Understanding erectile dysfunction: Diagnosis and treatment

What are the treatments?

If you are troubled by occasional erectile dysfunction, remember that arousal takes longer as you get older and that satisfaction should not be equated with performance. If your dysfunction is causing you problems, you should seek medical help. The number of treatment options has increased in recent years.

Many doctors will recommend changes in lifestyle as a first step in treatment. Suggestions include the following:

• Cut back on alcohol, tobacco and illegal drug use
• Change prescription medications under your doctor’s guidance, as some medicines not only interfere with achieving erection but can also decrease your interest in sex and the ability to reach orgasm
• Reduce stress
• Eat well
• Exercise regularly

Medication for erectile dysfunction

The most common medical treatments for erectile dysfunction include medications.  Several medications may be used:

• Sildenafil, tadalafil and vardenafil are effective in about seven out of 10 men who use them. A tablet is taken one hour before intercourse and, when effective, allows a normal erection with stimulation. These medications are not to be used by men who take any kind of nitroglycerin or nitrate drugs, because the combination can result in dangerously low blood pressure
• Self-injected medications can produce an erection. The medication is injected before sex into the side of the penis; these drugs may also improve long-term potency and penile blood flow
• Prostaglandin suppositories can be inserted into the urethra to produce erections
• Medically administered testosterone injections or patches help some men, but no specific level of the hormone guarantees potency

Devices to aid erection

Another option for the treatment of erectile dysfunction is a vacuum inflation device (or vacuum constriction device). This instrument draws blood into the penis by creating negative pressure around it; a rubber ring is then slipped over the base of the penis to maintain the erection. The ring should be removed after 30 minutes to restore circulation and prevent damage to the penile tissues.

Exercises to aid erection

A special type of exercise can help those men whose erectile dysfunction is caused by leaking veins: Kegel or pelvic-floor exercises. Often prescribed for women with urinary incontinence, these exercises consist of contracting and relaxing the pelvic muscles, the same ones that let you stop urinating in mid-flow. By strengthening these muscles, men may be able to achieve erection without additional treatment.

Surgery to aid erections

For certain blood-vessel problems, vascular surgery to open arteries leading to the penis may be beneficial. The effectiveness of such surgery can be quite variable and for the most part is not a main treatment option. It is usually for men with a traumatic injury to arteries that supply blood to the penis.

Penile implants

Some men choose a penile implant. The least expensive is a semi-rigid type that produces a permanent erection. More sophisticated and expensive implants are inflated by a pump mechanism placed beneath the skin of the scrotum. These are very effective, with very high patient and partner satisfaction.