Erectile Dysfunction (commonly called impotence) can be a cause of stress, poor self-confidence, relationship problems, and an unsatisfactory sex life for men. It is an embarrassing topic to discuss. Many men who are experiencing trouble with erections wonder – Do I have erectile dysfunction? or – Am I impotent? Symptoms of erectile dysfunction may include:
- Trouble getting an erection
- Trouble keeping an erection
- Reduced sexual desire
It’s important to remember that occasional trouble getting or keeping an erection, as well as reduced sexual desire, may not be a cause for concern. If the problem is ongoing, however, it can indicate underlying health conditions that may require treatment. A medical assessment is recommended if a consistent inability to experience satisfactory erections is causing stress and anxiety, low self-esteem, embarrassment, or relationship problems.
It’s a good idea to seek medical attention from a family doctor or urologist if you are unable to get satisfactory erections or are experiencing other problems related to sexual activity, such as delayed or premature ejaculation. Erectile dysfunction may be linked to other health conditions, such as heart disease, prostate cancer, or diabetes, that should be investigated and treated. The presence of other symptoms along with ED should prompt a doctor’s visit.
What Causes Erectile Dysfunction?
A number of different factors can cause erectile dysfunction. The erection process is a complex one, and dysfunction can occur if there is a problem in any of the processes necessary to obtain a firm, sustained erection. One of the primary causes of impotence is the presence of an underlying medical condition. The inability to achieve or maintain an erection is not directly age-related. Certain physical medical conditions, medications or psychological factors can lead to ED.
Physical causes of erectile dysfunction:
- Heart conditions such as atherosclerosis (blocked blood vessels), high cholesterol, and high blood pressure
- Metabolic syndrome — a combination of high blood pressure, high cholesterol, high insulin levels, and belly fat
- Neurological conditions such as multiple sclerosis or Parkinson’s disease
- Peyronie’s disease (curved penis due to scar tissue formation)
- Over-the-counter and prescription drugs (for example, some blood pressure medications, antidepressants, and muscle relaxants)
- Hormonal imbalance such as low testosterone
- Sleep disorders (for example, sleep apnea syndrome)
- Alcoholism, tobacco use, and other types of substance abuse
- Injuries or surgeries to the spinal cord or pelvic area
- Enlarged prostate or prostate cancer treatments
Psychological causes of erectile dysfunction:
- Anxiety, depression, stress, or other mental-health problems
Relationship troubles due to poor communication or other reasons
Erectile Dysfunction Diagnosis
To make a diagnosis of erectile dysfunction, clinicians obtain a history from the patient. A physical examination of the penis and testicles may be performed to test nerve sensation. In many instances, this is all that is needed for the doctor to make treatment recommendations. However, in some cases the doctor may order one or more laboratory tests. These tests help the physician pinpoint the underlying cause of the problem and the level of severity. The results of these tests can guide the doctor in prescribing appropriate treatment for erectile dysfunction.
General Health Tests
Complete blood count: A complete blood count (CBC) measures the quantity of red and white blood cells in the patient’s blood sample. It is performed to confirm or rule out anemia (insufficient red blood cells) which can mimic the symptoms of erectile dysfunction.
Urinalysis: A urine sample is analyzed for the presence and amount of protein, sugar, and hormones to rule out or confirm certain underlying medical problems, such as diabetes, low testosterone, and kidney dysfunction, which can lead to ED.
Thyroid Function Tests: These tests measure the level of thyroid hormones in the body. Thyroid hormones regulate metabolism and the production of sex hormones. Deficiency of these hormones may cause ED.
Liver and Kidney Function Tests: These tests assess for liver and kidney disease which can cause hormonal imbalance and ED.
Erectile Tissue Evaluation
Duplex Ultrasound: This test evaluates blood flow, including detection of venous leaks, scar tissue formation, or signs of vessel blockage.
Rigidity: Your doctor may use a device called a snap gauge, Digital Inflection Rigidometer, or Rigiscan, to measure the maximum rigidity achieved by the penis during an erection. A Rigiscan is a portable device used to measure nocturnal erections, via a pair of pressure loops attached at the base and the tip of the penis. Differences in daytime and nighttime readings may reveal underlying psychological causes. This test also provides information about the overall severity of ED symptoms.
Penile Nerve Function: Your doctor may perform a bulbocavernosus reflex test and penile biothesiometry test to evaluate for nerve damage. This test assesses nerve function in the penis and whether signals are being sent and received as needed to obtain a healthy erection.
Nocturnal Penile Tumescence: Two tests, snap gauge and strain gauge, are used to measure changes in penile circumference and rigidity during nocturnal erections. The snap gauge consists of three plastic bands of varying strength that are wrapped around the penis to assess function based on which of the bands break after erection.
Penile Biothesiometry: Electromagnetic vibrations are used to assess nerve function and sensitivity of the penile shaft and glands.
Vasoactive Injection: Certain solutions cause blood vessels to dilate and cause an erection when injected into the penis. This test is used to measure penile pressure.
Erectile Dysfunction Treatments
Once a diagnosis of erectile dysfunction has been made, it’s important to get the right treatment for any underlying health conditions that could be causing or worsening the ED. A number of treatment options are available, each with associated risks and benefits. Treatment choices depend on the underlying cause of erectile dysfunction, as well as your and your partner’s preferences.
