Erectile Dysfunction

The penis contains two cylindrical, spongelike structures (corpora cavernosa). During sexual arousal, nerve impulses increase blood flow to both of these cylinders. This sudden influx of blood causes an erection by expanding, straightening and stiffening the penis.

Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.

Having erection trouble from time to time isn't necessarily a cause for concern. If erectile dysfunction (ED) is an ongoing issue, however, it can cause stress, affect your self-confidence, and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.

If you're concerned about erectile dysfunction, talk to your doctor even if you're embarrassed. Sometimes, treating an underlying condition is enough to reverse erectile dysfunction. In other cases, medications or other direct treatments might be needed.

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What are the symptoms of erectile dysfunction?

Erectile dysfunction symptoms might include persistent:

• Trouble getting an erection

• Trouble keeping an erection

• Reduced sexual desire

What are the causes of erectile dysfunction?

Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Likewise, stress and mental health concerns can cause or worsen erectile dysfunction. Sometimes a combination of physical and psychological issues causes erectile dysfunction. For instance, a minor physical condition that slows your sexual response might cause anxiety about maintaining

an erection. The resulting anxiety can lead to or worsen erectile dysfunction.

Physical causes of erectile dysfunction:

• Heart disease

• Clogged blood vessels (atherosclerosis)

• High cholesterol

• High blood pressure

• Diabetes

• Obesity

• Metabolic syndrome – a condition involving increased blood pressure, high

insulin levels, body fat around the waist and high cholesterol

• Parkinson's disease

• Multiple sclerosis

• Certain prescription medications

• Tobacco use

• Peyronie's disease – development of scar tissue inside the penis

• Alcoholism and other forms of substance abuse

• Sleep disorders

• Treatments for prostate cancer or enlarged prostate

• Surgeries or injuries that affect the pelvic area or spinal cord

• Low testosterone

Psychological causes of erectile dysfunction:

The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:

• Depression, anxiety or other mental health conditions

• Stress

• Relationship problems due to stress, poor communication or other concerns

What prescription drugs may cause erectile dysfunction?

Erectile dysfunction (ED) is a common side effect of a number of prescription drugs. While these medications may treat a disease or condition, in doing so they can affect a man's hormones, nerves or blood circulation. The result may be ED or an increase in the risk of ED. If you have ED and think that it may be a result of the medication you are using, do not stop taking the medication. If the problem persists, contact your doctor and he or she may be able to prescribe a different medication. Common medications that may list ED as a potential side effect include:

• Diuretics (pills that cause an increase in urine flow)

• Antihypertensives (medication for high blood pressure)

• Antihistamines

• Antidepressants

• Parkinson's disease drugs

• Antiarrhythmics (medication for irregular heart action).

• Tranquilizers

• Muscle relaxants

• Histamine H2-receptor antagonists

• Hormones

• Prostate cancer drugs

• Anti-seizure medications.

What other substances or drugs may cause erectile dysfunction?

Other substances or drugs that can cause or lead to ED include these recreational and frequently abused drugs:

• Alcohol

• Amphetamines

• Barbiturates

• Cocaine

• Marijuana

• Methadone

• Nicotine

• Opiates

Aside from the well-known complications that the use and abuse of these drugs can cause, ED is not often mentioned. However, use of these drugs is a risk factor for ED. These drugs not only affect and often times slow down the central nervous system, but can also cause serious damage to the blood vessels, leading to permanent ED.

For some men, depression can accompany the condition of erectile dysfunction (ED) . It is common for men with ED to feel angry, frustrated, sad, unsure of themselves, or even less “manly.” Such feelings may lead to a lack of self-esteem and, in severe cases, to depression.

Depression that accompanies ED is treatable. The first step in addressing your concerns about ED-related depression is to be honest with yourself, your partner, and your doctor. After depression has been brought out into the open, coping with it may be easier and less stressful.

What are the risk factors for erectile dysfunction?

