Return to Sexual Problems - Overview

When a man becomes sexually aroused, increased blood flow to the genital area readies the body for intercourse. The penis becomes enlarged and erect. In men with erectile dysfunction (ED), however, this physical response doesn't happen as it should. And this isn't just a one-time or occasional occurrence. In fact, occasional failure to become aroused or desiring sex less often than your partner is perfectly normal. Stress, fatigue and anxiety can affect the body's response to sexual stimulation. The problem occurs when this lack of response happens persistently and on a regular basis for more than 25 percent of the time. With ED, intercourse is difficult or impossible.

ED is not only a common problem, particularly among older men, but also it is undertreated. The Massachusetts Male Aging Study of middle-aged and older men showed 35 percent of men ages 40 to 70 years had complete ED, which was strongly related to age, health status and emotional function. According to the American Medical Association (AMA), about 20 million American men, mostly older than 65, are affected. It is difficult to calculate an exact number because less than 10 percent seek treatment.

The following information is designed as a basic introduction to possible causes of and treatments for ED. If you suspect a problem, talk with your doctor or other health care professional.

Causes

Once thought to be a psychological condition, most cases of ED are now known to have a physical cause, such as a disease, an injury or a side effect from a drug. Certain medications can interfere with the nerve signals that cause an erection. Hardening of the arteries and high blood pressure can damage blood vessels and interfere with blood flow to the penis. Smoking is a major risk factor for these conditions as well as for ED. Diabetes can damage nerves and interfere with erection. Surgery for prostate cancer may cause ED. Other possible physical causes include alcoholism, liver failure, hormonal abnormalities (such as low testosterone) and neurological disorders. In most cases of ED, even when there is also a definite physical cause, men may feel anxious, guilty or depressed, which can make the problem worse.

Treatments

The AMA estimates 95 percent of ED cases are treatable through one of the following measures.

• Drug therapy: Viagra® (sildenafil) was approved by the U.S. Food and Drug Administration in 1998. Taken an hour or so before sexual activity, it increases the concentration of a natural chemical in the penis that causes the blood vessels to dilate, which increases blood flow to the penis. Unlike injection therapy (see below), it doesn't cause an automatic erection. Rather, it works in response to sexual stimulation. However, sildenafil isn't right for everyone. Men who have heart problems and take medications that help widen the coronary arteries are not good candidates because the drug combination can lower blood pressure dangerously. Some men with hormonal imbalances may be helped by testosterone shots, or skin patches. In 2003 the FDA approved Levitra® (vardenafil) for the treatment of ED. The way it works is similar to sildenafil. The latest medication approved for erectile dysfunction is Cialis® (tadalafil). It differs from the other two drugs only because its effects persist for 36 hours, rather than just a few hours.

• Psychotherapy: Whether there is a physical cause or not, men may benefit from working with a therapist to learn techniques that can decrease anxiety associated with intercourse.

• Vacuum constriction device: This involves placing a plastic tube over the penis and pumping the air out of the tube, drawing blood into the penis and making it erect. An elastic band is placed around the base of the penis to maintain the erection.

• Penile injection therapy: Medication injected directly into the side of the penis causes the blood vessels to widen and erection to occur.

• Intraurethral therapy: A soft pellet of medication is inserted into the urethra. Its absorption produces an erection.

• Surgery: Surgery may involve one of three procedures: implanting a device (prosthesis) that can cause the penis to become erect; reconstructing arteries to increase blood flow to the penis; or repairing the veins within the penis that are failing to keep sufficient blood within the organ. Artery reconstructions and vein repairs have generally not given good long-term benefits.

All these treatments have different complications and side effects. So men should work with their doctors to determine what's right for them.

Risk of blindness

In 2005, the Food and Drug Administration (FDA) approved updated labeling for Cialis, Levitra and Viagra to reflect a small number of reports of sudden vision loss, attributed to NAION (non arteritic ischemic optic neuropathy), a condition where blood flow is blocked to the optic nerve. The FDA advises patients to stop taking these medicines, and call a doctor or health care provider right away if they have sudden or decreased vision loss in one or both eyes. Further, patients taking or considering taking these products should inform their health care professionals if they have ever had severe loss of vision, which might reflect a prior episode of NAION. Such patients are at an increased risk of developing NAION again.

At this time, it is not possible to say if these medicines for erectile dysfunction were the cause of the loss of sight or whether the problem is related to other factors such as high blood pressure or diabetes, or to a combination of these problems.

Related Articles Male Sexual Problems Other Than Erectile Dysfunction Sex in Your 50s and Beyond Illness and Other Health Conditions Affecting Sexuality Sexual Dysfunction: a Widespread Problem Sexual Problems: Why Diagnosis Is Difficult

External Sources American Foundation for Urologic Disease. Non-Surgical Management of Erectile Dysfunction (ED). Accessed May 22, 2007. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Erectile Dysfunction. Accessed May 21, 2007.

This article was reviewed and updated June 2007.