Definition & Overview

Erectile dysfunction (ED), sometimes also known as impotence, refers to the inability to get or keep an erection. Although occasional ED can be considered normal particularly during times of stress, frequent ED can be a sign of health problems that require treatment.

ED can be treated with a range of methods including the use of medications, natural remedies, lifestyle changes, erectile dysfunction vacuums, and penile implants, among several others. It is important for patients to receive the proper treatment based on the general state of their health, taking into consideration any existing medical conditions that could be playing a role or contributing to the disorder. Treatments are thus chosen depending on the underlying cause of the condition, as well as its severity. Each of these treatment options comes with certain risks and potential complications.

Who Should Undergo and Expected Results

In the United States, more than 18 million men over the age of 20 suffer from mild to severe erectile dysfunction and although it is not a normal consequence of aging, it becomes more likely as men age. Statistics show that about 5% of all 40-year-old men suffer from ED, and this percentage rises to up to 25 percent for older men.

Erectile dysfunction has been linked to several possible causes, including but not limited to:

  • Vasculogenic conditions, or those that affect the flow of blood going to the penis, including:
  • Cardiovascular disease, including atherosclerosis or when the arteries leading to the heart harden and become narrow
  • Hypertension
  • Neurogenic conditions, such as:
  • Parkinson’s disease
  • Multiple sclerosis
  • Spinal injury
  • Spinal disorder
  • Stroke
  • Diabetes
  • Mental health problems (and their treatments), such as:
  • Depression and antidepressants
  • Schizophrenia and antipsychotics
  • Anxiety
  • Traumatic stress disorder related to past sexual problems or sexual abuse
  • Stress
  • Unhealthy lifestyle habits, such as excessive alcohol consumption and the use of illicit drugs especially heroin, cannabis, and cocaine
  • Other lifestyle habits, such as regular cycling especially when the patient rides in an incorrect position
  • Reduced libido
  • Hormonal conditions, such as:
  • Hypogonadism
  • Hyperthyroidism
  • Hypothyroidism
  • Cushing’s syndrome
  • Problems with the physical structure of the penis
  • Peyronie’s disease
  • Severe head injury
  • Penis injury
  • Any surgery performed on the penis or the pelvic area
  • The use of certain medications, particularly:
  • Diuretics
  • Antihypertensives
  • Fibrates
  • Corticosteroids
  • Antihistamines
  • Anticonvulsants
  • Anti-androgens
  • Chemotherapy medications


The goals of erectile dysfunction treatment are to determine the underlying cause of the problem and treat the erectile problem as a symptom and any related medical conditions. By treating any underlying condition, it is believed that ED will also be resolved.

How is the Procedure Performed?

Since erectile dysfunction has many possible causes, treatment can be approached in several different ways and may involve different doctors including a urologist, psychologist, and general practitioner, among others.

Upon presentation of symptoms related to erectile dysfunction, a general practitioner will prescribe some standard health tests to make a diagnosis. The doctor will also assess the patient’s lifestyle and habits to determine whether these factors are to be considered in formulating the treatment plan.

Once the cause of the problem is determined, the doctor will attempt to resolve the underlying medical condition first, while also advising the patient to make lifestyle changes to avoid aggravating the problem.

Based on the specific circumstances surrounding each case, doctors often formulate a treatment plan that involves a combination of different treatment methods, which include:

  • Lifestyle changes - Overweight individuals are advised to lose weight and achieve better fitness, while smokers are advised to quit smoking. Patients who consume a lot of alcohol or who take illicit drugs are advised to reduce or completely stop consumption. Regular exercise (especially pelvic floor muscle exercises) as well as stress relief techniques may also be recommended.

  • Medications - Patients may also be given medications specifically for ED, such as:

  1. PDE-5 - Currently, the most widely used ED medication is PDE-5, or phosphodiesterase-5 inhibitors, which temporarily increase the flow of blood going to the penis. The drug is currently marketed under different forms and names, such as sildenafil (Viagra), tadalafil (Cialis), avanafil (Spedra), and vardenafil (Levitra). However, these medications work for only 8 hours, so they have to be taken repeatedly or when the patient desires to have sexual intercourse, and their effects are only triggered by sexual arousal. Only one of them, tadalafil, provides long-term benefits, lasting for up to 36 hours after the medicine is taken. There is no guarantee, though, that these medications will work for every patient, and there are also some contraindications that make them unsafe for some, such as those who suffer from cardiovascular disease, Peyronie’s disease, and priapism (painful erections lasting several hours). They may also cause dangerous interactions when combined with alpha-blockers and used by patients who also suffer from low blood pressure, angina, and non-arteritic anterior ischaemic optic neuropathy.

  2. Alprostadil – Reserved only for severe cases wherein the ED does not respond to PDE-5 or other treatment options for that matter, Alprostadil is a synthetic hormone that can stimulate blood flow to the penis. It is given through a direct penile (intracavernosal) injection or urethral application, wherein a small pellet is placed inside the urethra. The drug can produce erections 5 to 15 minutes after application, and the duration of erections depends on the dosage used.

  • Medical devices, such as vacuum pumps - These are clear plastic tubes connected to a manual or battery-operated pump. They work by creating a vacuum and causing blood to fill up the penis leading to an erection. The pumps also come with a rubber ring that can be placed around the base of the penis to help maintain the erection for up to 30 minutes. The use of vacuum pumps is often effective for 9 out of 10 ED sufferers, regardless of the cause of ED.

  • Hormone therapy - Patients who suffer from ED as a symptom of a hormonal condition may receive hormone therapy, which is overseen by endocrinologists.

  • Penile implants - ED patients may also opt for penile implants, which can be semi-rigid or inflatable. Inflatable implants provide a more natural erection, but may not be effective among older men who seldom have sexual intercourse, in which case semi-rigid implants are more suitable.

  • Surgery - ED can also be treated surgically, but only as a last resort if all other treatment attempts have failed, or when the patient has a physical/anatomical/structural issue with his penis or is suffering from a serious pelvic injury.

  • Psychological treatments - If the patient’s ED symptoms are traced back to existing psychological issues, the patient may undergo psychological treatments, such as psychosexual counselling, cognitive behavioural therapy, or sensate focus (sex therapy).

Possible Risks and Complications

The different erectile dysfunction treatment options come with their own sets of potential risks and complications. For those taking medications such as PDE-5 inhibitors, the risks include:

  • Flushing or redness
  • Headaches or migraines
  • Nausea
  • Vomiting
  • Back pain
  • Stuffy nose
  • Runny nose
  • Indigestion
  • Vision problems
  • Muscle pain


The use of alprostadil, on the other hand, can cause blood pressure changes, pain in the penis, urethral bleeding or a burning sensation, swelling at the injection site, and headaches. It is also contraindicated in patients who have a penile implant and those who are suffering from balanitis, or infection and inflammation of the penis head.

As for the use of vacuum pumps, these devices may also be unsafe for some patients, such as those who suffer from bleeding disorders and taking anticoagulant medications. Improper use of the pumps may also cause bruising and pain.

References:

  • Javaroni V., Neves MF. “Erectile dysfunction and hypertension: Impact on cardiovascular risk and treatment.” International Journal of Hypertension volume 2012. http://www.hindawi.com/journals/ijhy/2012/627278/

  • Burns-Cox N., Gingell C. “Medical treatment of erectile dysfunction.” Postgrad Med J. 1998 Jun; 74(872): 336-342. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2360949/

  • Levine L. “Diagnosis and treatment of erectile dysfunction.” The American Journal of Medicine. http://www.amjmed.com/article/S0002-9343(00)00655-0/abstract

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