stress over work or relationships can distract you and keep you from performing during sex. Moreover, low self-esteem and performance anxiety can become a self-fulfilling prophecy.
• Relationship problems
• Cycling or horseback riding can put the wrong kind of pressure on the testes. Spending a lot of time on a bicycle, motorcycle, or horse can cause ED.
• Drug use
• Alcohol use
• Smoking- Chemicals from cigarette and cigar smoke can affect your blood vessels, affecting your ability to achieve an erection. While an occasional alcoholic drink is okay, alcohol can cause dehydration, which can cause a decrease in blood volume – and this is imperative in performance.
• Periodontitis (gum disease) seems like a stretch, but gum disease causes chronic inflammation that can affect the entire body. A correlation between gum disease and ED has been shown in studies without clear causation, but it makes sense.
• Sleep apnea is a dangerous sleep disorder where breathing stops multiple times per night for more than a few seconds. This consistent reduction in oxygen supply to the body can reduce sexual desire and the ability to perform. You could be at risk if you are a snorer.

How Is Erectile Dysfunction Treated?

ED is a treatable condition, but the type of treatment generally depends on the underlying cause of ED, so finding the cause of dysfunction is an essential part of the process. Treatments for ED range from counseling and lifestyle changes to drugs and surgery. If you suffer from ED, it is important to talk to your urologist. We can help identify the cause of your ED and figure out the most appropriate treatment.

Since it can be embarrassing to discuss erectile dysfunction, many men look for treatment options online. However, not all treatments are safe. Home remedies might be dangerous, and you should not self-prescribe for ED. In addition, many of the treatments available on the Internet are scams. They may not help your ED and could damage your health.

Many traditional diagnostics, including blood pressure testing, listening to your heart, and taking blood and urine samples, may reveal the presence of other conditions, such as diabetes or heart disease, which could be the underlying cause of your ED.

One aspect of ED that deserves more attention is the psychological component. For this reason, your doctor may ask you questions about your mental health and speak with your partner about their experiences.

Several lifestyle choices can worsen ED. Being overweight or obese can leave you with a laundry list of health problems – among them, problems maintaining an erection. Your physician may be able to recommend an exercise program that’s suited to you. In addition to lowering the number on the scale, physical activity can also help reduce stress and get your blood flowing. And while you’re correcting your habits, retire the cigarettes and pick up a prescription to help you kick that habit to the curb.

Available Therapies for Erectile Dysfunction

You have various options to treat your ED depending on its severity and any underlying health conditions you may have. These options include the following:

Prescription Medications (Pills for Ed)

This is the most widely known ED treatment. These medications are often preferred because they simply require taking a pill. Some examples of oral medications for the treatment of ED include Viagra (sildenafil), Cialis (tadalafil), and Levitra (vardenafil). These medications enhance the effects of nitric oxide in your body and relax your penile muscles, allowing you to respond normally to sexual stimulation.

While oral medication helps, it does not create an instant erection without sexual stimulation. Every drug has side effects, and it’s best to ask your doctor about what you may experience while on the medication. Also, tell him about any other prescriptions or supplements you are taking. For example, people who take nitroglycerin pills for cardiovascular disease cannot also take phosphodiesterase-5 inhibitors as they drastically lower blood pressure.

If you’re not comfortable with the effects of ED oral medication, your doctor will likely recommend other treatment methods to find what you’re comfortable with.

Alprostadil Self-Injection

With the alprostadil injection (Edex or Caverject Impulse), a tiny needle is used to inject the medicine into the side or base of your penis. If needed, your doctor may recommend a combination of other medications such as papaverine and phentolamine. Each dosage creates an erection that lasts up to an hour. You may feel minor pain at the injection site. There can be side effects associated with this medicine that your doctor will discuss.

Alprostadil Urethral Suppository

The alprostadil intraurethral suppository (Muse) involves placing a tiny suppository inside your penis using an applicator. The medication should make its way into the urethra.

You should get an erection within 10 minutes of the application, and the erection will last at least a half-hour. If you are considering this method, potential side effects will be explained by your doctor.

Testosterone Replacement

Sometimes, the cause of ED is due to low levels of testosterone in the body. If this is the case, your urologist may recommend testosterone replacement therapy alone or combined with other treatment methods.

Penile Implant

For a more permanent solution that does not involve oral medication or injections, ask your doctor about your suitability for penile implant surgery. An inflatable or semirigid penile implant allows you to have spontaneous sexual activity without relying on medications. This is typically recommended when all other treatment methods have failed to work.

Ultimately, ED requires a comprehensive evaluation from a men’s health specialist like Dr. Natale. Give our office a call to schedule a consultation.