Transcript Treating ED

A Visual Guide to Erectile Dysfunction
Reviewed by Varnada Karriem-Norwood, MD on April
16, 2012
What Is Erectile Dysfunction (ED)?
 Erectile dysfunction (ED)
occurs when a man has
consistent and repeated
problems sustaining an erection.
Without treatment, ED can
make sexual intercourse
difficult. According to the
Massachusetts Male Aging Study
on sexual dysfunction, the
problem can first emerge in a
man as early as 40. Based on the
study, an estimated 18-30
million men are affected by ED.
ED vs. Poor Libido
 There are several forms of
male sexual dysfunction,
including poor libido and
problems with ejaculation.
But ED refers specifically to
problems achieving or
maintaining an erection. Men
with ED often have a healthy
libido, yet the body fails to
respond. In most cases, there
is a physical basis for the
problem.
Symptoms of ED
 Symptoms of ED include:
 Erections that are too soft for
sexual intercourse.
 Erections that last only briefly.
 An inability to achieve
erections.
 Men who cannot get or
maintain an erection (75% of
the time that they attempt sex )
are considered to have erectile
dysfunction.
Who Gets ED?
 Sexual dysfunction and ED become
more common as men age.
According to the Massachusetts
Male Aging Study, about 40% of
men experience some degree of ED
at age 40 compared with 70% of
men at age 70. And the percentage
of complete ED increases from 5%
to 15% as age increases from 40 to
70 years. But this does not mean
growing older is the end of your
sex life. ED can be treated at any
age.
The Mechanics of ED
 An erection occurs when blood
fills two chambers known as the
corpora cavernosa. This causes
the penis to expand and stiffen,
much like a balloon as it is filled
with water. The process is
triggered by impulses from the
brain and genital nerves.
Anything that blocks these
impulses or restricts blood flow
to the penis can result in ED.
Causes of ED: Chronic Disease
 The link between chronic disease
and ED is most striking for
diabetes. Nearly one out of every
two men with diabetes experiences
ED.Yet evidence shows that good
blood sugar control can minimize
this risk. Other conditions that may
cause ED include cardiovascular
disease, atherosclerosis (hardening
of the arteries), kidney disease, and
multiple sclerosis. These illnesses
can impair blood flow or nerve
impulses throughout the body.
Causes of ED: Lifestyle
 Lifestyle choices that impair blood
circulation can contribute to ED.
Smoking, excessive drinking, and
drug abuse may damage the blood
vessels and reduce blood flow to
the penis. Smoking makes men with
atherosclerosis particularly
vulnerable to ED. Smokers have
almost twice the risks of ED
compared with nonsmokers. Being
overweight and getting too little
exercise also contribute to
ED. Studies indicate that men who
exercise regularly have a lower risk
of ED.
Causes of ED: Surgery
 Surgery, including treatments
for prostate cancer, bladder
cancer, or BPH can sometimes
damage nerves and blood vessels
near the penis. In some cases,
the nerve damage is permanent,
and the patient will require
treatment to achieve an
erection. In others, surgery
causes temporary ED that
improves on its own after 6 to
18 months.
Causes of ED: Medication
 ED may be a side effect of
medication, including
certain blood pressure
drugs, antidepressants, and
tranquilizers. Men should
talk with their doctor if
they suspect a prescription
or over-the-counter drug
may be causing erectile
problems.
Causes of ED: Psychological
 ED usually has something
physical behind it, particularly in
older men. But psychological
factors may be to blame in 10%
to 20% of men with ED.
Experts say stress, depression,
poor self-esteem, and
performance anxiety can shortcircuit the process that leads to
an erection. These factors can
also make the problem worse in
men whose ED stems from
something physical.
ED and Bicycling
 Research suggests avid cyclists
suffer more ED than other
athletes. The trouble lies in the
shape of some bicycle seats that
put pressure on the perineum.
This area between the anus and
scrotum contains arteries and
nerves vital to sexual arousal.
Cyclists who ride for many
hours each week may benefit
from seats designed to protect
the perineum.
Diagnosing ED: Physical Exam
 To diagnose ED, your doctor
will ask you questions about
your symptoms and medical
history. The doctor will conduct
a complete physical exam to
uncover signs such as poor
circulation or nerve trouble.
And your physician will look for
abnormalities of the genital area
that could cause problems with
erections.
