Sexual/Erectile Dysfunction (ED)

• What Can Cause ED
• Diagnosis and Treatment
  

If you’re feeling frustrated because of sexual problems, we can help.

Erectile dysfunction (ED) means that a man can’t get and hold an erection during sex. If it happens just sometimes – less than one in five times-- this is normal and usually doesn’t require treatment. Think of it as just an “off day.”

If it’s an ongoing problem, you want to talk it over with your urologist at John Muir Health. There may be an underlying physical problem that needs to be treated before you can get your sexual function back to where you want it to be.

ED can happen at any age, but is more likely to occur in older men. According to the Massachusetts Male Aging Study, severe ED increases from 5 percent in men 40 years of age to 15 percent in men 70 years and older.

There is usually a physical problem behind erectile dysfunction. That why it’s important to talk it over with your doctor.

What Can Cause Erectile Dysfunction (ED)

ED is not a natural part of aging. In most cases, it is caused by a physical problem, which can include:

• Cardiovascular disease, such as clogged blood vessels or hardening of the arteries. The main artery in the penis is only 1 millimeter in size. If blood cannot flow freely through this vessel, then ED can occur.
• Cardiovascular risks like high cholesterol, obesity, and high blood pressure
• Diabetes
• Nervous system diseases like multiple sclerosis and Parkinson’s
• Low testosterone

ED can also be caused by lifestyle choices that put your health at risk, such as drinking too much alcohol, use of narcotics, and smoking – or by behavioral conditions like anxiety and stress.

Sometimes medications can cause ED, but this not common. If you are taking a new medication and begin having erection problems, talk to your doctor; your medication or the dose you take may need to be changed.

Making some lifestyle changes on your own can help you get erectile dysfunction under control.  

Tips to Control ED

• Avoid smoking and the use of alcohol and narcotics
• Get regular exercise to help reduce stress, lose weight, and increase blood flow
• Talk the problem over with your partner – often it helps to get it out into the open and see what the two of you can do to relieve stress
• Learn relaxation techniques through the practice of yoga or mediation to help reduce stress. Biofeedback therapy, a technique that trains you to control certain physiological processes by giving you immediate feedback, can also be very effective in reducing stress.
  

Diagnosis and Treatment

• Erectile dysfunction is a very treatable condition, and most men see improvements over time
  

What to Expect

Your doctor can diagnose what is causing your erectile dysfunction by getting a history of your health and doing a physical exam. Because there can be many different causes, additional tests might be recommended, such as a blood profile, urine tests, or a cardiovascular evaluation.

Treatment

Your treatment plan might be as simple as making some lifestyle changes, like avoiding alcohol. Or medication might be the right remedy for you. In many cases, there is an underlying physical problem causing the condition – such as a clogged blood vessel that keeps your penis from getting the blood it needs for erection.

Whatever the cause, erectile dysfunction is a very personal condition. At John Muir Health, your treatment plan will be as individual as you are.
 
For many men we treat at John Muir Health, medication alone can be effective in treating erectile dysfunction.

Non-surgical Options

• Medication: In about 75-80% of cases we treat, medication can help most men. These medications are not for everyone. They can be dangerous if you have heart disease and are taking a medicine that contains nitrates, like nitroglycerin. You and your doctor can determine if medication is right for you.
• Options to aid a sustained erection:
  • Vacuum erection device: a hollow tube that you place over your penis and pump to create a vacuum that pulls blood into your penis
  • Injection therapy: self-injection of medication into penis
  • Suppository: expands blood vessels and increases blood flow to penis
  • Testosterone replacement

Surgical Options

Penis implants: This surgery is done on an outpatient basis with a recovery time of one to two weeks.  Penis implants come in two forms:

• Inflatable implants work like a bicycle tire, so you can control when and how long you hold an erection.
• Semi-rigid implants keep your penis firm, but able to bend.