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Erectile Dysfunction 

Introduction
Erectile Dysfunction (ED) is the inability to maintain an erection long enough to have sexual intercourse.  It is normal for men to have trouble maintaining an erection from time to time.  However, if it occurs more than 25% of the time, it may be time to talk to your doctor.  Although Erectile Dysfunction most frequently occurs in older men, it can occur at any age, usually because of physical problems or as a side effect of certain medications.  Fortunately, men with erectile dysfunction have several options to choose from to regain a satisfying sex life.

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Anatomy
The penis has two tubes (corpus cavernosum) on each side of the center tube (urethra).  The corpus cavernosa are sponge-like structures that fill with blood during sexual arousal.  The blood in the corpus cavernosum causes the penis to expand and stiffen during an erection.  Following sexual arousal or ejaculation, the extra blood leaves the corpus cavernosum and the penis returns to its former shape and size.

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Causes
Erectile dysfunction occurs for many reasons and is not just a consequence of getting older.  In fact, many healthy men have erections well into their 80's.  Some underlying health problems, such as heart disease, high blood pressure, high cholesterol, clogged blood vessels, diabetes, metabolic syndrome, and obesity can cause ED. 
 
Side effects from certain medications, cigarette smoking, substance abuse, some neurological diseases, injury, treatment for prostate cancer, and hormonal abnormalities can cause erectile dysfunction.  Psychological factors including depression, stress, anxiety, and feeling very tired can contribute to erectile dysfunction.
 
ED can also be caused by Parkinson's disease, multiple sclerosis and surgeries that affect the pelvic or spinal region.

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Symptoms
The main symptom of ED is the inability to maintain an erection more than 25% of the time.
 
In some cases Erectile Dysfunction is the first sign of an underlying health problem. Although it can be embarrassing to talk about ED, it is important to have your symptoms evaluated.

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Diagnosis
Your doctor will review your medical history and examine you.  Your prescription medications will be reviewed.  You should tell your doctor about emotional factors or lifestyle factors, such as alcohol or substance abuse.
 
Specific tests may be done to help determine a physical cause for erectile dysfunction.  Ultrasound may be used to check the blood vessels and blood flow in the penis.  Your doctor will evaluate the nerves in your penis.  Dynamic infusion cavernosometry and cavernosography (DICC) evaluates blood pressure and blood flow to the penis.  Nocturnal tumescence testing is used to help rule out a physical abnormality associated with erectile dysfunction. 

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Treatment
The treatment that you receive for erectile dysfunction depends on the cause and your personal preferences.  Medications, devices, surgery, and psychological counseling may help.
 
Oral Medications
There are several oral medications (phosphodiesterase inhibitors) that work to increase the blood flow to the penis in response to sexual arousal.  These medications work when a man is sexually stimulated and do not cause a constant erection.  Oral medications for erectile dysfunction allow sexual relations to happen as they normally would.  There are varying types of oral medications and varying doses.  While all the medications essentially work the same, some must be taken 20-30 minutes before intercourse and are for that one time use.  There are also low-dose medications that can be taken daily and medications that are taken once and last for up to three days.
 
Injected Medications
Injected medications use a very fine needle to deliver medication to the base or side of the penis.  The medication (alprostadil) goes directly to the corpus cavernosum and causes it to fill with blood.  Injected medications create an erection in about 5 to 20 minutes.  The erection typically lasts for about a half-hour.
 
Intraurethral Therapy
Intrauethral therapy involves placing a medicated (alprostadil) suppository into the tip of the penis (urethra).  The medicated suppository causes increased blood flow to the penis and creates an erection.
 
Hormone Replacement Therapy
Hormone replacement therapy is used for men with abnormally low testosterone.  By taking testosterone, these men are able to achieve an erection.

Penis Pumps
Penis pumps are devices that are placed over the penis.  An electric or manual pump removes air and creates a vacuum.  The vacuum causes an increased blood flow to the penis, creating an erection.
 
Vascular Surgery
Some men with blockages in the blood vessels can receive surgery to correct the condition.  By surgically opening the blood vessels, blood can flow into the penis and cause an erection.
 
Penile Implants
Penile implants are semi-rigid rods that are placed on both sides of the penis to position it in a semi-rigid state to allow sexual penetration.  The rods cause the penis to be semi-rigid at all times.  Inflatable penile implants work in a similar manner, but can be inflated or deflated to allow the penis to be firm only during sexual relations.
 
Psychological Counseling
Psychological counseling can help resolve feelings of stress, depression, and anxiety that may interfere with arousal and erection.  A sex therapist is trained to address specific problems.

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Prevention
You can help to prevent erectile dysfunction by staying healthy and avoiding the risk factors that you can control.

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Am I at Risk

Erectile Dysfunction can be a normal part of getting older and occurs more frequently in older men.  Risk factors for erectile dysfunction also include:

• Chronic health conditions:  heart and blood vessel disease, obesity, diabetes, high blood pressure, low testosterone levels, metabolic syndrome, and lung, liver, or kidney disease.
• Certain medications: antidepressants, antihistamines, tranquilizers, sleeping pills, treatments for prostate cancer
• Trauma or surgery to the nerves that are involved with erections
• Consuming alcohol
• Substance abuse (street drugs)
• Cigarette smoking
• Certain psychological conditions: stress, depression, anxiety

 

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Complications
Erectile dysfunction can lead to embarrassment, feelings of inadequacy for both sexual partners, and loss of confidence. 

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.