Erection Problems: Many Causes

Erectile dysfunction (ED) is the continued inability to get or maintain an erection that is firm enough for a man to have intercourse. You may be unable to get an erection at all, or you may lose the erection during intercourse. Erection problems are common in adult men and almost all men experience temporary difficulty getting or maintaining an erection. For others it is an ongoing problem. If you have difficulty having or keeping an erection more than 25% of the time, it is considered a problem. An erection requires the interaction of your brain, nerves, hormones, and blood vessels. Anything that interferes with the normal
process can result in erectile dysfunction.

Common causes include:

• Diseases and conditions such as diabetes, high blood pressure, heart or thyroid conditions, poor circulation, low testosterone, depression, spinal cord injury, penile nerve damage (for example, from prostate surgery), or neurological disorders (such as multiple sclerosis or Parkinson's disease)

• Certain medicines such as blood pressure medicines (especially beta-blockers) and antidepressants

Sometimes lifestyle changes can improve erectile function. These are:

• Elimination of alcohol, tobacco and illegal drugs

• Increased rest and time to relax

• Exercise and a healthy diet

• Open communication between both partners in a sexual relationship

• Counseling by a professional

Physical causes are more common in older men, while psychological causes are more common in younger men. Call your doctor if you have difficulty having or keeping an erection more than 25% of the time or if you have noticed a change in your ability to obtain an erection after starting a new medicine. Your doctor will take a complete medical history, perform a physical examination, and order tests. These tests may include:

• Urine analysis

• Blood tests, chemical tests (including Prostate Specific Antigen-PSA) and tests to determine the level of sexual hormones in the body

• Penile ultrasound (to evaluate for blood vessel or blood flow problems)

• Night-time penile monitoring using a medical device to see if

you are having adequate erections during sleep. (This helps to
determine if your problem with erections is psychological or
physical)

• Neurological testing

• Psychological testing of behaviors

The treatment depends on the cause. For example, if you have a hormonal imbalance, your doctor will prescribe medicine to treat the underlying cause. If your doctor notes a deficiency of male hormone, testosterone replacement therapy can be prescribed with one of the following:

• a skin patch

• gel containing testosterone

• periodic injection of testosterone

There are many other treatment options also available. These include medicines taken by mouth, injections into the penis, vacuum devices, and penile implant surgery.

Viagra, Levitra, and Cialis are three medicines prescribed for erectile dysfunction caused by either physical or psychological problems. (See Additional Information below).

If pills do not work, other options are available, such as Alprostadil (FDA approved in 1995) that is injected into the penis or inserted as pellets into the urethra. For some patients, doctors may recommend a vacuum pump which draws blood into the penis to create an erection.

If other methods do not work, a penile implant (prosthesis) is considered. It is surgically implanted and works well on demand. In about 10 percent of the cases, a patient may have a minor or major complication requiring corrective surgery, treatment for infection, and in some cases, removal of the device. If the implant has to be permanently removed, the ability to have natural erections is completely lost.