Male Reproductive Organs
Erectile dysfunction, or ED, is when it is hard to get or keep an erection that's firm enough for sex. ED affects as many as 30 million men.
Most men have problems with erections from time to time. But when this happens more than half of the time, then ED is present. ED can happen when health problems limit blood flow or damage nerves in the penis. ED can also be caused by stress or emotional reasons. ED can be an early warning of a more serious illness. Heart disease, high blood pressure and high blood sugar can all cause ED. Finding and treating the cause(s) of your ED can help your overall health and well-being.
How Erections Work
When you are not sexually aroused, your penis is soft and limp. During sexual arousal, nerve messages release chemicals that increase blood flow into the penis. The blood flows into 2 erection chambers made of spongy tissue (the corpus cavernosum) in the penis. The "smooth muscle" in the erection chambers relaxes, which lets blood enter and stay in the chambers. The pressure of the blood in the chambers makes the penis firm, giving you an erection. After you have an orgasm, the blood flows out of the chambers and the
The treatment for ED depends on what is causing it.
Your health care provider may ask you to change certain habits, stop smoking, or using drugs or alcohol. He or she may suggest treatment for emotional problems, relationship conflicts, depression, or performance anxiety. Or you may be asked to change the way you take other medicines. (Never stop or change any drug without first talking to your health care provider.)
Testosterone Replacement Therapy
If a blood test shows low testosterone levels (low T), testosterone replacement therapy (TRT) may help. However, adding TRT will not help your erection problems if you have normal testosterone levels.
Supplements
Dietary supplements (often called "herbal remedies") for ED are popular but may not be safe or even work. Unlike prescription drugs, they do not have to be proven to work to be sold. Check with your health care provider before you take any supplements or drugs to treat your ED.
Other Treatments
Most of the best-known treatments for ED work well and are safe. But in making your choice, ask your health care provider about any possible problems that could result with each option:
- Vacuum erection device
- Oral drugs
- Drugs in the penis
- Surgery
Vacuum Erection Device
Vacuum Erection Device
A vacuum erection device is a plastic tube that slips over the penis, making a seal with the skin of the body. A pump at the other end of the tube creates a low-pressure vacuum around the erectile tissue, which results in an erection. An elastic ring is then slipped onto the base of the penis. This holds the blood in the penis (and keeps it hard) for up to 30 minutes. With proper training, 75 out of 100 men can get a working erection using a vacuum erection device.
Oral Drugs
Drugs known as PDE-5 inhibitors relax muscle cells in the penis and increase blood flow. (These are the drugs you often see on TV and in Internet ads.)
- Viagra® (sildenafil citrate)
- Levitra® (vardenafil HCl)
- Cialis® (tadalafil)
Men with ED take these pills before having sex. The drugs boost the natural signals that are generated during sex to help you have a better erection that lasts longer. The drug works by relaxing the muscle cells in the penis, letting the blood flow better to give a firm erection. These drugs often work well, and nearly 80 out 100 men show improvement once they start using them.
The side effects of PDE-5 inhibitors are mild and often last just a short time. The side effects also get weaker the longer you use the drug. The most common side effects are:
- Headache
- Stuffy nose
- Flushing
- Muscle aches
In rare cases, sildenafil can cause blue-green shading of vision that lasts for a short time. There is no long-term risk and the problem goes away as the amount of the drug in the body lowers. It is important to follow the instructions for taking this drug to get the best results.
If you are taking nitrates for your heart, you should speak with your health care provider before using a PDE-5 inhibitor to learn how it might affect your health.
Drugs in the Penis
If oral drugs don't work, another drug, alprostadil, is approved for use in men with ED. This drug comes in two forms, depending on how it is to be used:
Self-Injection Therapy
Medical Injections for Impotence
The drug is injected into the side of penis with a very fine needle. The success rate for getting an erection firm enough to have sex is as high as 85%.
Intraurethral Therapy
Transurethral Therapy for Impotence
A tiny medicated pellet of the drug is placed in the urethra (the tube that carries urine out of your body). Using the drug this way avoids having to give yourself a shot, but makes it less likely to work.
The most common side effects of alprostadil are a burning feeling in the penis, and an erection that can last for over four hours and need medical attention to make it go down.
