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Overview
Erectile difficulty is the frequent or consistent inability to get
or sustain an erection of the penis sufficient to engage in sexual intercourse.
While most men occasionally fail to get an erection, or lose one prematurely
during sexual activity, a large number of men suffer from these problems regularly.
Accurate statistics are lacking on how many men are affected by the condition,
but some doctors estimate that about half of men aged 40 to 70 have frequent
problems achieving or maintaining an erection. Erectile difficulties are far
more common in older men.
Causes
A wide range of diseases, drugs, injuries, and psychological problems can
cause erectile difficulties. Here are some of the most common causes:
Circulatory problems: An erection occurs when the penis fills with
blood and a valve at the base of the penis traps it. Diabetes, high blood pressure,
cholesterol, clots, and "hardening of the arteries" can all interfere
with this process. Such circulatory problems are the number one cause of erectile
difficulties.
Peyronie's disease: This disease causes fibres and plaques to appear
in the genitals, interrupting blood flow.
Cancer: Cancer can interfere with nerves or arteries vital to erection.
Surgery: Surgery to the pelvis, and especially prostate surgery for
prostate cancer, can damage the nerves and arteries that are required to gain
and maintain an erection.
Spinal cord or pelvic injury: The nerves that stimulate erection can
be cut by injury to them.
Hormonal disorders: A lack of testosterone (male hormone or androgen)
can result from thyroid and nervous disorders.
Depression: This condition is a common cause of erectile difficulties.
Depression is a physical disorder as well as a psychiatric one, and can have
physical effects. This may be true even if you feel comfortable in a sexual
situation.
Alcoholism: Chronic alcoholism can produce erectile difficulties, even
if there is no alcohol in the blood at the time of sex.
Performance anxiety: Most men have had erection problems at some point
due to worrying about performing well during sexual intercourse. If this happens
often, the anticipation of sex can trigger nervous reactions that prevent erection,
setting up a vicious cycle.
Situational psychological problems: Some men have problems only in
certain situations or with certain people. In troubled relationships, men may
be unable to achieve erection with their partner but have no problem away from
home.
Sexual aversion: Being repelled by sex is rare. It is most common in
people who suffered child abuse and those who have been brought up in strict
religious surroundings. Aversion can also exist in homosexuals or
bisexuals who attempt to lead a heterosexual life against their basic inclinations.
Drugs: The following medication can cause erectile difficulties:
- alcohol
- anti-anxiety medications
- anti-cancer medications
- cocaine
- estrogens
- ganglionic and adrenergic (beta) blockers
- MAOI and tricyclic antidepressants
- narcotic pain relievers
- narcotics
- thiazide diuretics that are prescribed to control high blood pressure
- sedatives
Symptoms
When a man is unable to get or maintain an erection, it's termed erectile
difficulties. It may also be called erectile dysfunction.
A man may have erections sometimes, for example when he wakes up in the morning,
but be unable to get an erection during sex with his partner. This is often
a sign of a psychological problem that may or may not have to do with that particular
relationship.
If a man had regular erections in the past, but suddenly begins to have problems
getting an erection, there's a chance that it's a nerve or hormonal problem,
a circulatory problem, or the effect of alcohol, drugs, or medicine.
If a man still gets erections but they're not as hard or long lasting as
in the past, it's quite likely that a circulatory problem is causing the dysfunction.
If surgery or injury is involved, the sufferer may already know what's causing
the erectile difficulties. A doctor should be consulted about possible solutions.
While erectile difficulties are inevitably going to cause some anxiety, it's
vital for sufferers to keep their relationship with their partner or spouse
as regular as possible until a solution can be found. Modern medicine and therapeutic
techniques can help over 90% of erection problems.
Treatment
There's a wide range of treatments for erectile difficulties. Some are
pills, and others are injections or devices that should be used just before
sex. There are also treatments involving surgery.
Medications for erectile dysfunction include phosphodiesterase inhibitors,
prostaglandins, yohimbine, and testosterone.
Phosphodiesterase inhibitors: This class of medications includes sildenafil,
tadalafil, and vardenafil.* They work by inhibiting an enzyme called phosphodiesterase
type 5. This enzyme normally breaks down a molecule called cGMP.
Inhibiting the enzyme makes more cGMP available, which leads to relaxation of
smooth muscles in the penis, allowing more blood to enter and helping to produce
an erection. These medications are taken before sex and will cause an erection
only when the man is sexually stimulated.
The time the dose should be taken and how long the effects last depend on the
medication used. The most common side effect of these medications is a headache.
However, there is a potential for certain dangerous drug interactions. Anyone
taking this medication must let his doctor know about any medications he's on,
and especially if he's taking nitrates (e.g., nitroglycerin spray or nitroglycerin
patch) for heart problems.
Prostaglandins (alprostadil): Alprostadil can be injected into the penis
or inserted as a pellet through the urethra. It causes an erection that usually
lasts about 60 minutes. The danger with this method is that too high a dose
can cause priapism, an erection that won't go away. This condition can
cause serious bruising, bleeding, and extreme pain. Once the doctor is sure
of the right dose, the man can self-inject at home.
Some doctors may prescribe a combination of alprostadil with additional ingredients
such as phentolamine to help the medication work more effectively. This mixture
is prepared by the pharmacy according to the directions of the prescribing doctor.
It is injected into the penis before sex.
Yohimbine: Yohimbine is derived from a natural source. While it's somewhat
controversial, it's been shown to be useful in psychogenic erectile difficulties,
such as performance anxiety problems. It may raise blood pressure or interfere
with liver function.
Testosterone: This is only useful for people with specific disorders
like hypogonadism (small testicles at birth) that result in lower than
normal amounts of testosterone in the blood stream. Testosterone increases interest
in sex, as well as erections.
Common non-medication ways of treating erectile difficulties include vacuum
devices and penile implants.
Vacuum devices: This involves placing a tube over the penis, forming
an airtight seal around the base. By pumping air out of the tube, blood can
be drawn into the penis. Placing a ring around the base of the penis will maintain
the erection.
Penile implants: This treatment involves permanent implantation of flexible
rods or similar devices into the penis. Simple versions have the disadvantage
of giving the user a permanent erection. The latest (and most expensive) device
consists of inflatable rods activated by a tiny pump and switch in the scrotum.
Squeezing the scrotum stiffens the penis, whether the person is aroused or not.
The penis itself remains flaccid, however, so the diameter and length are usually
less than a natural erection, and hardness is lacking, although it's sufficient
for intercourse.
*All medications have both common (generic) and brand names. The brand name
is what a specific manufacturer calls the product (e.g., Tylenol®).
The common name is the medical name for the medication (e.g., acetaminophen).
A medication may have many brand names, but only one common name. This article
lists medications by their common names. For more information on brand names,
speak with your doctor or pharmacist.
Other tips:
To find out what's causing erection problems, a doctor will begin by asking
about other medical conditions the man might have, what medicines he's taking,
when his erection problems occur, and what form they take. Blood pressure
tests and tests of hormone levels are standard.
There are tests that aim to distinguish between psychological, nervous and
circulatory causes. One is the nocturnal penile tumescence (NPT)
test. A measuring device is attached to the penis to monitor erections during
sleep. Men without physical disorders usually have erections during REM (rapid
eye movement) sleep.
Several devices, including a Doppler radar, can track blood flow in
and out of the penis and identify circulatory problems.
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