Erectile Dysfunction (ED)

Erectile Dysfunction is diagnosed and treated by the Urology Division of Premier Medical Group.

What is Erectile Dysfunction (ED)?

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Erectile dysfunction (ED) is the inability of a man to achieve or maintain an erection sufficient for sexual intercourse. In fact, most men experience this condition at some point in their lives, usually by age 40. The problem can occur at any age.

Some men experience complete erectile dysfunction while others achieve erections that are not firm enough for penetration or become flaccid before climax. Erectile dysfunction has many causes, most of which are treatable, and is not an inevitable consequence of aging. ED can cause emotional and relationship problems, and often leads to diminished self-esteem.

High blood pressure, diabetes, dyslipidemia, and depression are examples of common medical conditions that can cause ED. Medications to treat these disorders can also cause ED, as can other chronic illnesses and side effects from some surgery, particularly prostate surgery.

How common is erectile dysfunction?

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The most recent data from the National Institutes of Health estimates that approximately 30 million men in the United States experience chronic erectile dysfunction.

Incidence of ED increases with age. Chronic ED affects about 5% of men in their 40s and 15-25% of men by the age of 65. Transient ED and inadequate erection affect as many as 50% of men between the ages of 40 and 70.

Dr. Evan Goldfischer specializes in erectile dysfunction. He sees patients in the Poughkeepsie office and you can also hear him as Dr. Love on WPDH (101.5) the first Monday of each month speaking on the topic of ED.

Questions to Ask Your Doctor

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  • Could my ED be a result of a normal aging process?
  • Do you work with trained therapist who can help us deal with the psychological effects of my ED?
  • How do we know if my ED is the result of a medical condition or psychological condition?
  • Sometimes I get only partial erections, what could cause this?
  • What types of tests will be performed to help determine if impotence is related to cardiovascular disease, kidney disease, diabetes, or another serious medical condition?
  • Will an ED diagnosis include blood tests, imaging tests, nerve tests, and/or other diagnostic tests?
  • Will lifestyle changes such as a healthier diet, avoiding alcohol, quitting smoking, exercising regularly, and getting enough sleep make a difference?
  • What types of ED treatments are available? And which ones do you recommend.

To learn more about Erectile Dysfunction, click here.

What causes erectile dysfunction?

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Erectile dysfunction has many underlying physical and psychological causes, most of which are treatable, and is not an inevitable consequence of aging. Getting and keeping an erection requires a complex chain of events. To produce an erection, your blood flow, testosterone, nervous system, and frame of mind must all work together. If something goes wrong with any link in the chain, ED can result.

High blood pressure, diabetes, dyslipidemia and depression are examples of common medical conditions that can cause ED. Medications to treat these disorders can also cause ED, as can other chronic illnesses and side effects from some surgery, particularly prostate surgery.

Underlying conditions associated with erectile dysfunction include the following:

Vascular Disease or Blood Flow Problems

Blood flow problems can be caused by blockages in the blood vessels inside the penis or in an artery that carries blood to the penis. If too little blood flows into the penis, you won’t get erections. Arteriosclerosis, the hardening and narrowing of the arteries, causes a reduction in blood flow throughout the body and can lead to ED. It is associated with age and accounts for 50 to 60 percent of ED in men over 60.

Long distance bike riding on a standard bike seat could also damage blood vessels. Other low blood flow causes can include diabetes, smoking, medications and radiation treatment to the prostate or pelvis.

Diabetes

High blood sugar associated with diabetes can damage small blood vessels and nerves throughout the body, which can impair nerve impulses and blood flow necessary for erection. About 60 percent of men with diabetes experience some sexual dysfunction. Patients who have had pelvic surgery, such as prostatectomy or colorectal surgery, can have ED as a result of nerve damage as well.

Hormone Imbalances

Hormone disorders account for 5 percent of the cases of ED. Testosterone deficiency can result in a loss of libido (sexual desire) and loss of erection. Among other conditions, an excess of the hormone prolactin, caused by a pituitary gland tumor, reduces levels of testosterone. Hormone imbalances can also result from kidney or liver disease.

Drugs

Some commonly prescribed medications can contribute to ED, including drugs for high blood pressure, heart medications, antidepressants, and sedatives. A number of over-the-counter medications also can lead to ED. Long-term use of alcohol and illicit drugs may affect the vascular and nervous systems and are associated with erectile dysfunction.

Pelvic Trauma, Surgery

Spinal cord injuries, brain injuries, and stroke can cause ED. Other nerve disorders such as Multiple Sclerosis, Parkinson’s and Alzheimer’s disease may also result in ED. Trauma to the pelvic region or spinal cord can damage veins and nerves needed to achieve and maintain erection.