Oral Medications: Drugs such as sildenafil (Viagra), vardenafil (Staxyn, Levitra), tadalafil (Cialis, Adcirca) and avanafil (Stendra) act by enhancing nitric oxide, the chemical that relaxes penile muscles and allows blood to flow into the organ. To obtain an erection with one of these medications, you still need sexual stimulation. The drugs simply amplify the amount of nitric oxide released in response to stimulation. The medications are not aphrodisiacs and do not cause sexual excitement. They may cause a number of side effects, such as flushing, headache, backache, visual changes, and stomach upset. It’s important to discuss drug interactions with your physician. Some medications, such as nitrates which are prescribed for chest pain, can be dangerous when taken in combination with oral ED drugs. These medications are also contraindicated in men with low blood pressure, heart disease, or heart failure.
Self-injection: A fine needle is used to inject a drug called alprostadil (brand names Edex, Caverject Impulse) at the base or side of the penis. The medication may be available in combinations with others, including phentolamine and papaverine. Pain from the injection is minor because the needle is very fine. The erection typically lasts an hour. Potential side effects can include priapism (prolonged erection), mild bleeding, and scar tissue formation (rare) at the injection site.
Urethral Suppository: The urethral suppository form of alprostadil is available under the brand name Muse. A special applicator is provided to place the suppository inside the urethra at the tip of the penis. Onset of erection is in about 10 minutes, and it lasts up to one hour. Side effects may include urethral bleeding and scar-tissue formation.
Testosterone Replacement: If laboratory tests reveal low levels of testosterone hormone as an underlying cause of reduced sexual desire, replacement therapy may be recommended alone or in combination with other treatments.
Penis Pump: A vacuum erection device is either a manual or battery-powered device attached to an acrylic cylinder. When placed over the penis, it draws air out of the cylinder, creates a vacuum, and pulls blood flow into the penis. A tension ring is then placed at the base of the penis to sustain the erection after removing the vacuum cylinder. The erection can last as long as sexual intercourse is desired. Removal of the ring releases the tension. Side effects can include restricted ejaculation and a sensation of a cold penis. Most side effects are manageable, and proper use of a vacuum erection device produces full penile engorgement for over 90% of men who use it. Learn more on our Guide to Penis Pumps.
Penile Implant: Bendable or inflatable rods are placed surgically inside the penis to allow the man to control the duration of the erection. This is not the first line of treatment for erectile dysfunction. However, penile implants work well in men who have failed conservative therapies. The placement of the implant is associated with surgical risks such as infection.
Penile Revascularization: This arterial bypass surgery is like a heart bypass. It is performed when a blocked artery is not allowing proper blood flow to the penis. The clogged artery is bypassed to restore flow. The surgery may be recommended to men with a history of trauma or evidence of penile artery lesions on arteriography.
Psychotherapy: If the underlying cause of erectile dysfunction is emotional issues, psychotherapy consisting of individual or couples counseling can help address factors such as performance anxiety, self-consciousness, stress, depression, and reduced libido.
Change in Lifestyle: Healthy lifestyle choices can help with not only ED but also other existing health problems. Men with ED should work with their clinician to address any underlying chronic medical conditions, such as heart disease and diabetes. Regular health examinations and screening tests can prevent ED from developing.
How to prevent Erectile Dysfunction
There are a number of ways to prevent erectile dysfunction or keep it from worsening. Healthy lifestyle choices can go a long way in preventing ED:
- Treatment of underlying medical conditions, such as heart disease and diabetes. These conditions are potential causes of erectile dysfunction and keeping them under control can prevent this condition from developing.
- Regular medical checkups and screening tests can detect health problems before they become chronic and lead to other problems, such as erectile dysfunction.
- A regular exercise routine helps prevent chronic medical conditions such as diabetes, obesity, high blood pressure, and high cholesterol, which are all potential causes of ED. Exercise can also help strengthen the muscles of the pelvic floor to sustain blood flow to the penis and maintain strong erections.
- A healthy diet can prevent and reverse obesity, high blood sugar, and high cholesterol. Good nutrition aids vascular health and keeps blood vessels healthy, thereby reducing the risk of erectile dysfunction. Studies have shown that men who eat fresh vegetables, fruits, and whole grains and avoid processed foods and red meat are at a lower risk of ED. Foods such as dark chocolate are rich in flavonoids, which are compounds that increase nitric oxide concentration in the blood, and can improve blood flow to the penis. Nuts like pistachios have also been shown to help men with ED.
- Men who are dependent on alcohol are at a higher risk of suffering from erectile dysfunction. Avoiding alcohol and drugs can improve sexual function.
- A number of psychological factors, such as stress and anxiety, can lead to erectile dysfunction. Obtaining professional help for mental-health conditions can address the underlying cause of the condition.
Augusta Medical System – SomaTherapy Products
Somatherapy products from Augusta Medical Systems are vacuum therapy devices that help men achieve a natural, sustainable erection without medications or surgery. These devices mimic the natural erection process by pulling blood into the penis. A simple 3-step process produces a strong, sustained erection with the help of a manual or electric pumping mechanism. The devices are available with multiple cylinder sizes to ensure comfort and a good fit of the vacuum chamber. More than 90 percent of clients experience relief of erectile dysfunction symptoms regardless of the underlying cause. This natural treatment means no man has to live with erectile dysfunction.