Erectile Dysfunction

What is erectile dysfunction?

Erectile dysfunction (ED)—also known as impotence—is a term used to describe the inability to accomplish and/or maintain an erect penis for sexual function.

Having a problem with an erection once in a while is normal, but chronic ED can induce stress, affect self-esteem and contribute to relationship issues. In addition, chronic ED can also be a sign of an underlying medical condition that needs to be addressed.

What causes erectile dysfunction?

Although ED is common as men age, growing old is not the root cause. ED can be the result of an issue with any part of the complex process that is involved in achieving an erection, which includes:

• Blood vessels
• Emotions
• Hormones
• Nerves and muscles
• The brain

In some cases, ED may even be caused by a combination of physical and psychological problems. For example, a minor physical condition can lead to anxiety that can actually worsen ED down the line.

Physical conditions that may cause ED include:

• Abuse of alcohol or other substances
• An enlarged prostate or prostate cancer treatments (e.g., radiation, surgery)
• Atherosclerosis (clogged arteries)
• Certain medications
• Diabetes
• Heart disease
• High blood pressure
• High cholesterol
• Injury or trauma to the pelvic area or spinal cord
• Multiple sclerosis
• Obesity
• Parkinson’s disease
• Peyronie’s disease (scar tissue that develops in the penis)
• Sleep disorders
• Tobacco use

Psychological causes of ED include:

• Anxiety
• Depression
• Other mental health conditions
• Relationship issues
• Stress

What are the treatment options for erectile dysfunction?

After treating any potential underlying condition, treatment options—or combinations of them—can depend on the cause and severity. Options may include medications, pumps, surgeries and implants.

Oral Medications

Oral medications for ED include:

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

These medications improve the effects of nitric oxide, a chemical the body naturally produces that relaxes the muscles in the penis. As a result, blood flood is increased and an erection is able to happen following sexual stimulation.

It should be noted that taking one of these medications will not immediately cause an erection; sexual stimulation is required in order to trigger the release of the nitric oxide.

Other Medications

There are other medications available that aren’t taken orally, such as: 

• Injections that are made directly into the penis to help achieve an erection, such as the P-Shot^®
• Testosterone replacement therapy due to low testosterone via a variety of delivery methods (e.g., patch, gel, intranasal)
• Suppositories that are inserted into the penile urethra (e.g., alprostadil urethral suppository)

Penis Pumps, Surgery and Implants

Should medications fail to be effective, other treatment modalities may be an option to relieve the effects of ED, including:

• A penis pump—also known as a vacuum erection device—in which a tube is placed over the penis and a vacuum is created within the tube that pulls the blood into the penis to create an erection
• Blood vessel surgery that bypasses obstructed penile arteries (, which is rarely performed and only in a small percentage of men)
• Penile implants inserted on both sides of the penis that are either inflatable (to be filled at-will to create an erection) or semi-rigid to rods that keep the penis flexible, but firm