What ED is
Erectile dysfunction (ED) means having trouble getting or keeping an erection firm enough for sex. Occasional trouble is common and is not ED. ED is when it happens regularly. It can affect men of all ages, and it can have a real effect on quality of life, so it is worth treating.
Signs and effects of ED can include:
- Trouble getting an erection
- Trouble keeping an erection
- Erections that are less firm than before
- Stress and anxiety around sex
- Lower sex drive
- Low self-esteem
- Not being able to have intercourse
ED can be an early warning sign. Erections depend on healthy blood vessels and nerves. ED can be an early sign of heart disease or diabetes, sometimes before other symptoms appear. That is one reason an evaluation matters, not just a prescription.
What causes it
ED often has more than one cause. Common ones are:
- Medical conditions such as high blood pressure, diabetes, heart disease and prostate cancer
- Psychological factors such as anxiety, depression and stress
- Lifestyle habits such as smoking, alcohol or drug use, and lack of exercise
- Medicines such as antidepressants, blood pressure medicines and antihistamines
- Hormone problems such as low testosterone
- Nerve conditions that affect the nerves to the penis
- Injury or trauma to the genital area
Your visit
Dr. Su asks about your symptoms, your health and the medicines you take, and does a physical exam. Blood tests, such as a testosterone level and blood sugar, may be part of the workup. Improving what is behind the ED, for example quitting smoking, being more active or adjusting a medicine, can help on its own and makes other treatments work better.
Treatment options
Most men start with pills and move to other options only if they need to. Dr. Su offers five main treatments.
PDE5 inhibitors
Oral medicines that increase blood flow to the penis to help you get and keep an erection. They work with sexual stimulation.
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Levitra)
- Avanafil (Stendra)
Intraurethral suppositories
A small medicated pellet is placed into the urethra, the opening at the tip of the penis. A good option if you cannot or do not want to take pills or use injections. It can cause some discomfort or irritation in the urethra.
Penile injections
Also called intracavernosal injection therapy (ICI). Medicine is injected into the base of the penis with a very fine needle. It widens the blood vessels and increases blood flow, producing an erection.
- Alprostadil
- Bimix
- Trimix
Low-intensity shockwave therapy
Sometimes called pulsewave therapy. A device delivers low-intensity sound waves to the penis. The aim is to stimulate the growth of new blood vessels and improve blood flow for better erections. It is usually painless, with few reported side effects, and it involves several sessions over a few weeks.
Inflatable penile prosthesis
A penile implant is a device placed surgically for severe ED that has not responded to other treatments. Cylinders sit inside the penis, with a pump in the scrotum and a small fluid reservoir. Squeezing the pump moves fluid into the cylinders to create an erection. It can be a safe and effective option for severe ED.
Dr. Su also places non-inflatable (malleable) implants and two-piece inflatable implants. She will explain which type suits you if you decide on an implant.
Go to the emergency room if an erection lasts more than 4 hours, especially after an injection or suppository. This is called priapism, and it needs prompt treatment to prevent lasting damage.
ED after prostate cancer treatment
Prostate cancer and its treatment can affect erections. The same treatment options apply. If you are facing prostate cancer surgery, ask Dr. Su about nerve-sparing robotic prostatectomy, which aims to preserve the nerves responsible for erections when it is safe to do so.
Questions patients ask
Is ED just part of getting older?
ED becomes more common with age, but it is not something you simply have to accept. It can be treated at any age, and it can point to other health problems worth finding.
Can I take ED pills with my heart or blood pressure medicines?
Many men can, but not everyone. PDE5 inhibitors must never be taken with nitrate medicines such as nitroglycerin, because together they can drop your blood pressure dangerously. Care is also needed with alpha-blockers, which are often used for prostate symptoms. Tell Dr. Su every medicine you take.
What if pills do not work for me?
There are still good options. Suppositories and penile injections work in a different way from pills, and a penile implant is an option for severe ED that has not responded to other treatments.
Can anyone tell I have a penile implant?
The parts of an inflatable implant sit inside the body, with the pump in the scrotum, so it is generally not noticeable to others.