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

Have trouble with ED/erectile dysfunction? Learn more about this condition and treatments.

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:

Diabetes & ED

ED and blood pressure: Learn more about the connection between the two.
View full infographic.

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:

  • pills,
  • injections,
  • penile suppositories,
  • vacuum devices, and
  • surgery.

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:

  • injections,
  • suppositories,
  • vacuum devices, or
  • surgery.

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).

Pros Cons
  • Works Well
  • No drug effects
  • Cheapest option
  • Cumbersome
  • Unnatural erection
  • Bruising or burst blood vessels
  • Penile pain
  • Pain with ejaculation
  • Numbness
  • "Hinging" or instability of erection
  • Penis may feel cold to partner
  • Poor overall satisfaction

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.

Pros Cons
  • Very effective (85%)
  • Mimics normal erection
  • Discreet
  • Risk of prolonged erection (priapism)
  • Risk of penile scarring
  • Pain with injection (usually mild)
  • Bruising or bleeding
  • Hard to use if have tremor or poor vision or severe obesity
  • Poor long-term satisfaction (less than 40%)

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.

Pros Cons
  • No needle
  • Mimics normal erection
  • Discreet
  • Gives best erection to glans (head of penis)
  • Rare scarring or prolong erection (priapism)
  • Pain in penis (30%)
  • Expensive
  • Less effective than injections (50%)
  • Bleeding from urethra
  • Hard to use if have tremor or poor vision or severe obesity
  • Poor long-term satisfaction (less than 40%)

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

When to Seek Treatment for Erectile Dysfunction: Jim Hotaling, MD, ESPN 700