Men's Health
There's more to erectile dysfunction than you think
The little blue pill isn't the only option.
If you mentioned the words "erectile dysfunction" 20 years ago, people might have blushed or raised a worrisome eyebrow. Not today.
Culture changes, science progresses and former U.S. presidential candidates make pitches for erectile dysfunction treatments.
But there is a lot more to erectile dysfunction than just treating it with the little blue pill.
What is erectile dysfunction?
Erectile dysfunction (ED) technically covers a variety of problems, but is typically used to describe the inability to attain and maintain an erection sufficient for sexual intercourse. This condition is also commonly known as impotence.
The problem is more common in men over age 65, but it can occur at any age. It is normal for men to experience changes in erectile function, such as taking longer to achieve an erection. When the problem becomes persistent, it can be a sign of a physical or emotional problem.
The dysfunction can occur because of cardiovascular or neurological disorders, as well as diseases such as diabetes, in which 40 percent of patients suffer from dysfunction, according to the National Institutes of Health.
ED results from a disruption in any of three phases required to produce an erection. The first phase is sexual arousal. This is followed by the nervous system response that increases blood flow to the penis. The final phase is relaxation of the blood vessels of the penis that allows more blood to flow into the penis to cause an erection. A disturbance in any of these three phases can cause impotence.
Testosterone is important to the erection process, and those levels begin decreasing in men after age 40. Also, some research suggests that when the penis is flaccid for long periods of time, scar tissue forms in cells, interfering with the penis's ability to expand when filled with blood.
For years, the primary cause of ED had been considered to be psychological, but today most doctors and researchers think that 80 percent of cases are physical.
In some psychological cases, "recent events such as transient anger at the spouse, guilt over normal but 'unfaithful' sexual interest in another person or stress and burnout at work may be involved," says Mack Lipkin, M.D., professor of clinical medicine and director of the division of primary care in the Department of Medicine at New York University Medical Center.
Treating the problem
The first step in treating ED is to identify what is causing the dysfunction. Consult with your primary care physician or urologist.
Causes for ED are vascular disease, neurological problems, complications of diabetes, prostate and treatment of prostate disease, medications, hormonal disorders, psychological disorders and substance abuse.
If medication is causing the problem, another drug may be substituted in its place. Men having difficulties with their romantic partner may need to seek outside therapy for solutions. But for half or more of men experiencing ED, it is caused by disease or by the effects of prostate treatment.
All experts recommend discussing with your sexual partner what you are going through and how you wish to approach fixing it, including options and treatments.
"Both the patient and his sexual partner should be reassured that erectile dysfunction is normal and has no indication of a permanent or irreversible loss of sexual function or desire," says Gerald D. Brock, M.D., Department of Surgery, Division of Urology at the University of Western Ontario in London, Ontario. "Open communication is important and should be maintained throughout the diagnosis and treatment process, which is often more successful if couples work together as a team."
Oral medications
The first tablet available for erectile dysfunction, Viagra (sildenafil), has been largely responsible for helping to bring the topic of erectile dysfunction out into the open. A second tablet called Cialis (tadalafil) is now also available, and has a similar mechanism of action to Viagra.
Both Viagra and Cialis help in the process of gaining and maintaining an erection by working on the biochemical mechanism of an erection. They belong to a group of medicines called phosphodiesterase type 5 (PDE5) inhibitors. This treatment works by stopping PDE5 from breaking down cyclic guanosine monophosphate (cGMP), an erection-producing chemical. This helps to relax the smooth muscle cells in the penis's erectile tissue, allowing more blood to flow in to the penis to cause an erection.
Medications such as Viagra and Cialis will work only if you are sexually stimulated. They are not aphrodisiacs and won't increase your sex drive.
Side effects of Viagra and Cialis include headaches, flushes, indigestion and, in rare situations, a distortion of vision or change in color vision.
PDE5 inhibitors, such as Viagra and Cialis, cannot be taken by all men, so your doctor will need to evaluate your suitability before prescribing either of these medications. Men with certain heart problems or those taking nitrates for angina, for example, should never take Viagra or Cialis. Check with your doctor to find out if either Viagra or Cialis may be suitable for you.
Injection therapy
Men with ED as a result of diabetes or radical prostate surgery have more success with injection therapy. In injection therapy, approved drugs are injected using a fine needle directly into the side of the penis. An erection usually occurs within 5 to 20 minutes and lasts for 30 to 60 minutes.
Success rates for injection therapy range from 60 to 80 percent. The main side effects are bruising or scarring and moderate pain. This therapy can be expensive.
A similar method involves tiny pellets that a man can insert into the urethra at the head of his penis before sex. After the pellets are inserted using a disposable plastic applicator, the pellets dissolve and are absorbed by surrounding tissue, dilating arteries, allowing blood to flow in.
Devices to help achieve erection
Devices to help achieve and keep erections range from bands to vacuum tubes and surgical implants.
For men who can get erections but not keep them, a penile band (a ring-like device) can be fastened around the base of the erect penis to keep blood from escaping.
Vacuum pumps are perhaps the most noninvasive device in the market. A man lubricates his penis and puts it into an airtight plastic cylinder attached to a hand-held pump. When air is pumped out of the cylinder, a vacuum increases blood flow to the penis.
Once an erection occurs, the man removes the cylinder and places a band around the base of his erect penis. The pumps work for about 80 to 90 percent of men and can be used as often as desired. Some men experience pain, bruising or difficulty ejaculating from using pumps.
Penile implants date to the 1930s. They are inserted into the penis as permanently stiff rods or as inflatable cylinders that become erect when filled with a saline solution that is pumped from a reservoir implanted in either the abdomen or the scrotum.
"Before the introduction of [Viagra] for the treatment of erectile dysfunction, penile implants were recognized as the most effective, though most invasive, therapy with a high satisfaction rate," says Grant E. Stanley, M.D., of the Department of Urology at the Tulane University School of Medicine in New Orleans.
Vascular surgery
Two types of operations improve erections, but each is recommended only for unusual situations. One involves tying off blood vessels that allow blood to leak out of an erect penis. The other entails bypassing blocked blood vessels to let more blood into the penis.
Bypass operations are reserved mainly for patients with blood-flow problems caused by injuries such as pelvic fractures.
Hormone therapy
Testosterone supplements are only for men with abnormally low levels of testosterone. The supplements, which may increase libido and ability to have an erection, come in three forms: pills, intramuscular injections and skin patches.
Several new medications for ED have been developed and are awaiting approval by the U.S. Federal Drug Administration.
For men finding it extremely difficult to solve their problems with the above solutions
or who have some psychological troubles, the International Impotence Association recommends that they (and their partners, if willing) receive counseling from a qualified psychotherapist.
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