Erectile Dysfunction
Overview
Erectile dysfunction, or impotence, is the inability to get and keep an erection sufficient for intercourse. It is estimated that over 50 percent of men in the U.S. suffer from ED. Years ago it was thought that most causes of ED were psychological. We now know that most causes of ED are physical (90 percent).
Physiology of Erection
An erection occurs after sexual stimulation causes causing a relaxation of smooth muscle cells in the penis which allows an increase of blood flow into the penis. A normal erection allows a temporary trapping of blood to maintain an erection.
Causes
- Peyronie’s disease
- Low testosterone
- Vascular disease
- High blood pressure
- High cholesterol
- Diabetes
- Smoking
- Obesity
- Medications (i.e., depression, high blood pressure)
- Pelvic surgery or radiation (i.e., cancer treatment)
- Psychological stress or anxiety
Complications
Erectile dysfunction may cause stress, cause relationship problems, affect self-confidence, and impair the ability to achieve a pregnancy.
Evaluation and treatment
Evaluation will include a comprehensive history and physical examination and assessment of serum hormones. Penile doppler ultrasound may be utilized to aid in the assessment of the penile soft tissue and blood vessel anatomy. Treatments are tailored to patients’ needs and are aimed at improving a sexual function and satisfaction.
Treatments
- Oral medications
- Penile injections
- Urethral suppositories
- Vacuum erection devices
- Inflatable penile prosthesis
- Testosterone supplementation