Occasionally, men will have difficulty having an erection, which is not a reason for concern unless it continues to happen consistently.

What is Erectile Dysfunction?

men who continue to exercise and eat well can improve ED symptoms
Exercise and diet later in life can improve ED symptoms.

Erectile Dysfunction (ED), or impotence, is the inability of males to get or keep an erection firm enough for sexual intercourse. ED does not affect the ability to have an orgasm.

Symptoms of Erectile Dysfunction:

  • Difficulty getting an erection
  • Difficulty maintaining an erection
  • Decreased libido

Causes of Erectile Dysfunction

ED may be caused by emotional or physical issues that involve the brain, hormones, nerves, and blood vessels.  Seemingly unrelated medical disorders and medication can also add to ED symptoms.  As experts with ED, our goal in the Urology and Urologic Oncology Center of Excellence is to determine the root cause of problems and develop a treatment plan that works to correct it.

Physical or anatomical causes of erectile dysfunction:

blood test
A PSA blood test can determine if a particular protein in the prostate is elevated, likely revealing the presence of cancer.
  • Heart disease
  • Atherosclerosis
  • High cholesterol
  • High blood pressure
  • Diabetes
  • Obesity
  • Metabolic syndrome
  • Parkinson’s disease
  • Multiple sclerosis
  • Medications
  • Smoking
  • Peyronie’s disease (development of scar tissue inside the penis)
  • Alcoholism
  • Surgery or radiation for prostate issues
  • Surgeries or injuries that affect the penis, testicles, back, pelvic area or spinal cord

Diagnosis of Erectile Dysfunction

  • Physical exam of penis, testicles, and prostate as well as neurologic test
  • Blood tests (PSA and testosterone tests)
  • Urine tests (urinalysis)
  • Ultrasound of penile blood flow
  • Psychological exam to determine if stress or depression

Risk Factors of Erectile Dysfunction

Multidisciplinary Urology Team - Surgery - Medical Oncology - Radiation - Ultrasound
The multidisciplinary urology team at Saint John’s Health Center is ready to support you.

As you get older, erections can take longer to induce and may not be as firm.  This is a common occurrence for men as our bodies change later in life.  While a small percentage of men between 40 and 49 years of age reported their first experience of ED, those of 50 years and beyond revealed a substantial increase.

Risk factors include:

  • Medical conditions – diabetes or heart disease
  • Smoking or tobacco products which restricts blood flow
  • Continuous drug and alcohol use
  • Medications
  • Obesity
  • Psychological conditions like depression
  • Prostate surgery or radiation to prostate
  • Traumatic Injuries to pelvic, this can damage the nerves or arteries to penis

Treatments for Erectile Dysfunction

Oral Medications

medication can boost Nitric oxide to the blood vessels of the penis
Medication can elevate the effect of nitric oxide in the penis, relaxing the penis and increasing blood flow.

Medications for ED enhance the effects of nitric oxide—a natural chemical your body produces that relaxes muscles in the penis. Such medications increase blood flow to the penis which help it to become erect.

  • Generic and brand named erectyle disfuction drugs by Pfizer
  • Lilly Icos and Eli Lilly distributed drugs
  • Erectle dsyfuntion pharmaceutcals by Bayer Corp.
  • Drugs my Vivus Inc. that also boost nitric oxide

Sexual stimulation or physical stimulation of the penis will cause the release of nitric oxide from your penile nerves. As the amount of nitric oxide is increased, the penis to become erect normally. These medications do not enhance libido, though having more productive erection may inspire increased sexual activity.

Possible side effects of ED medications include:
  • Flushing (sudden redness of the skin)
  • Nasal congestion
  • Headache
  • Muscle aches
  • Vision changes (sensitivity to light, blurred vision)
  • Backache
  • Stomach upset

Erectile dysfunction medication contraindications
Erectile dysfunction medication is contraindicated with low blood pressure.

Your doctor will help you find the right medication and proper dosage.

DO NOT USE these medications if you:
  • Take nitrate drugs. Nitrates are usually given for chest pain (angina, coronary artery disease), such as Minitran, Nitro-Dur, Nitrostat, isosorbide mononitrate, and isosorbide dinitrate
  • Have heart disease or heart failure
  • Have very low blood pressure (hypotension)
    • 90/60 – Low blood pressure
    • 80/50 – Very low blood pressure

Other Treatments and Remedies for Erectile Dysfunction

Alprostadil self-injection

This self-injection delivers medication to the base or side of the penis using a very fine needle. Some examples of the different medications that can be injected in this area include papaverine (a vasodilator), alprostadil (injection or topical cream), and phentolamine (for high blood pressure). Such medications can be used together or individually.

Side effects of the injection can include mild bleeding and scar tissue at the injection site and prolonged erection called priapism, a dangerous medical condition resulting in penile pain.

Aging - testosterone levels
Men experience decreasing testosterone levels for most of their entire lives.
Alprostadil urethral suppository

Alprostadil intraurethral therapy (Vivus’s MUSE) involves placing an intraurethral medication inside the opening of the penis (urethra). The resulting erection usually starts within 10 minutes. Side effects can include urethral or penile pain.  Urethra bleeding, though rare, can occur as well as the formation of scar tissue inside the penis.

Testosterone replacement

Some men have erectile dysfunction because of low testosterone. Testosterone replacement therapy and other treatments that raise testosterone levels may be given by injection or applied to the skin using a patch (or gel ointment).

Vacuum Erection

A vacuum erection device (penile pump) uses a hollow tube and a hand-operated or battery-powered pump to pull blood into the penis using low pressure. The tube is placed over your penis, a seal is made using a soft rubber ring, then the air is pulled out of the tube using the pump. This vacuum creates a negative pressure force that pulls blood into the penis, creating an almost instant erection.  Once an erection is achieved, the pump is removed, and a ring is retained around the base of the penis to maintain the internal pressure of blood.  After intercourse, the ring is removed. Side effects include bruising of the penis and decreased ejaculation.

Penile implants

A device is placed surgically inside the penis to make it erect. These implants consist of either inflatable or bendable rods. Inflatable devices allow you to manually control when and how long the erection should last. The malleable rods keep the penis firm yet bendable.

Complications & Prevention of Erectile Dysfunction

Staying active - healthy lifestyle
Make seeing your doctor part of your health routine and goals, reducing the likelihood of complications.


  • Poor sex life
  • Personal stress
  • Embarrassment
  • Relationship issues
  • Unable to get your spouse pregnant


  • See your doctor early
  • Manage diabetes
  • Quit smoking
  • Exercise regularly
  • Treat depression and mental health concerns

If you have questions regarding Erectile Dysfunction (ED) or treatments, please call today. Click here to request an appointment.