Occasional difficulty getting or maintaining an erection is common and is not necessarily a cause for concern. When erectile problems persist or begin affecting sexual health, confidence or relationships, an evaluation can help identify contributing factors and determine which treatment options may be appropriate.
What Is Erectile Dysfunction?
Erectile dysfunction (ED) is the persistent difficulty achieving or maintaining an erection firm enough for satisfactory sexual activity. ED becomes more common with age, but it is not simply an inevitable part of getting older. It can develop from changes involving blood flow, nerves, hormones, medications, emotional health or a combination of factors.
What Are the Symptoms of Erectile Dysfunction?
ED can affect men differently. Some have difficulty achieving an erection, while others can achieve an erection but have difficulty maintaining it. Symptoms may occur occasionally at first or become more persistent over time.
- Difficulty getting an erection
- Difficulty maintaining an erection during sexual activity
- Erections that are not firm enough for satisfactory sexual activity
- Changes in the consistency or reliability of erections
Sexual desire and erectile function are related but are not the same. A decrease in libido may occur alongside ED, but it can also suggest hormonal, medication-related, emotional or other health factors that should be evaluated separately.
What Causes Erectile Dysfunction?
An erection depends on coordinated signals between the brain, nerves, hormones and blood vessels. A problem affecting any part of this process can contribute to ED, and many men have more than one contributing factor.
- Cardiovascular disease and atherosclerosis
- High blood pressure and high cholesterol
- Diabetes and other metabolic conditions
- Obesity
- Low testosterone or other hormonal conditions
- Neurologic conditions such as Parkinson’s disease or multiple sclerosis
- Peyronie’s disease
- Smoking and excessive alcohol use
- Certain medications
- Pelvic surgery, including prostate surgery
- Radiation treatment involving the pelvis
- Injury affecting the pelvis, spinal cord, nerves or blood vessels
- Depression, anxiety, stress or relationship concerns
Because the cause is not always obvious, identifying the factors contributing to ED is an important part of choosing an effective treatment.
How Is Erectile Dysfunction Treated?
Treatment for erectile dysfunction is based on the underlying cause, severity of symptoms, overall health, previous treatment and personal preferences. Some men respond well to lifestyle changes or medication, while others benefit from injections, vacuum devices or surgical treatment. There is no single treatment that is right for everyone.
Oral Medications for Erectile Dysfunction
Oral medications known as phosphodiesterase type 5 (PDE5) inhibitors are commonly used to treat ED. These medications enhance the effects of nitric oxide, helping blood vessels in the penis relax and increasing blood flow during sexual stimulation. Options include sildenafil, tadalafil, vardenafil and avanafil.
PDE5 inhibitors do not automatically produce an erection and do not increase sexual desire. Sexual stimulation is still needed to initiate the natural signals involved in an erection. Different medications vary in how quickly they take effect, how long they remain active and how they interact with food or other medications.
Are ED Medications Safe for Everyone?
ED medications are safe and effective for many men, but they are not appropriate for everyone. PDE5 inhibitors should not be used with nitrate medications or other nitric oxide donor drugs because the combination can cause a dangerous drop in blood pressure. Men with unstable or significant cardiovascular conditions should be medically evaluated to determine whether sexual activity and ED treatment are appropriate.
Other medications and health conditions can also affect which ED treatment is safest. A physician should review current medications and cardiovascular health before treatment begins rather than relying on a specific blood pressure reading alone.
Possible Side Effects of Oral ED Medications
Side effects vary by medication and individual response but may include headache, flushing, nasal congestion, indigestion, back or muscle discomfort and temporary visual changes. Your physician can help select a medication and dose based on effectiveness, side effects and other health considerations.
Other Treatments for Erectile Dysfunction
When oral medications do not provide adequate results, cause unwanted side effects or cannot be used safely, other treatments can help produce an erection. The choice depends on the cause of ED, previous treatments, comfort with different therapies and the patient’s goals.
