What is erectile dysfunction (ED)?
Erectile dysfunction is defined as the inability to attain and/or maintain an erection suitable for sexual activity.
What are the causes of ED?
Erectile dysfunction can be caused by a number of factors, including the following:
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Vascular disease — Blood supply to the penis can become blocked or reduced as a result of vascular disease such as atherosclerosis (hardening of the arteries).
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Nerve disorders — Nerves that send impulse to the penis can become damaged from stroke, diabetes, or other causes.
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Psychological states — These includes stress, depression, and performance anxiety.
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Trauma — An injury might contribute to ED.
Chronic illness, medications, and Peyronie's Disease (scar tissue in the penis) can also cause erectile dysfunction.
How is ED treated?
The first step to treating ED is finding the underlying cause, then the appropriate treatment can be given. If the problem continues after treatment, there are a number of non-surgical treatments that can help a man gain and maintain erections.
Non-surgical treatments
Oral corporeal pharmacotherapy
Sildenafil (Viagra) was the first oral medicine approved to treat ED. It is taken about one hour before sexual activity. Men who are on medicines that contain nitrates such as nitroglycerine, should not take Viagra. The combination of Viagra and nitrates can cause low blood pressure (hypotension). The most common side effects of Viagra are dyspepsia (indigestion), nasal congestion, flushing, headaches, and a transient visual disturbance. There have been no reports of priapism (prolonged, painful erection) with Viagra therapy. Other medicines used to treat ED include vardenafil (Levitra) and tadalafil (Cialis)
Vacuum constriction device
The vacuum constriction device is a cylinder that is placed over the penis. The air is pumped out of the cylinder, which draws blood into the penis and causes an erection. The erection is maintained by slipping a band off the base of the cylinder and onto the base of the penis. The band can stay in place up to 20 minutes. The vacuum device can be safely used to treat most causes of erectile failure. Lack of spontaneity and cumbersomeness of the device seem to be the biggest concerns of patients.
Intracavernosal injection therapy
This type of treatment is more commonly known as penile self-injection. Using a tiny needle and syringe, the man injects a small amount of medicine into the side of his penis. The medicine relaxes the blood vessels, allowing blood to flow into the penis. This treatment has been widely used and accepted since the early 1980s. The three most commonly used medicines are prostaglandin E
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(alprostadil) and papaverine, and phentolamine (Resitine).
Injection therapy is effective in treating a wide variety of erection problems caused by blood vessel, nerve, and psychological conditions. The most common adverse side effects are pain and penile scarring (fibrosis). Patients with cerebral vascular disease or severe cardiovascular diseases might not be able to tolerate the dizziness and high blood pressure occasionally encountered with injection therapy. A painful erection that lasts longer than two to three hours (priapism) can occur but can be lessened with proper dosing and by following the treatment guidelines.
Transurethral pharmacotherapy
For this treatment, you place a suppository into the urinary tube (urethra) using a plastic applicator. The suppository contains the medicine alprostadil (MUSE), which is absorbed into the blood stream. MUSE relaxes the blood vessels, allowing blood to flow into the penis.
MUSE appears to be less effective than either injection or vacuum therapy. MUSE can be used to treat erectile dysfunction due to a wide variety of causes. Patients with urethral problems must use special care when using this treatment, since the suppository is placed directly into the urethra.
Sex therapy
Sex therapy can be very beneficial to most men when counseling is provided by a skilled sex therapist. Psychological causes might contribute to erectile failure even when there is a clear organic cause. Sex therapy also helps a man's partner accept and cope with the problem. A patient whose erectile failure has a clear psychological cause should receive sex counseling before any invasive treatments are pursued.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 11/15/2003
