Doctor's Notes on Impotence/Erectile Dysfunction
Erectile dysfunction (impotence or ED) is defined as the inability of a male to achieve and/or maintain a hard enough erection sufficient for satisfactory completion of sexual activity. Signs and symptoms are described in the definition. Other signs and symptoms may include
In general, causes of ED are divided into organic (physical) and psychogenic (mental). Many men have both general causes. Organic causes of ED may include arterial vascular disease, peripheral vascular disease, angina, high blood pressure, tobacco use, diabetes, prostate enlargement, scleroderma, cirrhosis, cancers, COPD, thyroid problems, pituitary problems, low testosterone and other diseases, and trauma to the male sex organs. Psychological conditions include depression, anxiety, and widower syndrome (grief due to loss of spouse). Many men with ED have several contributing specific causes.
What Are the Treatments for Impotence/Erectile Dysfunction (ED)?
Treatments of erectile dysfunction (ED) can be psychological, medical, and/or surgical. In some patients, treatments may be combined.
- Psychological: treats causes of ED like stress, anxiety, and/or depression with counseling
- Medications: testosterone (hormone replacement), sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), avanafil (Stendra; enhance blood flow to penis), and alprostadil (self-injection or urethral suppository for erection)
- Physical/Surgical: penis pump (vacuum-assisted erection), penile implants (inserted devices into both sides of the penis that keep penis firm), and a new treatment termed shockwave or ultrasound therapy to increase blood flow to the penis
You, your partner, and your doctor should determine the best therapy for your ED.
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Causes of Erectile DysfunctionThe male erection is a complex process involving multiple body systems. As such, there are myriad causes for erectile dysfunction. Some causes are psychological issues problems with the nervous system; problems with the vascular system like high blood pressure; low testosterone levels; medical conditions like diabetes or prostate cancer; and side effects of medications.
Diagnosing Erectile DysfunctionMale sexual problems are often difficult to diagnose because many are reluctant to discuss them. Testing involves physical examination and lab testing to determine whether erectile dysfunction is caused by physical or psychological problems.
Erectile Dysfunction FAQsErectile dysfunction (or ED), also called male impotence, describes a man's inability to achieve and maintain an erection of his penis sufficient for mutually satisfactory sexual intercourse with his partner. Erectile dysfunction is treatable with a variety of methods, including medications, devices and therapy. ED may be a symptom of other disorders and diseases such as high blood pressure or heart disease.
Erectile Dysfunction MedicationsErectile dysfunction (ED) is also referred to as impotence. Erectile dysfunction is the consistent inability to attain or maintain an erection. Medications to treat erectile dysfunction include: PDE5 inhibitors (sildenafil [Viagra], vardenafil [Levitra], tadalafil [Cialis]); androgens (Depo-Testosterone, Delatest, Andro-L.A., AndroGel, Testim, Androderm, Testoderm); and prostaglandins alprostadil (Caverject, Edex, Muse Pellet). Side effects, drug interactions, warnings and precautions, and patient information should be reviewed prior to taking any medication.
Heart DiseaseCoronary heart disease (CHD) is a group of different types of heart disease. Symptoms of heart disease depend on the cause and inclue chest pain or angina, shortness of breath, palpitations, and dizziness. Many conditions causes heart disease, for example, genetics, obesity, high cholesterol, and smoking. Treatment for heart disease depend on the cause and include diet and other lifestyle changes, medications, procedures, and surgery. The prognosis (outlook) and life span for someone with heart disease varies depending on the cause.
Nonsurgical Treatment of Erectile DysfunctionDifferent categories of medical (non-surgical) treatments exist to cure or assauge erectile dysfunction. They include medications, supplements, hormonal therapy, intraurethral pellets, penile injections and external vacuum devices. A number of medical and/or psychological factors may cause erectile dysfunction.
Surgical Treatment of Erectile DysfunctionSurgical options are available to treat erectile dysfunction are available for those who don't respond to medical treatment. Surgical options include: Semirigid or malleable rod implants Inflatable implants Vascular reconstructive surgery Each procedure has it own advantages and drawbacks.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.