WHAT IS ERECTILE DYSFUNCTION

Your sexual wellness is an integral part of your overall happiness. As we age, erectile dysfunction isn't uncommon, yet many men suffer silently, too embarrassed to speak about their symptoms with their family doctor. Having the ability to access various forms of treatments is essential to meet your individual needs.

With Erectile Dysfunction (ED), it is difficult to get or keep an erection that is rigid enough for sex. When ED becomes a problem, your family doctor can help. ED could be a warning sign of cardiovascular disease, revealing blockages potentially building in a man's vascular system. It is crucial to rule this out to ensure it isn't your ED's underlying cause.

If ED is affecting your sexual well-being or your relationships, you don't need to suffer silently. Standard treatment options using ED medication, like Viagra or Cialis, can fix or enhance your erectile function, improve circulatory health and get you back on track with a satisfying sex life.

Physical Causes of ED

• There is not enough blood flow into the penis. Many health issues can reduce blood flow, such as hardened arteries, heart disease, high blood sugar (Diabetes), and smoking.
• The penis cannot trap blood during an erection. If blood does not stay in the penis, a man cannot keep an erection. This issue can happen at any age.
• Nerve signals from the brain or spinal cord do not reach the penis. Certain diseases, injuries, or surgery in the pelvic area can harm nerves in the penis.
• Diabetes can cause small vessel disease or nerve damage to the penis.
• Cancer treatments near the pelvis can affect the penis' function. Surgery and radiation for lower abdomen or pelvis cancers can cause ED. Treating prostate, colon-rectal, or bladder cancer often leaves men with ED. Cancer survivors should see a Urologist for sexual health concerns.
• Drugs used to treat other health problems can negatively impact erections.
• Patients should talk about drug side effects with their primary care doctors.

Emotional Causes of ED

Regular sex needs the mind and body to work harmoniously. Emotional or relationship problems can cause or worsen a person's ED. Some emotional issues that can cause ED are:

• Depression
• Anxiety
• Relationship issues
• Stress at home or work
• Stress from social, cultural, or religious beliefs
• Worrying about sexual performance

Oral Medications

A reliable and efficient treatment for erectile dysfunction is oral medications, including:

• Sildenafil (Viagra)
• Tadalafil (Adcirca, Cialis)
• Vardenafil (Levitra, Staxyn)
• Avanafil (Stendra)

ED medication works by enhancing the effects of nitric oxide, a natural chemical the body produces that relaxes muscles in the penis. Increasing blood flow allows a man to get and maintain an erection. Sexual stimulation is first required before taking the medication, which releases nitric oxide from the penile nerves. These medications boost the signal, allowing normal penile function to take effect.

The medications vary in dosage, how long they work, and their side effects. If side effects occur, they typically include flushing, nasal congestion, headache, visual changes, backache, and stomach upset. If you do not obtain an erection, contacting your physician is essential. Do not take more or increase your dosage without first speaking to your doctor. Your doctor will assess your situation to determine which medication will work best for you. These medications might not treat your erectile dysfunction immediately.

Before taking any medication for erectile dysfunction, including over-the-counter supplements and herbal therapies, get your doctor's approval. Medications for ED do not work for everyone and might be less effective in certain conditions, such as after prostate surgery or if you have diabetes. Some medications might also be dangerous if you:

• Take nitrate drugs — commonly prescribed for chest pain (angina) — such as nitroglycerin (Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Monoket) and isosorbide dinitrate (Isordil, Bidil)
• Have heart disease or heart failure
• Have shallow blood pressure (hypotension)

Other Treatments

Other treatments for erectile dysfunction include:

• Alprostadil self-injection. With this method, you use a fine needle to inject alprostadil (Caverject, Edex) into the base or side of your penis. In some cases, medications generally used for other conditions are used for penile injections on their own or in combination. Examples include alprostadil and phentolamine. Often these combination medications are known as bimix (if two medications are included) or trimix (if three are included).
• Each injection is dosed to create an erection lasting no longer than an hour. Pain from the injection is usually minor.
• Side effects can include mild bleeding from the injection, prolonged erection (priapism), and, rarely, formation of fibrous tissue at the injection site.
• Alprostadil urethral suppository. Alprostadil (Muse) intraurethral therapy involves placing a tiny alprostadil suppository inside your penis in the penile urethra. You use a special applicator to insert the suppository into your penile urethra. The erection usually starts within 10 minutes and, when practical, lasts between 30 and 60 minutes. Side effects might include a burning feeling in the penis, minor bleeding in the urethra, and the formation of fibrous tissue inside your penis.
• Testosterone replacement. Some people have erectile dysfunction that might be complicated by low hormone testosterone levels. In this case, testosterone replacement therapy might be recommended as the first step or given in combination with other therapies.
• Penis pumps. A penis pump (vacuum erection device) is a hollow tube with a hand-powered or battery-powered pump. The tube is placed over your penis, and then the pump is used to suck out the air inside the tube. This creates a vacuum that pulls blood into your penis.
• Penile implants. This treatment involves surgically placing devices into both sides of the penis. These implants consist of either inflatable or malleable (bendable) rods. Inflatable devices allow you to control when and how long you have an erection. The malleable rods keep your penis firm but bendable.
• Shock Wave Therapy. LI-ESWT for ED works by applying low-intensity shock waves to the penis. A practitioner uses a handheld probe to administer the treatment. People do not usually need any freezing before treatment and may experience a tingling sensation in the treatment area. A session typically lasts around 15 minutes; repeat treatments are often required. A process called angiogenesis stimulates new blood vessel growth and increases penile blood flow, which may improve erectile function.

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