As you get older, erections might take longer to develop and might not be as firm. You might need more direct touch to your penis to get and keep an erection. Various risk factors can contribute to erectile dysfunction, including:

• Medical conditions, particularly diabetes or heart conditions

• Tobacco use, which restricts blood flow to veins and arteries, can over time cause chronic health conditions that lead to erectile dysfunction

• Being overweight, especially if you're obese

• Certain medical treatments, such as prostate surgery or radiation treatment for cancer

• Injuries, particularly if they damage the nerves or arteries that control erections

• Medications, including antidepressants, antihistamines and medications to treat high blood pressure, pain or prostate conditions

• Psychological conditions, such as stress, anxiety or depression

• Drug and alcohol use, especially if you're a long-term drug user or heavy drinker

Does prostate disease cause erectile dysfunction?

Prostate cancer does not cause ED. However, prostate surgery to remove the cancer and radiation therapy to treat prostate cancer can cause ED. Treatment of non-cancerous, benign prostate disease can also cause the condition.

When should you see a doctor?

A family doctor is a good place to start when you have erectile problems. See your doctor if:

• You have concerns about your erections or you're experiencing other sexual problems such as premature or delayed ejaculation

• You have diabetes, heart disease or another known health condition that might be linked to erectile dysfunction

• You have other symptoms along with erectile dysfunction

What are the treatment options for erectile dysfunction?

You can work with a health care professional to treat an underlying cause of your erectile dysfunction (ED). Choosing an ED treatment is a personal decision. However, you also may benefit from talking with your partner about which treatment is best for you as a couple.

Treatment options include lifestyle changes, counseling, and medications.

Lifestyle Changes

Your health care professional may suggest that you make lifestyle changes

to help reduce or improve ED. You can quit smoking, limit or stop drinking alcohol, increase physical activity, maintain a healthy body weight, and stop illegal drug use You can seek help from a health professional if you have trouble making these changes on your own.


Talk with your doctor about going to a counselor if psychological or

emotional issues are affecting your ED. A counselor can teach you how to lower your anxiety or stress related to sex. Your counselor may suggest that you bring your partner to counseling sessions to learn how to support you. As you work on relieving your anxiety or stress, a doctor can focus on treating the physical causes of ED. Your counselor may suggest that you bring your partner to counseling sessions to learn how to support you.

What medications can be used to treat erectile dysfunction?

Oral Medications

A health care professional may prescribe you an oral medicine, or medicine you take by mouth, such as one of the following, to help you get and maintain an erection. Common prescriptions include sildenafil, vardenafil, tadalafil, or avanafil. All of these medicines work by relaxing smooth muscles and increasing blood flow in the penis during sexual stimulation. You should not take any of these medicines to treat ED if you are taking nitrates to treat a heart condition. Nitrates widen and relax your blood vessels. The combination can lead to a sudden drop in blood pressure, which may cause you to become faint or dizzy, or fall, leading to possible


Also talk to your health care professional if you are taking alpha-blockers for prostate enlargement. The combination of alpha-blockers and ED medicines also could cause a sudden drop in blood pressure.

A health care professional may prescribe testosterone if you have low levels of this hormone in your blood. Although taking testosterone may help your ED, it is often unhelpful if your ED is caused by circulatory or nerve problems. Taking testosterone may also lead to side effects, including a high red blood cell count and problems urinating.

Testosterone treatment also has not been proven to help ED associated with age-related or late-onset hypogonadism. Do not take testosterone therapy that hasn't been prescribed by your doctor. Testosterone therapy can affect how your other medicines work and can cause serious side effects.

Injectable Medications and Suppositories

Many men get stronger erections by injecting a medicine called alprostadil

into the penis, causing it to become filled with blood. Oral medicines can improve your response to sexual stimulation, but they do not trigger an automatic erection like injectable medicines do. Examples of injectable medications that are available at Compounding Solutions include, but are not limited to:

• Tri-mix (Papaverine, Phentolamine, Alprostadil)

• Super Tri-mix (Papaverine, Phentolamine, Alprostadil)

• Bi-mix (Phentolamine, Papaverine)

• Quad-mix (Papaverine, Phentolamine, Alprostadil, Atropine)

Instead of injecting a medicine, some men insert a suppository of alprostadil into the urethra . A suppository is a solid piece of medicine that you insert into your body where it dissolves. A health care professional will prescribe a prefilled applicator for you to insert the pellet about an inch into your urethra. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes.