While many men shy away from discussing erectile dysfunction with their doctor, many treatments are available.
Physical causes of erectile dysfunction are more common in older men, while younger men tend to experience erectile dysfunction due to psychological factors. While not considered a normal part of aging, erectile dysfunction often results from underlying conditions that are common in older men.
Psychological erectile dysfunction tends to happen abruptly and occur because of a recent situation involving stress, alcohol, or drugs. One factor indicating a physical condition over a psychological one is the inability to have or maintain an erection upon waking up in the morning. A person with erectile dysfunction that persists for three months and cannot be linked to a stressful event, drugs, alcohol, or a specific medical condition should seek medical attention from a urologist.
- Blood vessel disorders.
- Any condition that deprives the penis of oxygen-rich blood can lead to erectile dysfunction.
- Hypertension (high blood pressure), which affects the arteries.
- Atherosclerosis, the process of fatty plaque deposits accumulating on artery walls and constricting blood vessels.
- A blood clot or vascular surgery can impair blood flow to the penis.
- Nerve damage affecting nerves that travel to and from the penis can result in erectile dysfunction.
Such damage can occur due to the following:
- Spinal cord injury, lower spinal disease, and pelvic trauma, such as a fracture, can damage nerves that contribute to erections.
- Diabetes mellitus often leads to atherosclerosis and nerve damage that can affect the penis.
- Alcoholism may also cause nerve damage.
- Multiple sclerosis affects the central nervous system and leads to sexual dysfunction in many male patients.
- Rectal or prostate surgery may also damage the penis nerves.
About 25% of erectile dysfunction cases are attributed to certain medications, including:
- High blood pressure medications.
- Anti-ulcer medications.
- Chemotherapy drugs.
- Drugs used for psychological disorders, i.e. antidepressants, anti-anxiety, and anti-psychotic drugs.
- Ketoconazole (antifungal medication).
- Drugs with anticholinergic side effects, which impair part of the nervous system.
- Male hormone-blocking drugs.
- Hormonal Disturbances. Low levels of testosterone can produce erectile dysfunction.Note that the low male hormone levels associated with aging tend to contribute to a lower sex drive, not to erectile dysfunction.
Psychological Factors. These can include the following:
- Performance anxiety.
- Sexual guilt.
- Fear of intimacy.
- Ambivalence about sexual orientation.
Medical & Personal History. Your urologist will ask some frank, personal questions.
These questions will address:
- The onset of the dysfunction the frequency, quality, and duration of any erections whether erections occur at night or in the morning.
- Medical & sexual history.
- Current stresses in your life.
- Any medications you are taking.
While these questions may seem intrusive, they are necessary to properly treat your individual condition. The urologist may also ask to speak to your sexual partner.
A physical exam will include: examination of the genital area. a digital rectal exam. ruling out of any medical conditions like hypertension, diabetes, atherosclerosis, and nerve damage.
Blood tests measure:
Prolactin levels, if necessary, to find any endocrine system dysfunction.
PSA levels (if over age 40) Thyroid and adrenal gland functions.
Imaging techniques, i.e. ultrasound and/or X-rays help evaluate blood flow to the penis. The Penile Brachial Index compares the blood pressure in the penis with the blood pressure in the arm to see any problems with arterial flow to the penis. An injection to dilate penile arteries will help the urologist observe erectile response, curvature of the penis, and response after erection.
Sexual activity can help prevent erectile dysfunction, as frequent erections stimulate penile blood flow. Kegel exercises — tightening and releasing the pelvic muscles — may help improve blood circulation to the pelvic area.
Changing or reducing any medications that may be contributing to erectile dysfunction.
Psychotherapy or Behavioral Therapy is often recommended for those suffering from erectile dysfunction, regardless of the cause.
Partners are often involved in this process. Viagra, a relatively new oral medication, has offered hope to many men.
Other medications can be inserted or injected into the penis with relatively little discomfort.
Vacuum devices and other external management techniques are safe, effective, and simple to use in most cases. Penile implants, which require outpatient surgery and are effective for many men. When damage to the arteries or blood vessels is causing erectile dysfunction, vascular surgery may be recommended