What is Erectile Dysfunction (ED)?

Erectile Dysfunction is the inability to obtain or sustain an erection suitable for satisfying sex. This can be a very alarming to a man and very psychologically disturbing. Many men feel embarrassed or alone in this struggle however it is extremely common. About half of middle aged men struggle with this to some degree.

What are some causes of ED?

Obtaining and sustaining an erection is actually a very complicated process involving many systems. A difficulty in any part can cause problems. This is a limited discussion of some of the more common causes. Often no one specific cause is to blame but a combination of many.

Anatomic: In some rare circumstances trauma or other causes could lead to damage to the penile arteries. In these instances there may be some surgical options to reroute blood flow to restore erections.

Psychological: Stress and anxiety have a strong effect on erections. Often this can be relational, personal or actually medical. Unfortunately the more one worries about the ability to perform the more stress involved and this can lead to a self-fulfilling prophecy.

Hormonal: Although not always a primary cause, change in testosterone levels can affect erections. Decreased libido and energy can lead to psychological stress and decreased sexual health and anxiety. Additionally there can be some direct effect on erection.

Medications:  Not only do the diseases above lead to ED but often the medications used to treat these have side effects increasing erectile dysfunction.

Physiological:

• Vascular disease: There has been much recent evidence that ED can be an early warning sign of heart and vascular disease. The arteries to the penis are smaller than in the heart and can show earlier signs of disease manifesting in ED.
• Diabetes: This leads not only to early vascular disease but also causes nerve damage. Therefore not only are the signals for erections decreased but once arrived, the vessels are less able to respond. Many studies show that more medication is needed to treat ED in diabetics for these reasons.
• Hypertension (high blood pressure): High pressures in the vascular system also leads to vascular disease leading to decreased elasticity and blood flow. This also can contribute to ED
• High Cholesterol: Cholesterol levels correlate with vascular disease which as noted above will decrease erectile ability.

What are some treatments of ED?

Evaluation

Although most ED in men can be linked to chronic medical issues it is always important to see if there are any other correctable causes of erectile dysfunction

Medications

The mainstay of treatment are medications call PDE5 inhibitors.  The first of these was Viagra and made ED a recognizable term.  Because of the good effect, tolerability and convenience most men will start with a trial.  There are some side effects and contraindications to these medications but most men do well and are candidates to try.

Intermediate Options

There are several options if you are not a candidate for or failed medications.  Penile injections can be done at home to deliver a local dose of medication to directly cause an erection and can give reliable natural feeling erections.  Urethral suppositories are another way of giving a local dose of medication to the penis.  A vacuum erection device is another good option which had no medication and therefore no interactions and when used appropriately can provide good satisfaction.

Surgical Options

An implanted inflatable penile prosthesis has been a good option for many decades now.  With improved engineering these can be expected to last many years.  When other options have failed this has been shown to have an extremely high satisfaction rate and give a reliable erection.

What is your approach to sexual health at the Men’s Health Center?

I believe that sexual health is an important part of overall health and needs to be addressed. Improving overall health will address the causative issues above. By addressing the root causes and not simply the downstream effect there is a better chance of RESTORING (not just placating) your natural sexual health and ensuring that you need the least amount of medications and interventions possible while achieving the best outcomes.

How can I get more information?

What is Peyronie’s Disease?

Peyronie’s disease is a curvature of the penis caused by a plaque or scar which causes contracture of that area and bending the penis.

How did I get Peyronie’s?

There is currently no clearly defined mechanism or cause.  It is often associated with trauma and our bodies reaction to this, whether one significant event or many small traumatic events.  There have also been associations with connective tissue disorders such as Dupuytren’s contracture and even some medications.

How is Peyronie’s treated?

As with many ill defined disorders there is no magic bullet yet for treating Peyronie’s.  Several oral medications are used with some success in milder cases.  For more bothersome cases injectible medications are often used to try and break up the plaque.  Verapamil has been used with some good success but still lacks strong evidence in studies.  There is one new medication which looks to be promising called Xiaflex and is now FDA approved specifically for treatment of Peyronie’s.