Peyronie’s Disease

This is a rare inflammatory condition that causes scarring of erectile tissue. The scarring produces curving of the penis that can impede sexual function and cause painful erections.

Venous Leak

When the veins in the penis are not able to prevent the blood from leaving the penis during erection, erection cannot be maintained. A Venous leak can be an outcome of injury, disease, or damage to the veins in the penis.

Psychological Conditions

Stress, guilt, worry, and anxiety can all contribute to loss of libido and erectile dysfunction. When a man experiences loss of erection, he begins to worry that it will happen again. This concern can create anxiety associated with performance and could lead to chronic problems during sex. A cycle is created and if this cycle is not broken, it can result in chronic impotence.

Nerve Problems

Spinal cord damage, uncontrolled diabetes or surgery on the rectum, prostate or bladder, can all cause damage to the nervous system. An injury along the path prevents the signals from getting through.

How is erectile dysfunction diagnosed?

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The doctor will obtain a thorough medical history to find out about past pelvic surgery, diabetes, cardiovascular disease, kidney disease, and any medications the man may be taking.

The physical examination may include a genital examination, a measurement of blood flow through the penis, hormone tests, and a glucose test for diabetes.

In some cases, nocturnal penile tumescence testing is performed to find out whether the man has erections while asleep. Healthy men usually have about four or five erections throughout the night.

The man applies a device, called a Rigiscan, to the penis before going to bed at night, and the device measures whether he has had erections. If a man is able to have normal erections in his sleep, this finding suggests a psychological cause for his impotence.

How is erectile dysfunction treated?

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Sexual performance is often a large part of a man’s self-esteem. Erectile dysfunction can be devastating not only to a man’s sex life, but to his entire sense of being.

Men with ED can become uncertain of themselves and avoid intimate situations with their partners, which increases the pressure and anxiety associated with a condition that is often treatable. Prescription ED medications help most men who try them. If these medications do not help, there are other options.

The first step to overcoming these feelings is to acknowledge the problem and communicate honestly and openly with each other.

What are the treatment options for erectile dysfunction?

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Medications

Viagra, Levitra, and Cialis are the commonly used medications for the treatment of ED. These drugs generally work within 30 minutes and have been known to be effective in men of most ages. They vary in how long the erection lasts. Patients taking nitrate drugs (used to treat chest pain) should not take selective PDE-5 inhibitors such as Viagra, Levitra, and Cialis.

Common side effects of selective enzyme inhibitors include headache, reddening of the face and neck (flushing), indigestion, and nasal congestion. Cialis may cause muscle aches and back pain, side effects that usually resolve on their own within 48 hours.

Vacuum Erection Devices

Vacuum devices are simple mechanical tools that allow a man to achieve and maintain an erection. The penis is inserted into a hollow plastic tube, which is pressed against the body to form a seal. A vacuum is created in the tube by the use of a small hand pump, which draws blood into the penis, causing the penis to engorge, enlarge and become rigid. After one to three minutes in the vacuum, an adequate erection is achieved and a soft rubber O-ring is then placed around the base of the penis to trap blood and maintain the erection. Sexual intercourse can take place after the vacuum tube is removed. The rubber O-ring maintains the erection until removed.

Injection Therapy

Patients can be taught to inject a medication into their penis about 20 minutes before sexual intercourse. The erection usually last long enough to complete the sexual encounter. Risks include bruising and priapism (which is when the erect penis will not return to a flaccid state).

Penile Prosthesis

This is a device implanted inside the penis that allows men with ED to achieve an erection. A penile implant requires surgery. Most men with penile implants, and their partners, state they are satisfied with the results.

The simplest type of penile prosthesis consists of a pair of bendable rods surgically implanted within the erection chamber of the penis. Some men choose the inflatable prosthesis, which has a reservoir and pump. This is surgically implanted and connected to the penis by tubing to a separate reservoir of fluid. To inflate the prosthesis, the man presses the pump, which transfers the fluid to the cylinders in the penis inflating them and causing an erection. The prosthesis does not change the sensation on the skin or affect ejaculation.

Psychological Therapy

Many men develop ED as a result of some type of mental or psychological problem which frequently can be overcome. Often when the physical cause for ED is treated, consequent self-esteem problems may persist and continue to impair normal function and performance. Trained psychotherapists can work with couples to develop better sexual communication, lessen the tension, and help to create reasonable expectations for sex, all of which can improve erectile function.

Medical intervention and psychological therapy work best when combined and used in a well thought out treatment plan. Both partners should be willing to make behavioral changes and adapt to changes that may have resulted from medical or surgical treatment.

The physicians at Premier Medical Group Urology Division work with several therapists in the Poughkeepsie area, who specialize sexual communication.