All About Erectile Dysfunction

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It’s a classic tale: Getting ready to wrap up a visit with a male patient, the provider asks if there any other questions. The patient pauses, breathes deeply, and says, “Well, there is this one other thing…”

It’s an issue that affects as many as 30 million men in the US, but few are comfortable discussing erectile dysfunction, otherwise known as impotence or ED. And while the inability to get and keep an erection firm enough for sex might seem like a problem limited to the bedroom, ED can have serious implications in other areas of life as well. Although occasional impotence isn’t always a sign for concern, ongoing issues can cause stress, affect self-confidence, and contribute to relationship problems. Chronic ED can even be a sign of a serious underlying health condition.

ED doesn’t affect just older men, either. In fact, it’s a lot more common in younger men than previously thought. One study suggests that ED affects about 26 percent of men under 40. But age does seem to be a contributing factor. Almost half of men over the age of 75 experience ED, but it’s not an inevitable part of getting older, and it’s treatable at any age.

What causes ED?

There’s a long list of contributing factors that may result in ED. Many are physical and include:

  • Disease—the most common cause in older men—such as diabetes, high blood pressure, nerve disease, nerve damage, multiple sclerosis, Parkinson disease, atherosclerosis, and heart disease
  • Injury
  • Any disorder that affects the nerves or impairs blood flow in the penis
  • Medications including antidepressants and beta blockers
  • Sleep disorders
  • Treatments for prostate cancer or enlarged prostate
  • Surgeries or injuries that affect the pelvic area or spinal cord
  • Hormonal imbalances

In men under 40, psychogenic issues are more likely to cause ED. These include:

At any age, the following lifestyle factors can contribute significantly to ED:

  • Smoking
  • Alcoholism or substance abuse
  • Being overweight
  • Sedentary lifestyle

How is ED diagnosed?

Generally, it’s not necessary to perform extensive tests in order to diagnose ED. There are some blood and urine tests that can be ordered, but your provider may base his or her diagnosis on a review of your medical history, risks, and lifestyle factors. In rare instances, a provider may perform an ultrasound to check blood flow or order an overnight erection test that involves wrapping a device around the penis and measuring the number and strength of overnight erections.

What are the treatments?

ED can be addressed at any age, and there are a number of medical and nonmedical treatment options. Medications always carry a risk of side effects, so it’s important to work with a health care provider to understand your risks before starting any medical treatment, including:

  • Oral medications like Sildenafil (Viagra, Revatio), Tadalafil (Cialis, Adcirca), Vardenafil (Levitra, Staxyn), and Avanafil (Stendra) enhance the effect of nitric oxide in the body in order to relax the muscles in the penis and increase blood flow. They won’t automatically cause an erection; sexual stimulation is necessary to release the nitric oxide from penile nerves.
  • Alpostadil self-injection produces an erection that lasts about half an hour.
  • Alpostadil urethral suppository involves placing a suppository inside penis in the penile urethra using a special applicator, causing an erection that usually starts within 10 minutes and lasts between 3 to 60 minutes.
  • Testosterone replacement—if the ED is caused by low levels of testosterone, replacement is the recommended first step, and can be accomplished through topical gels, creams, patches, underarm applications, or injections.
  • Penis pumps—legitimate medical pumps (not those advertised on TV) pull blood into the penis and use a tension ring around the base of the penis to keep the blood there. Erections usually last long enough for sex.
  • Penile implants involve surgically placing an inflatable device into both sides of the penis, and is only recommended after trying other methods.
  • Psychological counseling can help address underlying mental issues.
  • Blood vessel surgery—although it is a rare cause of ED, leaking or obstructed blood vessels can be repaired with surgery.

Medical treatments aren’t the only solution for ED; there are plenty of lifestyle modifications and alternative methods that can make a big difference, including:

  • If you’re a smoker, quit now.
  • Maintain a healthy weight.
  • Exercise daily.
  • Get enough adequate sleep.
  • Try Kegel exercises to strengthen the pelvic muscles; they’re not just for women. And stick with it: exercises must be done consistently for several months in order to get a benefit.
  • Seek help for alcohol or drug problems.
  • Consider relationship counseling for existing problems.
  • Talk to your provider about nutritional supplements including amino acid arginine, bioflavonoids, zinc, vitamin C, vitamin E, and flaxseed meal, which have been used to improve erectile function.
  • Herbal remedies like Asian ginseng, Yohimbe bark, and Ginkgo biloba may also help, but it’s important consult with a provider before taking to ensure they’re safe, as supplements are not regulated by the FDA.
  • Acupuncture has also been shown to help.

Remember, occasional impotence is more common than many men realize, but chronic ED can be a sign of something serious. Talk to your provider about your symptoms and any treatment option you may be considering.

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The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, the San Francisco Bay Area, Seattle, and Washington, DC.

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