Erectile Dysfunction

Erectile dysfunction is defined as the inability to achieve or maintain an erection. Chronic erectile dysfunction affects approximately 5 percent of men in their 40s and 15-25 percent of men over the age of 65. Transient erectile dysfunction can affect up to 50 percent of men between the ages of 40 and 70.

Under normal physiological conditions, neurotransmitters in the brain initiate an erection by sending messages to the vascular (blood) system to increase blood flow to the penis. The corpora cavernosa (tubes of connective tissue) and erectile tissue in the penis expand as a result of the increased blood flow and pressure. Following ejaculation, pressure in the penis decreases to reduce blood flow and allow the penis to resume its normal shape.

Erectile dysfunction may be caused by the following conditions:

  • Nerve damage
  • Reduced blood flow to the penis
  • Vascular disease
  • Venous leak (vein leakage)
  • Diabetes and other hormonal disorders
  • Neurologic conditions
  • Pelvic trauma
  • Damage from surgery or radiation therapy
  • Peyronie's disease (scarring of erectile tissue)
  • Psychological conditions
  • Certain prescription drugs

Patients suffering from erectile dysfunction often experience negative psychological side effects. They may have low self esteem or feel inadequate as a sexual partner. Partners of patients suffering from erectile dysfunction may also feel the emotional strain of the diagnosis.

Specific laboratory tests may be performed to determine the cause of erectile dysfunction including:

Blood Tests
These tests may involve checking hormone levels, cholesterol, blood sugar, liver and kidney function and thyroid function.

Urinalysis
This procedure is used to analyze protein, sugar and hormone levels that can indicate diabetes, kidney problems and testosterone deficiency.

Nocturnal penile tumescence (NPT)
This procedure is used to measure changes in penile rigidity and circumference during nighttime erection, as men typically have erections five to six times a night.

Treatment of erectile dysfunction begins with non-surgical procedures. If a patient suffers from erectile dysfunction because of a psychological problem, they often have success through visits with sex therapists. Medication for erectile dysfunction caused by physiological conditions can include oral enzyme inhibitors such as Viagra, Levitra and Cialis, self-injected medication, urethral suppositories or vacuum erection devices.

Surgical treatment for erectile dysfunction may include penile implants or vascular reconstructive surgery.

Penile implantation is a surgical procedure where malleable or inflatable rods are inserted into the penis. There are three forms of penile prostheses: semi-rigid prostheses, inflatable prostheses and self-contained prostheses.

  1. Semi-rigid prostheses involve the surgical implantation of a silicon-covered flexible metal rod that provides rigidity for intercourse.
  2. Inflatable penile prostheses involve the surgical implantation of two soft silicone or plastic tubes into the penis, a small reservoir in the abdomen and a small pump in the scrotum. A patient produces an erection with this prosthesis by squeezing the pump in the scrotum to move sterile liquid from the reservoir in the abdomen into the tubes. A valve moves fluid back to the reservoir to stop the erection.
  3. Self-contained inflatable prostheses consist of a pair of inflatable tubes inserted into the penis with a pump attached to the end of the implant and a reservoir located in the shaft of the penis.

Click here to learn more about penile implants as a treatment option for erectile dysfunction.

Vascular reconstructive surgery can be performed to improve blood flow to the penis.

Click here to learn more about top risk factors for men's health.