The term erectile dysfunction covers a range of disorders, including curvature of the penis during erection (Peyronie's disease), prolonged painful erection not associated with sexual desire (Priapism) and premature ejaculation. But typically, Erectile dysfunction (ED), also called impotence, is defined as man's inability to have an erection hard enough to have sex or to keep an erection long enough to finish having sex.
Erectile dysfunction affects the lives of 20 million to 30 million American men and their partners.
Although erectile dysfunction is more common in men over age 65, it can occur at any age. Still, it's important to realize that an occasional episode of erectile dysfunction happens to most men and is perfectly normal. In fact, in most cases it's nothing to worry about. As men age, it's also normal for them to experience changes in erectile function. Erections may take longer to develop, may not be as rigid or may require more direct stimulation to be achieved. Men may also notice that orgasms are less intense, the volume of ejaculations is reduced and recovery time increases between erections.
When erectile dysfunction proves to be a pattern or a persistent problem, however, it can harm a man's self-image as well as his sexual life. It can also be a sign of a physical or emotional problem that requires treatment. Erectile dysfunction was once a taboo subject. But attitudes are changing. More men are seeking help for the problem, and doctors are gaining a better understanding of what causes erectile dysfunction and are finding new and better ways to treat it.
Signs & Symptoms
Causes
Risk Factors
When to seek medical advice
Screening & Diagnosis
Treatment
Prevention
Coping Skills
It's also important for a man who experiences occasional or persistent erectile dysfunction to remember his sexual partner. Your partner may see your inability to have an erection as a sign of diminished sexual desire. Your reassurance that this is not the case can be helpful in this situation.
To appropriately treat erectile dysfunction and strengthen your relationship with your partner, try to communicate openly and honestly about your condition. Couples may also want to seek counseling to confront any concerns they may have about erectile dysfunction and to learn how to discuss their feelings. Couples should try to maintain this communication throughout the diagnosis and treatment process. In fact, treatment is often more successful if couples work together as a team.
Drugs for treating ED can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis. In March 1998, the Food and Drug Administration (FDA) approved Viagra, the first pill to treat ED. In August 2003, the FDA gave approval to a second oral medicine, vardenafil hydrochloride (Levitra). Additional oral medicines are being tested for safety and effectiveness.
Taken an hour before sexual activity, Viagra and Levitra work by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow.
While oral medicines improve the response to sexual stimulation, they do not trigger an automatic erection as injections do. The recommended dose for Viagra is 50 mg, and the physician may adjust this dose to 100 mg or 25 mg, depending on the patient. The recommended dose for Levitra is 10 mg, and the physician may adjust this dose to 20 mg if 10 mg is insufficient. Lower doses of 5 mg and 2.5 mg are available for patients who take other medicines or have conditions that may decrease the body's ability to use Levitra.
Neither Viagra nor Levitra should be used more than once a day. Men who take nitrate-based drugs such as nitroglycerin for heart problems should not use either drug because the combination can cause a sudden drop in blood pressure. Also, Levitra should not be taken with any of the drugs called alpha-blockers, which are used to treat prostate enlargement or high blood pressure.
Oral testosterone can reduce ED in some men with low levels of natural testosterone, but it is often ineffective and may cause liver damage. Patients also have claimed that other oral drugs--including yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone--are effective, but the results of scientific studies to substantiate these claims have been inconsistent. Improvements observed following use of these drugs may be examples of the placebo effect, that is, a change that results simply from the patient's believing that an improvement will occur.
Many men achieve stronger erections by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine, and alprostadil (marketed as Caverject) widen blood vessels. These drugs may create unwanted side effects, however, including persistent erection (known as priapism) and scarring. Nitroglycerin, a muscle relaxant, can sometimes enhance erection when rubbed on the penis.
A system for inserting a pellet of alprostadil into the urethra is marketed as Muse. The system uses a prefilled applicator to deliver the pellet about an inch deep into the urethra. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes. The most common side effects are aching in the penis, testicles, and area between the penis and rectum; warmth or burning sensation in the urethra; redness from increased blood flow to the penis; and minor urethral bleeding or spotting.
Research on drugs for treating ED is expanding rapidly. Patients should ask their doctor about the latest advances. (www.cure-ed.org )
