Erectile dysfunction (ED) is a common sexual problem that involves the inability to get or maintain an erection firm enough for sexual intercourse.
ED affects an estimated 30 million men in the US, and the likelihood of experiencing it becomes exponentially greater as you age. By age 65, as many as a quarter of all men experience erectile dysfunction.
Physical and psychological causes – or a combination of the two – may contribute to male sexual dysfunction. However, the vast majority of instances of ED are due to physical (organic) causes as opposed to psychological origins.
The list of organic causes of ED is seemingly endless. For example, the following all increase your risk of erectile dysfunction:
Causes of ED
- Alcohol consumption
- Cardiovascular disease
- High blood pressure
- High cholesterol
- Injury to the penis
- Lack of exercise
- Marijuana use
- Medication side effects
While ED can be distressing for men and their partners, it is important to know that there are treatment solutions available, no matter the cause. Because every case of erectile dysfunction involves a unique set of physical, medical, and psychosexual factors, the first step is to talk to your urologist about how to best restore or enhance your sexual function.
The most common medications used to treat erectile dysfunction are vasodilators that chemically enhance the erection process by widening blood vessels, allowing blood to travel more easily to the penis during arousal, resulting in an erection. These drugs make arousal physically possible – although sexual stimulation is still necessary to achieve an erection.
The FDA has approved the following vasodilators, known as oral phosphodiesterase type 5 inhibitors (PDE5i), to treat ED:
- Tadalafil (expected duration: up to 36 hours)
- Sildenafil (expected duration: up to 12 hours)
- Vardenafil (expected duration: up to 10 hours)
- Avanafil (expected duration: up to 6 hours)
Depending on which of these is used, it can take 15 minutes to 2 hours to take effect. Also, it is important to note that doubling the dose doesn’t double effect of the drug; taking the lowest dosage needed for the desired effect should be goal of ED medication use.
Mild to moderate side effects can occur, including indigestion, back pain, headaches, flushing, dizziness, and vision problems. Type 5 inhibitors should not be taken in conjunction with nitrates or certain antidepressants, antifungal medications, and HIV/AIDS drugs.
More than half of men who use type 5 inhibitors are able to successfully treat their ED with these medications. Men with low levels of testosterone may benefit from a combination of type 5 inhibitors as well as testosterone therapy.
If nonsurgical options like medications fail to provide relief for ED, your urologist may recommend a surgically implanted penile prosthesis.
The benefits of penile implants is that it allows erections on-demand, as often and for as long as desired. It is considered a permanent treatment, and commonly used when other ED treatment methods fail. The vast majority of men who elect to have penile implant surgery are satisfied with the outcome, particularly with the inflatable models.
Side effects include penile edema (swelling) or hematoma (localized bleeding outside a blood vessel), and injury to the penis or urethra. Surgical risks and complications include post-op pain, possible infection, device malfunction, or change in the appearance of the penis.
Find out more about penile implants.
Penile injection therapy is one of the most common treatments for patients with ED. Sometimes called P-shots, the injections are made into the corpus cavernosa — the spongy erectile tissue along the body of the penis, which contains most of the blood during an erection. Penile injections work by relaxing the smooth muscle and opening blood vessels in the penis, which allows blood to flow in. They are successful in over 80 percent of men with ED. Injection therapy is a desirable option for men for whom oral medications do not work or involve undesirable side effects – such as those that can occur in men who also take nitrates or beta blockers for heart disease.
There are several commonly used medications for these injections. One of the most successful is Tri-Mix, a combination of medications that trigger an erection. Also commonly used are papaverine, phentolamine, and atropine. Combinations of the four medications are sometimes used. The FDA has approved the vasodilator alprostadil for penile injections to treat ED.
Patients who opt for this type of ED therapy are trained to provide themselves the injection. The needle involved is tiny and feels like a pinprick rather than a typical injection. It can take from 5 to 15 minutes to take effect.
Side effects include pain with the injection, in the penis, and in the genitals generally. The development of plaque, scar tissue, or penile deformities have also been reported.
Low-intensity extracorporeal shockwave therapy (Li-ESWT) is a promising, noninvasive therapy used to treat a variety of medical conditions. For example, it has been shown to safely and effectively treat heel pain caused by plantar fasciitis as well as tendon issues like tennis elbow.
When used on men with ED, a handheld device is gently moved over the skin of the penis to deliver sound waves through erectile tissue and into the penis. It is thought to work by breaking up plaque within blood vessels and stimulating new blood vessel growth. It is important to note that this therapy is not a quick fix: it can take time at the cellular level for damaged tissue to heal.
Shockwave therapy is not yet approved by the FDA to treat male sexual dysfunction. There is a lack of data regarding its long-term effectiveness. Ask your urologist if shockwave therapy is appropriate for you.
If you have low levels of testosterone – a condition also called low-T – you may be able to improve your sexual dysfunction symptoms with testosterone therapy.
This therapy involves using an applicator to insert a tiny alprostadil pellet into the urethra through the tip of the penis, where it quickly dissolves and is absorbed into urethral tissue. It involves the same vasodilator medication used in penile injection therapy, which temporarily widens blood vessels in the penis, allowing for an erection during arousal. It can take 5 or 10 minutes to take effect and usually lasts for under an hour. This therapy is also sometimes referred to by the brand name of the product: MUSE (medicated urethral system for erections).
Reported side effects include genital pain, burning, and dizziness.
Your urologist may recommend this treatment method if you wish to avoid ED medications taken orally or by injection.
These mechanical aids consist of a tube that is placed over the penis and pumped manually or automatically via batteries, which creates a vacuum and draws blood into the shaft of the penis, causing it to become erect. A band slipped onto the lower end of the penis helps to maintain the erection during intercourse.
Vacuum erection devices are a safe and effective, low-cost option for men with ED. They carry no risk of adverse reaction to medications or certain health conditions. These devices may be preferred by men with heart problems, or after prostate-removal surgery (when type 5 inhibitor medications are less likely to be effective).
Side effects may include bruising, difficulty with ejaculation, and discomfort. For some men, the band slipped onto the lower end of the penis can hurt and quickly numb the area. Vacuum erection devices may not be appropriate for men with bleeding disorders or a history of prolonged erections (priapism).