Erectile dysfunction (ED) affects 15 to 30 million men in the United States. Exact numbers are difficult to obtain because many men do not discuss their sexual difficulties with their healthcare providers.
In years past, there was a stigma associated with the inability to attain or maintain an erection of the penis. Even the traditional term for ED – impotence – implies weakness, powerlessness, and a total inability to engage in sexual activity. More recently, it's been understood that ED most often has a physical cause, that it is a symptom of a condition or a disease and not a disease itself. Because ED can be a symptom of a potentially serious disease, it's important to make an appointment with your healthcare provider if you're experiencing ED.
How ED Is Diagnosed
Your medical and sexual history can help your physician define the degree and nature of ED. Include information about any other physical problems you might be experiencing (for example, tenderness in your abdomen, difficulty urinating, excessive thirst, or pubic hair loss). Also be sure to tell your physician about any drugs you are taking – prescription, over-the-counter, or street (such as marijuana).
Your doctor will perform a physical exam, and may order various laboratory tests. By monitoring erections that occur during sleep (nocturnal penile tumescence), you'll be able to rule out certain causes of ED. Healthy men have involuntary erections during sleep. If nocturnal erections do not occur, the cause of ED is likely physical. However, tests of nocturnal erections are not completely reliable.
Your physician might also ask you and your sexual partner a series of questions to determine expectations and perceptions encountered during sexual intercourse. Your answers could reveal any psychological factors resulting from, compounding, or causing ED.
Solutions
ED is almost 100 percent treatable – in all age groups. Taking care of the illness or disease that is causing ED is your physician's first focus. If ED persists after the primary cause is treated, or if ED is not resulting from a disease or medication, other options are available. Most physicians suggest that treatments begin with the least invasive. Starting with the least invasive and moving to the most invasive, treatments are:
Treatment of Primary Cause: In the case of high blood pressure or cholesterol, your doctor may suggest the DASH diet or, if necessary, medication. In many cases, changing medications, or eliminating or cutting back on a drug can resolve ED.
Psychotherapy and Behavior Modification: Designed to decrease anxiety associated with intercourse, it includes techniques on the gradual development of intimacy and stimulation.
Oral Drug Therapy: Drugs vary, but the most widely known is Viagra®. It will only cause an erection when you are sexually aroused.
Intra Urethral Pellets: A pellet is inserted into the urethra at the tip of the penis, causing the blood vessels to relax so the penis fills with blood and becomes erect.
Penile Injections: A muscle relaxant is injected directly into the base of the penis, allowing blood to fill the erection chambers.
Vacuum/Constrictive Devices: Mechanical vacuum devices cause erection by creating a partial vacuum around the penis, which draws blood into the penis, engorging it and expanding it. A semi rigid rubber sheath is placed on the base of the penis after attaining erection to trap the blood and maintain the erection during intercourse.
Surgery: Surgery usually has one of three goals: 1) to implant a device that can cause the penis to become erect, 2) to reconstruct arteries to increase blood flow to the penis, and 3) to block off veins that allow blood to leak from the penile tissues.
As medical understanding and treatments options advance, more men are seeking help and returning to near-normal sexual activity. As you discuss treatment options with your physician, be sure to ask about any possible side effects of the treatments.
Preventive Measures
Some of the primary causes of ED – atherosclerosis, diabetes mellitus, high blood pressure, and high cholesterol – might be diminished or prevented by a healthful lifestyle:
- If you smoke, stop.
- If you drink, limit yourself to one or two a day.
- Eat foods low in saturated fat and cholesterol.
- Increase your fiber intake. Use the U.S. Department of Agriculture's food pyramid (mypyramid.gov) as a guide.
- Be physically active at least 30 minutes daily.
- Lose weight if you need to.
- Drink plenty of water.
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