ERECTILE DYSFUNCTION

Common Causes of ED

If you suspect you have ED, discuss with your doctor to determine the underlying factor or cause of the condition. Some common causes can include:

• Increasing age
• Diabetes
• Diet that is unhealthy
• Heart disease
• High blood pressure
• Low testosterone
• Peyronie’s disease (penile curvature)
• Stress/mental health issues
• Certain medications
• Side effects from treatments for other diseases such as prostate cancer

How is ED diagnosed?

During your visit, your doctor will ask about your medical history and may examine your abdominal and genital area. You’ll be asked about situations when you have difficulty obtaining erections, presence of morning/overnight erections, and any prior surgery or radiation.

It is essential to provide a detailed history of medication and drug use since nearly 25% of ED cases can be attributed to medications for other conditions.

Next, based on the information gathered, your urologist may request:

• Hormone tests (testosterone, luteinizing hormone, and thyroid – stimulating hormone, prolactin, and serum hormone-binding globulin)
• Urinalysis
• PSA (prostate-specific antigen)
• Lipid profile
• Serum chemistry

Functional tests such as prostaglandin E1 injection, formal neurologic testing, nocturnal penile tumescence testing, and biothesiometry may be requested, together with imaging studies such as transrectal, testes, and penile ultrasonography and angiography.

An occasional inability to achieve an erection is normal. But the inability to reach or sustain an erection more than half of the time, at any age, indicates erectile dysfunction. Other symptoms may include decreased sexual desire and less rigid erections.

What are the treatment options for ED?

If ED is diagnosed, your doctor may recommend treatment depending on the cause and the severity of the issue.

• Simple lifestyle changes such as losing weight, quitting smoking, or drinking less alcohol are effective for some men.
• Adjusting your dosages or changing medications may be recommended if your ED is suspected to be linked to a medicine you are taking. Check with your prescribing provider before stopping or making any changes to your medications.
• Oral medications such as sildenafil, vardenafil, tadalafil, or avanafil can also be prescribed to temporarily increase blood flow to the penis so that when a man is sexually stimulated, he can get an erection.
• Injection or topical application of alprostadil, phentolamine, or papaverine. These are medications that help increase blood flow through muscles and blood vessels in the penis by relaxing their walls and making them wider.
• Low-intensity shockwave therapy (LiSWT) stimulates the growth of new blood vessels. Once blood flow is improved (usually after six treatments), patients may experience stronger, stiffer erections.
• Testosterone hormone therapy using gels, oral medications, patches, pellets, or injections may be prescribed if a man’s testosterone levels are low.
• External vacuum or constriction device can be used to draw blood into the penis for an erection. A small rubber ring is then placed around the base of the penis to maintain the erection.
• Surgical options such as revascularization, placement of a penile implant, or surgical correction of venous outflow may be recommended.