Diagnosing ED: Lab Tests
 Several lab tests can help
diagnose male sexual
problems. Measuring
testosterone levels can
determine whether there is a
hormonal imbalance, which is
often linked to decreased
desire. Blood cell counts,
cholesterol levels, and liver
function tests can reveal
medical conditions that may
account for ED.
ED: A Sign of Heart Disease?
 In some cases, ED can be a warning
sign of more serious disease. A
2010 study suggests ED is a strong
predictor of heart attack, stroke,
and death from cardiovascular
disease. The researchers say all men
diagnosed with ED should be
evaluated for cardiovascular disease.
This does not mean every man with
ED will develop heart disease, or
that every man with heart disease
has ED, but patients should be
aware of the link.
Treating ED: Lifestyle Changes
 Many men with ED are able
to improve sexual function by
making a few lifestyle
changes. Giving up smoking,
losing weight, and exercising
more often can help by
improving blood flow. If you
suspect a medication could be
contributing to ED, talk to
your doctor about adjusting
your dosage or switching to
another option.
Treating ED: Oral Medications
 You’ve probably heard of Viagra, but it’s
not the only pill for ED. This class of
drugs also includes
Cialis, Levitra, Staxyn, and Stendra. All
work by improving blood flow to the
penis during arousal. They're generally
taken 30-60 minutes before sexual
activity and should not be used more
than once a day. Cialis can be taken up
to 36 hours before sexual activity and
also comes in a lower, daily dose.
Staxyn dissolves in the mouth. All
require an OK from your doctor first
for safety.
Treating ED: Injections
 While pills for ED are
convenient, some men sustain
stronger erections by injecting
medication directly into the
penis. Drugs approved for this
purpose work by widening the
blood vessels, causing the penis
to become engorged with blood.
Another option is inserting a
medicated pellet into the
urethra. The pellet can trigger
an erection within 10 minutes.
Treating ED: Vacuum Devices (Pumps)
 Vacuum devices for ED, also
called pumps, offer an
alternative to medication. The
penis is placed inside a cylinder.
A pump draws air out of the
cylinder, creating a partial
vacuum around the penis. This
causes it to fill with blood,
leading to an erection. An elastic
band worn around the base of
the penis maintains the erection
during intercourse.
Treating ED: Surgery
 If ED is caused by a blockage
in an artery leading to the
penis, surgery can often
restore blood flow. Good
candidates are typically
younger men whose blockage
stems from an injury to the
crotch or pelvis. The
procedure is not
recommended for older men
with widespread narrowing
of the arteries.
Treating ED: Implants
 In men with persistent ED, a
penile implant can restore
sexual function. An inflatable
implant uses two cylinders that
are surgically placed inside the
penis. When an erection is
desired, the man uses a pump to
fill the cylinders with
pressurized fluid. Another
option is a malleable implant,
which bolsters erections with
surgically implanted rods.
Treating ED: Psychotherapy
 Even when ED has a known
physical cause, psychotherapy
can be beneficial. A therapist
can teach the man and his
partner techniques to reduce
performance anxiety and
improve intimacy. Therapy
can also help couples adjust
to the use of vacuum devices
and implants.
Treating ED: Alternative Therapies
 Talk with your doctor before trying
supplements for ED. They can
contain 10 or more ingredients and
may complicate other health
conditions. Asian ginseng and
ginkgo biloba (seen here) are
popular, but there isn't a lot of good
research on their effectiveness.
Some men find that taking a DHEA
supplement improves their ability
to have an erection. Unfortunately,
the long-term safety of DHEA
supplements is unknown. Most
doctors do not recommend using
it.
Treating ED: Buyer Beware
 A quick web search will reveal
dozens of "dietary supplements"
that claim to treat ED. But the
FDA warns that many of these
are not what they seem. An
investigation discovered the pills
often contain prescription drugs
not listed on the label, including
the active ingredient in Viagra.
This puts the man at risk for
dangerous drug interactions.
ED: Reducing Your Risk
 Some tips to reduce your




risk of ED include:
Exercise and maintain a
healthy weight.
Stop smoking.
Avoid alcohol and
substance abuse.
Keep your diabetes under
control.
Discussing ED With Your Partner
 It's natural to feel angry or
embarrassed when dealing
with ED. But don't forget that
your partner is also affected.
Talking openly about ED will
help your partner understand
the diagnosis and treatment
options. This will reassure
your partner that you haven't
lost interest.