Erectile Dysfunction

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Erectile dysfunction affects nearly 20 million men in the United States.

Erectile dysfunction (ED) is a condition characterized by the inability to obtain or sustain an erection. Although men of any age may have erection issues now and then, older men are more likely to have chronic ED, defined as a problem with erections that lasts 3-4 months or more.

  • Occasional erectile dysfunction may be experienced in about half of all men in the 40- to 70-year-old age group.
  • There are many conservative and surgical treatments a urologist can recommend to help patients manage or reverse this condition.

What Causes Erectile Dysfunction?

Normally, neurotransmitters in the brain trigger the blood flow that’s required to achieve an erection when stimulated. Sometimes, this process doesn’t occur as expected, resulting in erectile dysfunction. Stress, anxiety, and depression are among the psychological factors that may affect the ability to get or sustain an erection. ED is sometimes linked to physical issues, some of which may include:

  • Diabetes-damaged nerves and blood vessels
  • Kidney disease
  • Circulation issues affecting the pelvis and penis
  • Some prescription medications
  • Vein leakage or vascular disease
  • Nerve injuries
  • Prostate enlargement
  • Spinal cord injuries

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How Is It Diagnosed?

Since there are many possible sources of erectile dysfunction, diagnosis typically involves several tests following an initial examination and discussion. A patient may be asked if they have any new sources of stress or if the problem suddenly developed, to determine where to focus efforts with treatment. In addition, hormonal blood testing and a penile Doppler ultrasound may be used to confirm diagnosis and cater management.

Treating ED Without Surgery

Treatment will depend on the likely source of erectile dysfunction. If medications are the suspected problem, changes in over-the-counter or prescription drugs used may help. When ED is related to a psychological problem, treatment may involve a combination of medication and sex therapy. Viagra, Cialis, Levitra, Stendra, and similar PDE5 inhibitors are sometimes prescribed. If testosterone levels are low, hormonal replacement may be considered. Other non-surgical treatments may also include injections directly into the penis, urethral suppositories, vacuum erection devices, and alternative remedies such as nutritional supplements.

Surgical Options for Erectile Dysfunction

If the main cause of ED is a blood flow or circulation problem, surgery may be an option if conservative treatments aren’t effective. Many men will benefit from a penile implant to restore erectile function. The inflatable penile prosthesis is a totally concealed, hydraulic device which consists of three small components: two cylinders, a pump, and a reservoir. The reservoir contains fluid, which is transferred by the pump into the tubes, causing the penis to expand and become rigid. Both Coloplast and AMS (Boston Scientific) devices can be offered. Surgery requires a small 2-inch incision at the base of the penis and requires 1 hour of duration. This can be done as outpatient or the patient can stay in the hospital overnight if needed.

Erectile dysfunction isn’t always preventable. Even so, the risk of developing problems with ED can sometimes be effectively reduced by avoiding certain habits that may affect blood flow and the health of tissues in and around the penis. Nicotine and other chemicals in cigarette smoke, for example, have been linked to issues with circulation. A diet that includes beneficial foods like onions, peanuts, cranberries, and small amounts of red wine that are good for circulation may also be helpful for some men. Dietary consultations are also offered as needed.

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