Alphabetical List of Conditions Treated / Erectile Dysfunction

Erectile Dysfunction - Urology UCLA

Overview of Erectile Dysfunction

Erectile dysfunction (ED, often referred to as impotence) is defined as the ongoing inability to achieve or maintain an erection sufficient for sexual intercourse. It is very common, affecting as many as 15-30 million men in the Untied States. Although the risk of its occurrence increases with age, it is not an inevitable part of aging. ED usually has a physical cause – in some cases it is also a byproduct of an underlying health condition that requires attention – and is almost always treatable. Indeed, publicity surrounding the introduction in 1998 of the oral drug sildenafil citrate (Viagra) has led to a dramatic increase in the number of men seeking therapy and resuming normal sexual activity.

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Risk Factors

An erection results from a complex sequence of events involving nerves, arteries, veins, muscles and tissues – and dysfunction involving any of these can result in erectile difficulties. It’s estimated that as many as 70 percent of ED cases can be attributed to conditions that include diabetes, atherosclerosis, vascular disease, neurological disease, kidney disease and alcoholism. Medications affecting the nerves or impairing blood flow to the penis can play a role, and smoking and being overweight can also contribute. Certain surgeries with the potential to injure nerves and arteries near the penis have the potential to cause ED as a side effect, though advances in surgical techniques – including the nerve-sparing radical prostatectomy – have reduced the likelihood of this occurring. Only about 10-20 percent of ED cases are believed to have purely psychological origins – far fewer than was thought in the past.

Treatment of Erectile Dysfunction

Any of a variety of treatments can help to return sexual function, depending on the cause. In some cases, simple lifestyle changes – quitting smoking, losing weight, and exercising – can be enough. Eliminating, reducing, or changing medications that might be contributing to the problem can also be considered. When these strategies are insufficient, medications for ED can be effective. The class of drugs known as phosphodiesterase inhibitors (of which Viagra was first, followed by Levitra and Cialis) enhance the effects of nitric oxide, a chemical that relaxes the smooth muscle of the penis, enabling blood to flow more readily into the organ. Patients with certain medical conditions, or who are taking medications for conditions such as hypertension and benign prostatic hyperplasia, are typically not advised to take these ED drugs.

For other men, there are injectable drugs, which engorge the penis with blood to produce an erection. Mechanical vacuum devices can be effective, particularly for men who are able to have partial erections. Surgery may also be an option; this can involve inflatable penile implants and, in rarer cases, vascular reconstruction to improve blood flow to the penis, or surgery to block veins from allowing blood to leave the penis. When psychological factors are believed to be contributing – particularly in men who are experiencing anxiety or depression – psychological counseling is recommended. Alternative treatments such as nutritional supplements, herbal remedies and acupuncture are also considered by some to be useful, although most of these therapies are unproven, and because of the lack of regulation around these products, they should be taken with caution and after consultation with a physician.

The bottom line: Given all of the effective treatment options and the possibility that erectile dysfunction is symptomatic of an underlying medical condition requiring attention, ED is a problem that should not be ignored.