Miner M, Nehra A, Jackson G, et al. All men with vasculogenic erectile dysfunction require a cardiovascular workup. Am J Med. 2014;127(3):174-182. PMID: 24423973 pubmed.ncbi.nlm.nih.gov/24423973/.
If your inability to get an erection is stemming from an underlying psychological condition, it can be really hard to find the focus and motivation to start exercising – but with the help of counselling, relaxation techniques and open communication with loved ones, many people find that getting fit does wonders for their mood and sex life. .
Metabolic syndrome is a risk factor for ED in men older than age 50 years. It is a cluster of conditions that includes obesity and abdominal fat, unhealthy cholesterol and triglyceride levels, high blood pressure, and insulin resistance.
The diagnosis of erectile dysfunction is made clinically, based on a patient’s symptoms. It therefore is important for patients to be evaluated by their GP in the first instance. At this appointment, a full history will be taken from the patient regarding the current symptoms and other medical issues. Regular medications will also be reviewed to ensure that there are no contributing factors. Questions regarding alcohol intake and smoking will also be asked. A general physical examination will be performed by the GP, which may include checking blood pressure and an examination of the genitals. Examination of the vascular system and peripheral nervous system may also be undertaken.
ED is also a very common problem in men with high blood pressure. Many of the drugs used to treat hypertension (diuretics, calcium channel blockers, and beta-blockers) may also cause ED.
If your doctor rules out other causes, he or she may prescribe Sildenafil (brand name: Viagra), tadalfil (brand name Cialis), and vardenafil (brand name Levitra). These medicines are taken by mouth to help you maintain an erection.
Managing other health conditions and making the necessary lifestyle changes are important to help overcome erectile dysfunction. That’s why our team at the Male Infertility & Sexual Health Program at UH uses a specialized, team-based approach to deliver expert and highly individual ED care.
A 2004 Harvard Study found that walking for at least 30 minutes every day reduces the risk of ED by about 40%.
Penile prostheses are very effective, and most patients who have a penile prosthesis placed are satisfied with the prosthesis. Different than a normal erection, the prosthesis does not elongate, in fact, some men notice that after the prosthesis is placed their penis appears a little shorter.
As with most other organ system in the human body, changes and loss of function is normal consequence of the ageing process. This is also true of the endocrine system, specifically the levels of testosterone production from the Leydig cells of the testicle. Accompanying the decrease in testosterone is a decrease in erections which also has a component in decrease in the blood supply to the penis making erection not as frequent and not as rigid compared with a young man’s erectile function. Although these changes are in itself not life threatening, they can impact a man’s relationship with his partner, and also ED may be a harbinger of other undiagnosed conditions such as coronary artery disease (CAD), hypercholesterolaemia or diabetes mellitus.6
Physicians make a diagnosis of erectile dysfunction in men who complain of troubles having a hard enough erection or a hard erection that does not last long enough. It is important as you talk with your doctor that you be candid in terms of when your troubles started, how bothersome your erectile dysfunction is, how severe it is, and discuss all your medical conditions along with all prescribed and nonprescribed medications that you are taking. Your doctor will ask several questions to determine if your symptoms are suggestive of erectile dysfunction and to assess its severity and possible causes. Your doctor will try to get information to answer the following questions:
Contributors DFM and NB wrote the majority of the manuscript. MK wrote the section on testosterone and made review comments and approved the final manuscript along with the attached figure.
Individuals must remove the rubber band immediately after completing intercourse. Leaving the band on too long can harm the penis. Rarely, bruising of the penis or blood in the ejaculate/urine may occur.
Oral drugs Popular medicines like sildenafil (Viagra), tadalafil (Adcirca, Cialis), vardenafil (Levitra, Staxyn), and avanafil (Stendra) work by boosting the effects of nitric oxide — a chemical that relaxes muscles in the penis. Note that drugs in this class (PDE-5 inhibitors) are contraindicated in patients who take nitrates in any form, because the combination can lead to severe hypotension.
If the lining of the blood vessels (known as the endothelium) becomes damaged and inflamed, this can also disrupt nitric oxide (NO) production.
If you’re older, there’s probably a physical reason for your ED. But the causes can be in your head, too. Experts say stress, depression, low self-esteem, and performance anxiety can short-circuit the process that leads to an erection. These factors can also make the problem worse if your ED stems from a physical problem.
PDE5 inhibitor drugs are generally the first choice of treatment for ED. They are: