Erectile dysfunction

Overview

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 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.

Symptoms

Erectile dysfunction symptoms might include persistent:

• Trouble getting an erection

• Trouble keeping an erection

• Reduced sexual desire

When to 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

Causes

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

In many cases, erectile dysfunction is caused by something physical. Common causes include:

• 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

Risk factors

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

Complications

Complications resulting from erectile dysfunction can include:

• An unsatisfactory sex life

• Stress or anxiety

• Embarrassment or low self-esteem

• Relationship problems

• The inability to get your partner pregnant

Prevention

The best way to prevent erectile dysfunction is to make healthy lifestyle choices and to manage any existing health conditions. For example:

• Work with your doctor to manage diabetes, heart disease or other chronic health conditions.

• See your doctor for regular checkups and medical screening tests.

• Stop smoking, limit or avoid alcohol, and don't use illegal drugs.

• Exercise regularly.

• Take steps to reduce stress.

• Get help for anxiety, depression or other mental health concerns.

Treatment

The first thing your doctor will do is to make sure you're getting the right treatment for any health conditions that could be causing or worsening your erectile dysfunction.

Depending on the cause and severity of your erectile dysfunction and any underlying health conditions, you might have various treatment options. Your doctor can explain the risks and benefits of each treatment and will consider your preferences. Your partner's preferences also might play a role in your treatment choices.

Oral medications

Oral medications are a successful erectile dysfunction treatment for many men. They include:

• Sildenafil (Viagra)

• Tadalafil (Adcirca, Cialis)

• Vardenafil (Levitra, Staxyn)

All three medications enhance the effects of nitric oxide ? a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow and allows you to get an erection in response to sexual stimulation.

Taking one of these tablets will not automatically produce an erection. Sexual stimulation is needed first to cause the release of nitric oxide from your penile nerves. These medications amplify that signal, allowing normal penile function in some people. Oral erectile dysfunction medications are not aphrodisiacs, will not cause excitement and are not needed in people who get normal erections.

The medications vary in dosage, how long they work and side effects. Possible side effects include flushing, nasal congestion, headache, visual changes, backache and stomach upset.

Your doctor will consider your particular situation to determine which medication might work best. These medications might not treat your erectile dysfunction immediately. You might need to work with your doctor to find the right medication and dosage for you.

Before taking any medication for erectile dysfunction, including over-the-counter supplements and herbal remedies, get your doctor's OK. Medications for erectile dysfunction do not work in everyone and might be less effective in certain conditions, such as after prostate surgery or if you have diabetes. Some medications might also be dangerous if you:

• Take nitrate drugs ? commonly prescribed for chest pain (angina) ? such as nitroglycerin (Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Monoket) and isosorbide dinitrate (Isordil, Bidil)

• Have heart disease or heart failure

• Have very low blood pressure (hypotension)

Lifestyle and home remedies

For many people, erectile dysfunction is caused or worsened by lifestyle choices. Here are some steps that might help:

• If you smoke, quit. If you have trouble quitting, get help. Try nicotine replacement, such as over-the-counter gum or lozenges, or ask your doctor about a prescription medication that can help you quit.

• Lose excess pounds. Being overweight can cause ? or worsen ? erectile dysfunction.

• Include physical activity in your daily routine. Exercise can help with underlying conditions that play a part in erectile dysfunction in a number of ways, including reducing stress, helping you lose weight and increasing blood flow.

• Get treatment for alcohol or drug problems. Drinking too much or taking certain illegal drugs can worsen erectile dysfunction directly or by causing long-term health problems.

• Work through relationship issues. Consider couples counseling if you're having trouble improving communication with your partner or working through problems on your own.