Erectile Dysfunction (ED)

ED is the repeated inability of a man to achieve or sustain an erection satisfactory for sexual intercourse. It often has a physical cause.

Common physical causes include: blood-flow problems, disease (diabetes or cardiovascular disease), low testosterone levels, neurological disease and trauma (stroke or spinal cord injury), high cholesterol, high blood pressure, obesity, previous prostate or pelvic surgery, and as a side effect of certain medications.

Erectile dysfunction can also result from psychological factors including fatigue, stress and anxiety. Certain lifestyle choices such as smoking and excessive alcohol consumption can also contribute to ED.

Although ED is not a consequence of growing old, its incidence increases with age. Most men will experience occasional erection problems. However, chronic erectile dysfunction is different; it is persistent. Fortunately ED is treatable at any age.

Want to know your ED score? Take the Sexual Health Inventory for Men (SHIM) test.

Symptoms

Common symptoms of ED include:

  • The inability to achieve an erection at any time
  • The inability to maintain an erection firm enough for sexual intercourse
  • The inability to sustain an erection long enough to complete sexual intercourse

Treatment for ED

Oral medication. Taken as prescribed to increase blood flow to the penis before sexual activity.

Injections. Self-administered drug injections into the base of the penis to trigger an erection.

Urethral suppositories. Drug pellet inserted into the urethra at the tip of the penis. It enhances penile blood flow resulting in an erection.

Vacuum erection device. A medical device that allows a man to achieve erections by creating an air vacuum around the penis. It consists of three components: a cylinder, pump and an elastic ring. The cylinder is placed over the penis and air is withdrawn with the pump, creating a vacuum that increases blood flow to the penis. The increased blood flow results in an erection, which is sustained with the elastic ring. Works best in men who are able to achieve partial erections.

Penile prostheses (implants). A medical device surgically implanted in a man’s penis that allows erections to occur. A penile implant does not interfere with a man’s libido (sexual desire) or his ability to climax. It is not visible, although some models provide more natural looking erections.

There are two types of penile prostheses:

  • Semi-rigid device. Consists of a pair of silicone-covered rods inserted into the penis. With this implant, the penis is always semi-rigid. It can be bent into position to initiate sex, or curved for concealment.
  • Inflatable penile prosthesis (IPP). Allows for more natural-looking erections and better flaccidity (non-erect states). Can either be a two-piece or a threepiece unit.

The two-piece IPP consists of a pair of hollow cylinders implanted on either side of the penis, and pump bulb in the scrotum. The pump bulb contains fluid. The patient squeezes the pump to inflate and deflate the prosthesis.

Three-piece IPP. Acts and feels more like a natural erection than the one or two-piece implants. It consists of a pair of hollow cylinders implanted in the penis, a small reservoir in the abdomen, and a pump.

A man gets erection by squeezing the pump in the scrotum. Upon completion of sexual intercourse, the man depresses the release valve on the pump, which drains the fluid out of the cylinder and back into the reservoir. In clinical studies, three-piece IPPs receive high satisfaction rates among its users and their partners.

Surgery for IPPs is performed in a hospital with the patient receiving a general and a local anesthetic. It takes about 30 minutes to one hour to implant the device, which can be activated about four weeks after surgery. Although IPP surgery is low risk, complications may include infection, mechanical failure and pain.

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