What Is Erectile Dysfunction?
Erectile dysfunction or ED (also known as impotence) is when a man cannot achieve or sustain an erection for sexual intercourse. This can be:
- a total inability,
- inconsistent ability, or
- a tendency to sustain only brief erections.
Over 18 million adult men* in the United States have erectile dysfunction. In fact, at least 50 percent of men over the age of 50 experience some loss of function. Despite being a common male condition, it is not normal, no matter how old you are.
Only 10 percent of men seek treatment and many (50 percent) discontinue treatment once they start it because they are too embarrassed to discuss their sexual health issues with a doctor. There is no need to suffer in silence.
Our urological specialists at University of Utah Health understand your sensitivities related to ED. We develop treatment plans customized for your needs to help you get your sexual function back.
Causes of ED
An erection occurs when blood flows into the corpora cavernosa (erection bodies) and gets trapped there. If the blood has problems getting to or staying in those erection bodies, you may have erectile dysfunction.
There are many potential causes for erectile dysfunction, such as these conditions/circumstances:
- Vascular conditions:
- Diabetes
- Trauma:
- Neurologic disease:
- Radiation to the pelvis for cancer
- Endocrine:
- Hypogonadism (low testosterone)
- Hyperprolactinemia (high prolactin levels)
- Pelvis surgery:
- Radical prostatectomy (a surgical procedure for the partial or complete removal of the prostate)
- Surgeries for rectal cancer or bladder cancer
- Medication side effects:
- Antidepressants
- Antihypertensives (high blood pressure medicine)
- Antiandrogens (testosterone blockers)
- Antiarrhythmics (heart rhythm medicine)
- Alcohol
- Cigarette smoking
- Cocaine and marijuana
Diabetes & ED
Half of men with diabetes will experience ED within 10 years of their diagnosis. High blood sugar levels can damage the nerves that control sexual stimulation. They can also damage the blood vessels needed to provide adequate blood flow to the penis in order to have and maintain an erection.
While oral medications are a common first step for therapy, they only tend to work in about 50 percent of men with diabetes. Diabetic men are more likely to move on to other treatment options, such as the pump, penile injection therapy, and penile implants. However, the penile implant has the highest satisfaction rate of all treatment options.
ED & Heart Disease
Erectile dysfunction can be a warning sign of current or future heart disease sometimes. In fact, ED can precede coronary artery disease in almost 70 percent of cases.
When you have heart disease, or coronary artery disease (blocked blood vessels), it will affect the tiny arteries in your penis sooner. Many times, we will refer you to a cardiologist to determine if you have cardiovascular disease that is causing your ED.
Improving your heart health can help lower your risk for ED. You can start by:
- increasing physical activity,
- quitting tobacco products,
- losing weight, and
- consuming a healthy, well-balanced diet.
Learn more about heart health.
Prostate Cancer & ED
Erectile dysfunction is a potential complication following prostate cancer treatments. The nerves that control an erection lie very close to the prostate and may be injured during treatment. However, some men may regain their previous level of erectile function with nerve-sparing procedures. But it may take up to a year while some men may never recover their ability to have a natural erection.
Radiation for prostate cancer can cause ED symptoms to appear gradually, usually within two to three years after treatment. If you are experiencing ED after undergoing prostate cancer treatment, you can get a healthy sex life back. We can help you choose the best treatment options for you.
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ED Treatments
There are many treatments for erectile dysfunction, such as:
Surgery provides the only true cure, but men typically want to explore other, less invasive options first.
ED Pills
Currently, three pills (Viagra/sildenafil, Levitra/vardenafil, Cialis/tadalafil) are available and FDA-approved for erectile dysfunction. They are all called phosphodiesterase inhibitors, which means they act by blocking a chemical that stops erections.
Viagra was introduced in 1998 (the others in 2003) and revolutionized the way that men and their partners looked at ED.
Using ED Medications
Keep in mind that these medications are amplifiers, not magic pills; you must have sexual stimulation for them to work. These pills also typically do not work the first few times. Here are instructions for how to properly take Viagra, Levitra, or Cialis:
- Take your medication one hour before sexual activity.
- Take the pills prior to a meal or after a light snack, especially for Viagra. They do not absorb well if you have a full stomach.
You’ll need to take these pills at least four times before deciding if they work for you or not.
ED Medications Side Effects
As with any medication, these medications do have side effects including:
- headache,
- facial flushing,
- upset stomach,
- back pain (Cialis),
- sensitivity to light, or
- blurry vision.
Do NOT take these medications if you are on nitroglycerin, taking medications with nitrates, or even have nitroglycerin at home. Ask your doctor if you have any questions about this.
These medications do NOT protect you against sexually transmitted diseases.
You must remember that these are prescription-only medications. Do NOT share these medications with your friends or family as they may have medical conditions that would prevent them from taking this medicine.
What if ED Pills Don't Work?
If pills don't work for you or the side effects bother you severely, we can use alternative treatments. These include:
ED Vacuums
A vacuum device (VED) is an external device (not a drug) that goes over the penis. When pumped, it pulls blood into the penis then a special ring is placed over the base of the penis to keep it erect.
VEDs are generally safe (although there have been some very rare but serious complications).
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ED Injections
You can also inject drugs directly by inserting a tiny needle into the penis. Several drugs and drug combinations are available, including alprostadil (Edex, Caverject), phentolamine, and papavarine (usually given in combination as Bimix or Trimix).
You can usually get an erection within five to 10 minutes of injecting this medicine. Your erection should last between 20 minutes to an hour.
Injections do require training and it may be tricky to get the right dose initially. We always do the first injection in the office to show you how to do it and to give us a good idea about the proper dose. Our patients are usually anxious about injecting their penis but are almost always surprised by how painless the process is.
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Although injections often work well, we don't recommend long-term use.
ED Suppositories
Urethral suppositories (MUSE) have the same ingredient as ED injections (alprostadil) only they are in pellet form. You will insert the pellet into your urethra (urinary channel), where it will dissolve.
Similar to injections, we always give the first suppository in our office to make sure there are no problems and that you are comfortable doing this.
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Despite the appeal of suppositories, their effectiveness is relatively poor and overall patient satisfaction is relatively low.
ED Surgery Options
The medical treatments for erectile dysfunction may provide satisfying erections, but they do not give you a long-term cure for your problem. If anything, they are band-aids for the symptoms but not a total solution.
Most men and their partners want:
- An erection that is rigid and satisfying for sexual activity,
- The ability to be spontaneous in their sex lives,
- The ability to predict and control how long the erection lasts and how often they can use it, and
- An erection that naturally occurs without devices or other impediments.
Currently, penile implants are the closest thing to a natural erection that we can do through through treatment. Implants are clearly the winner for overall satisfaction rates with around 95 percent satisfaction (compared to 50 percent for pills, 40 percent for injections, and 20 percent for vacuum devices).
*McCabe MP, et al. (2016) Incidence and prevalence of sexual dysfunction in women
and men: A consensus statement from the fourth international consultation on sexual
medicine 2015. J Sex Med 13:144–152.
Our Doctors on the Radio
Video: Erectile Dysfunction Explained, Past Seminar
Meet Our Patients
Gene Miluk
The first time he experienced ED in his mid-50s he thought it was just a fluke, which was a reasonable assumption to make. More than half of men experience episodic erectile dysfunction at some time in their life from things like stress, too much alcohol, or as a side effect of medication.
