Erectile dysfunction (ED), or impotence, is the inability to attain or maintain an erection of the penis that is firm enough for penetration during sexual intercourse. To initiate and maintain an erection, the penis must fill with blood. Nerve signals stimulate this blood fill. The nerves prompt certain blood vessels in the penis to expand so blood can fill it. Meanwhile, other blood vessels constrict, trapping blood inside.
An estimated 25-30 million American men have erectile dysfunction, but it is highly treatable. Erectile dysfunction increases with age, affecting about 20% of men aged 20 and older and 78% of men aged 75 and older.
Causes of Erectile Dysfunction
The following factors can cause erectile dysfunction:
- Venous Leak: Veins are compressed when blood fills the penis. This will help trap the blood in the penis. If these veins are not fully compressed, then blood can leave the penis. The inability to keep blood in the penis will make it difficult to reach or keep an erection. The compression of the veins may not occur, or may be weaker than it should if the blood vessels that are supposed to fill do not fill enough. Blood vessels may not fill enough because of injury or disease.
- Neurovascular Function: Erection cannot be attained if nerve signals do not prompt blood vessels to do their job or if blood flow to the penis is reduced. Nerve problems also can diminish feeling in the penis, resulting in impotence.
- Many medications, medical conditions, or psychological factors can cause erectile dysfunction by impairing vascular or nerve function.
Penile erection is a complex interaction of your nervous system, blood circulation, and your emotions. Symptoms may include:
- A less firm penis
- Fewer erections
- Fewer spontaneous nighttime erections
Sensation in your penis comes from nerves other than the ones that cause erection. Those nerves may not be affected when the erectile nerves are, and are not damaged by prostate surgery, making orgasm possible without erection.
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for erectile dysfunction include:
- Age—The incidence of erectile dysfunction rises with age, ranging from 5% of the male population at age 40, to 15%-25% at age 65 and older.
- Medical conditions, including:
- Cardiovascular disease
- Arteriosclerosis—hardening of the arteries
- Chronic kidney disease
- Cirrhosis of the liver
- Chronic obstructive pulmonary disease (COPD)
- Peyronie's disease (bending of the penis caused by scar tissue)
- Endocrine disorders like hypogonadism, hyperthyroidism, hypothyroidism, and Cushing syndrome
- Neurological disorders like multiple sclerosis, peripheral neuropathy, and stroke
- High blood pressure
- Psychiatric disorders like anxiety, depression, and schizophrenia
- Psychological problems like stress, personal relationships, or new partners
- Trauma, whether through an accident or surgery:
- Vascular surgery
- Urologic surgery, such as prostate surgery
- Pelvic surgeries (particularly for prostate cancer)
- Spinal cord injury
- Certain behaviors can increase your risk of erectile dysfunction, including:
- Alcohol use
- Illegal drug use, such as heroin and marijuana
- Anabolic steroid use
- Heavy smoking
- Certain medications can increase your risk of erectile dysfunction. NOTE: If you suspect a medication may be the cause of your erectile dysfunction, do not stop taking the medication without talking to your doctor first.
- Histamine blockers
You will be asked about your symptoms and medical history, and a physical exam will be performed. Be prepared to identify every medication you are taking since as many as 25% of all erectile dysfunction cases are due to medications. Expect questions about the frequency, quality, and duration of your erections. Your answers may help determine if primarily psychological and/or physiological factors are causing your impotence.
Your penis, testes, and rectum will be examined. If a physical cause is suspected, laboratory tests may be ordered to evaluate:
- Blood glucose, lipids (cholesterol), and thyroid function.
- Testosterone —If you are over 50 or if your doctor suspects hypogonadism (small testes and reduced body hair), a blood test for testosterone will be ordered.
- Endocrine-related causes such as thyroid stimulating hormone (TSH), prolactin, and fasting blood sugar.
- Nocturnal erections —Potent men have spontaneous erections at night. If you do not remember them because you were asleep, there are devices that can measure and record them.
- Psychology —There are always psychological factors associated with sexual functioning, whether they are the cause or just a result. You and possibly your partner may be given a questionnaire to help determine what emotional and psychological factors may be contributing to your condition.
- Cardiac function tests—Poor cardiovascular function is associated with erectile dysfunction.
The treatment and management of erectile dysfunction involves medications, psychological counseling, lifestyle changes, possibly surgery, and attention to other medical conditions that may be causing dysfunction or affecting your sexual function.
The goal of treatment is to restore normal sexual function whenever possible and to discover alternatives to maintain or enhance the richness of your relationship. Treatment can include:
- Lifestyle changes:
- Quit smoking
- Manage your other medical conditions.
- Talk to your doctor about changing medications.
- Maintain a healthful diet, weight, and exercise program.
- Do not use recreational drugs.
- Consider counseling.
- Maintain the intimacy in your relationship.
- Medication options that include pills, urethral inserts, and injections.
- Surgery—when all other efforts to restore or bypass your ED have failed, surgery is still an option to restore erections.
- Penile implants can be semirigid and malleable or inflatable.
- A semirigid implant consists of 1 or 2 bendable rods that are inserted into the penis. Once installed and healed, the penis and the prosthesis can be bent into position. It can be placed upward for intercourse or downward for clothing and urination.
- An inflatable implant consists of a balloon-like cylinder that fits into the penis, a pump that is placed into the scrotum, and a reservoir of liquid that is placed nearby, inside the pelvis. The penis is limp until the pump is repeatedly squeezed, filling the balloon from the reservoir. After intercourse, the balloon in the penis can be deflated.
- Vascular Reconstruction—If circulation is reduced to your penis due to vascular disease, reconstruction of your arteries may restore erectile function. This is complex surgery that is performed in only a few hospitals in the United States. Occasionally, in these rare cases, the vascular defect can be repaired.
- Alternative therapies, like acupuncture or supplements, may be beneficial when used under the supervision of a qualified physician.
Penile Prostheses (Implant)
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Remember, you are not alone. Erectile dysfunction is a fairly common condition that usually responds well to treatment. Talk with your doctor about the best option for you. Bree Pell, FNP-BC, with Regional Health is available for consultation, diagnosis, and to discuss treatment options. To schedule an appointment, call the practice at (540) 674-4560 or click to book an appointment online below.