Penile Injection Therapy
Injection therapy delivers medication directly into the side of the penis using a very fine needle. Medications such as alprostadil may be used alone or in combination with other medications to increase blood flow and produce an erection.
Patients are taught how to administer injections safely and use the appropriate dose. Possible side effects include discomfort, bruising or bleeding, scar tissue and a prolonged erection called priapism. An erection lasting four hours or longer requires urgent medical attention.
Intraurethral Medication
Alprostadil can also be delivered through the urethra rather than by injection. A small medicated pellet is placed into the urethral opening using a specialized applicator, where the medication is absorbed and increases blood flow to the penis. Possible side effects include penile or urethral discomfort and minor bleeding.
Vacuum Erection Devices
A vacuum erection device uses a cylinder placed over the penis and a manual or battery-powered pump to create negative pressure, drawing blood into the penis. Once an erection develops, a constriction ring is placed around the base of the penis to help maintain it during sexual activity.
Vacuum devices avoid systemic medication and can be effective for many men, including some who cannot use oral ED medications. Possible effects include bruising, temporary discomfort and changes in ejaculation.
Testosterone Therapy
Testosterone therapy is not a general treatment for erectile dysfunction. It may be appropriate for men who have symptoms of testosterone deficiency and laboratory testing confirms low testosterone levels. When low testosterone and ED occur together, treatment is individualized according to symptoms, health history and response to other ED therapies.
Penile Prosthesis Surgery
For men who do not respond to other treatments, cannot use them or prefer a more definitive solution, a penile prosthesis can provide reliable control over erections. The device is surgically placed inside the penis and does not depend on medication or external equipment to produce rigidity.
Inflatable Penile Prosthesis
An inflatable prosthesis uses fluid-filled components placed inside the body. The patient activates a small concealed pump when an erection is desired and releases the device afterward. When deflated, the penis returns to a more natural resting state.
Malleable Penile Prosthesis
A malleable prosthesis uses bendable rods placed inside the penis. The penis remains firm enough for sexual activity and can be positioned manually when an erection is desired. Your urologist can explain the advantages and considerations of each type of implant.
Improving Erectile Function and Overall Health
Because erectile function is closely connected to cardiovascular, metabolic and emotional health, addressing underlying health factors can be an important part of treatment. Lifestyle changes may improve erectile function for some men while also reducing the risk of cardiovascular disease, diabetes and other conditions.
- Exercise regularly and remain physically active
- Maintain a healthy weight
- Stop smoking and avoid tobacco products
- Manage diabetes, blood pressure and cholesterol
- Limit excessive alcohol use
- Address depression, anxiety and chronic stress
- Review medications with your physician if sexual side effects are a concern
Do not stop a prescription medication on your own because you suspect it may be contributing to ED. In some cases, another medication or treatment strategy may be available.
Emotional Health and Relationships
Erectile dysfunction can affect confidence, intimacy and relationships, while stress, anxiety, depression and concerns about sexual performance can also contribute to erectile difficulties. Physical and psychological factors frequently overlap rather than occurring separately.
When appropriate, counseling, sex therapy or mental health support can complement medical treatment. Partners may also be included in discussions when the patient feels that would be helpful.
Personalized Erectile Dysfunction Care at Saint John’s
At Providence Saint John’s Health Center, our urology and men’s health specialists evaluate erectile dysfunction in the context of the whole patient rather than treating the symptom alone. Care may include evaluation of cardiovascular, metabolic, hormonal, neurologic and treatment-related factors along with a discussion of sexual health and personal goals.
Treatment can range from lifestyle changes and oral medication to injection therapy, vacuum devices and penile prosthesis surgery. For men experiencing ED after prostate cancer or other pelvic treatment, our broader urologic oncology expertise also allows sexual health concerns to be considered as part of long-term recovery and quality of life.
If erectile dysfunction is persistent or affecting your quality of life, our men’s health and urology specialists can help identify contributing factors and develop a treatment plan personalized to you.
If you have questions regarding Erectile Dysfunction (ED) or treatments, please call today. Click here to request an appointment.
