A Man's Guide to Erectile Dysfunction

Erectile dysfunction can be devastating to a man's sense of self, whether it's caused by physical or emotional causes. Learn about available treatments.

By Dennis Thompson Jr.

Medically reviewed by Pat F. Bass III, MD, MPH

Some men suspect low testosterone is the cause of erectile dysfunction but there are many other physical and emotional factors at play.

Erectile dysfunction is the inability to achieve or maintain an erection firm enough for sexual intercourse. Beyond the physical manifestations, erectile dysfunction causes much emotional damage, creating negative feelings that can range from anger to insecurity to a loss of self-esteem. A strong link has been found between erectile dysfunction and depression.

Erectile dysfunction is not rare. Between 15 and 30 million American men may experience it to some degree at some point in their lives. The number of men seeking medical help for erectile dysfunction surged after 1998, when the first effective drug was released, encouraging more men to come forward for treatment.

Causes of Erectile Dysfunction

An erection starts when sexual stimulation causes the brain, nerves, blood vessels, and hormones to send impulses to muscles surrounding two chambers of spongy tissue in the penis known as the corpora cavernosa. Those muscles then relax, allowing blood to flow into the spongy tissue and making the penis expand, resulting in an erection. Another group of muscles closes off blood flow once erection is achieved, allowing a man to maintain his erection.

Erectile dysfunction occurs when that sequence of events is disrupted by any one of many factors, including:

• Illness: Trauma or disease that damages any of the structures of the penis, including muscles, nerves, or arteries, can cause erectile dysfunction. In up to 70 percent of men it can be traced to conditions like diabetes, alcoholism, and kidney, vascular, and neurologic diseases, among other health conditions.
• Unhealthy lifestyle: Smoking, being overweight, being sedentary, and other unhealthy habits contribute to the diseases that cause erectile dysfunction.
• Surgery: Damage to the nerves, arteries, and organs necessary for achieving and maintaining erection can be a side effect of some surgical procedures.
• Medications: Side effects of drugs for totally unrelated conditions, from high blood pressure meds to allergies treatments to appetite suppressants, can include erectile dysfunction.
• Emotional issues: Problems from stress at work to disorders like depression and even the fear of being unable to perform sexually may explain as many as 20 percent of cases of erectile dysfunction.

Erectile Dysfunction: Treatments That Work

Drugs to treat erectile dysfunction are one of the medical breakthroughs of the last decade. Called phosphodiesterase (PDE) inhibitors, they boost the effects of nitric oxide, the chemical responsible for proper blood flow to the penis. These drugs include:

• Viagra (sildenafil citrate)
• Levitra (vardenafil hydrochloride)
• Cialis (tadalafil)

Talk to your doctor about any drugs you’re taking because of the potential for dangerous interactions. For instance, if you take nitroglycerin for heart problems like angina or alpha-blockers for high blood pressure, taking a PDE can cause a sudden drop in blood pressure and may not be the right option for you.

These other erectile dysfunction treatments that have also been proven effective:

• Certain drugs can be injected into the penis to achieve an erection, though there are side effects, including erections that last too long.
• A drug called alprostadil, contained in a small pellet, is inserted into the urethra and creates an erection within minutes; it, too, has side effects, including an achy or burning sensation.
• A vacuum pump is available that draws blood into the penis.
• Surgery can be performed to implant a device in the penis to create an erection; problems with implants include mechanical breakdown and infection.

Erectile Dysfunction: Avoid Unproven Treatments

A number of over-the-counter herbal products — hawked on late night cable television or through those spam emails that flood your inbox — often promise natural male enhancement. Unfortunately, there haven’t been any scientific studies to show that any of them have value. Touted herb supplements to be particularly aware of are those containing arginine, ginkgo biloba, ginseng, horny goat weed, maca root, tribulus terrestris, and yohimbe. None have been shown to improve a man's ability to achieve or maintain an erection, and you stand to lose time and possibly hundreds of dollars to find that out, according to the consumer watchdog group, the Center for Science in the Public Interest.

If you’re experiencing erectile dysfunction, as stressful as the condition is, there has never been a better time to talk to your doctor about the prescription choices available.

Learn more in the Everyday Health Men's Health Center.

http://www.everydayhealth.com/mens-health/erectile-dysfunction.aspx?xid=salesnl_7060_20130517