Erectile
dysfunction takes more than a physical toll. The emotional impact on a man and
his partner can prove just as difficult. It is common for men with ED to feel
anger, frustration, sadness, or a lack of confidence. However, the condition
can be treated.
The first
step in addressing your concerns about ED is to be honest with yourself, your
partner, and your doctor. Once you have brought ED out into the open, coping
with it as you go through treatment will be easier and less stressful.
Communication is essential to successful diagnosis and treatment as well as to
helping your partner understand your feelings.
While you are
being treated for ED, it is important to be patient with your progress. A
treatment that works for one person may not work for another. It is also
important to know that the treatment you choose may not work the first time or
may not work every time. For some couples, sex therapy may help partners
support each other and maintain intimacy while coping with ED. It may also help
to learn more about others' experiences with ED. Contact your doctor about
support groups in your area.
Talking to your partner
If you are
diagnosed with erectile dysfunction, feelings of anger and resentment that you
may naturally experience may harm your relationship with your partner unless
you find a way to communicate them. While these emotions are understandable, it
is important to take into account that your partner is also affected by your
ED. Moreover, feeling comfortable talking about your relationship
treatment. A
man who has difficulty sharing and resolving his feelings about ED may make the
problem worse.
The best way
to communicate with your partner is to try to get past the initial
embarrassment and awkwardness and confront the problem head-on. If you have
difficulty discussing the topic, counseling may help.
For some
couples, sex therapy may help partners support each other and maintain intimacy
while coping with ED.
A partner of
someone experiencing ED can help by discussing feelings honestly while showing
care and concern. Rather than assigning blame, it can be much more effective to
take the approach that dealing with the problem will be a team effort.
Meantime, you can together explore alternative techniques to find sexual
pleasure so that there's no pressure to "perform." Focus on ways to
solve ED, rather than how ED affects your relationship. Give your partner
positive feedback so that he's willing to discuss his feelings. Remind him that
there are many options for successful treatment. If your partner does not
succeed initially, encourage him to continue to visit the doctor and explore
other options.
Lifestyle changes
Men can often
improve their erectile function by making changes in their daily habits.
Further, these steps help men lead healthier lives overall.
Men who
maintain a healthy weight, who exercise regularly, and who reduce stress and
anxiety lower their risk of erectile dysfunction. Men with high cholesterol may
damage the linings of blood vessels throughout the body, including those in the
penis. Cholesterol can also harden, narrow, or block these arteries, leading to
erectile dysfunction. You can lower your cholesterol through diet, exercise,
and medication.
Nonsmokers
have a lower risk of atherosclerosis (hardening of the arteries), and men who
quit smoking may partly or fully restore erectile function. Excess drinking can
inhibit erectile functioning and can affect production of the hormone
testosterone, affecting sex drive and erections. More than 80 percent of
chronic alcoholics have chronic ED. Illegal drugs can also cause impotence. Men
with diabetes risk damaging the arteries and nerve endings serving the penis if
their diabetes is out of control. Diet, exercise, and medical control for
diabetes can all help men avoid risk of diabetes-related ED.Nonsurgical treatments
The first
step in treating ED is to find the underlying cause; the doctor can then decide
what sort of treatment is likely to work. If the problem continues, a number of
nonsurgical options can help a man gain and maintain erections.
Oral medications
Sildenafil
(Viagra) was the first oral medicine approved to treat erectile dysfunction. It
works by increasing the flow of blood to the penis so that a man can get an
erection when he is sexually stimulated. Though the directions advise men to
take the drug one hour before sexual activity, research indicates that the drug
can sometimes work when taken from 30 minutes to eight hours before
intercourse.
Take Viagra
exactly as directed. Do not increase or decrease the dosage of Viagra or take
the drug more often than prescribed by your doctor. Do not take Viagra more
than once a day. Men who are on nitrate medications such as nitroglycerine
should not take Viagra, since the combination of Viagra and nitrates can cause
blood pressure to dip too low (hypotension). The most common side effects of
Viagra are dyspepsia (indigestion), nasal congestion, flushing, headaches, and
transient visual disturbance.
Before taking
Viagra, tell your doctor if you:
Are allergic
to Viagra or any other drugs
Are taking
any prescription or over-the-counter medications including herbal and dietary
supplements
Are scheduled
for surgery
Take
nitroglycerin or a long-acting nitrate to treat chest pain. The combination of
Viagra and these drugs can cause dangerously low blood pressure.
Have ever had
a heart attack, heart disease, angina (chest pain associated with heart
disease), stroke, or retinitis pigmentosa (a rare disease of the eye that
causes vision loss)
Other oral
medications that work in a similar fashion are tadalafil (Cialis) and
vardenafil (Levitra). These two drugs are in the same class of medications that
includes sildenafil (Viagra) and have generally similar success rates and side
effects. Cialis (tadalafil), however, has a longer duration of action, up to 36
hours. As a result of scientific
research brought herbal solutions without side effects conducted in recent
years. Example Prolargent 5x5 Extreme and passion RX these herbal pills
increase sexual boost like viagra and cialis without side effects.
Suppositories
For this
treatment, known as "transurethral pharmacotherapy or MUSE," the man
with erectile dysfunction places a suppository into the urinary tube (urethra)
using a plastic applicator. The suppository contains the medicine alprostadil,
which is absorbed into the nearby erection chambers (corpora cavernosa).
Alprostadil belongs to a group of drugs called vasodilators --drugs that
increase blood flow by relaxing and expanding blood vessels. It is identical to
a naturally occurring substance found in the body that helps keep the blood
vessels open, and it helps treat ED by increasing the blood flow to the penis.
Though
suppositories appear to be less effective than either injections or vacuum
therapy, the drug can be used to treat erectile dysfunction due to a wide
variety of causes.
Before
inserting the suppository, you should urinate; the small amount of urine left
in the urethra will help dissolve the suppository after you insert it. To help
dissolve the suppository, roll your penis between your hands for 10 seconds. If
you feel any stinging, continue this motion to help stop it. Sitting, standing,
or walking for 10 minutes while an erection develops can help increase the
blood flow to your penis to gain a proper erection. Alprostadil usually begins
to work in about five to 10 minutes. Intercourse should be attempted within 10
to 30 minutes of using this medication. An erection may continue after ejaculation.
Do not insert
more than two doses of alprostadil within a 24-hour period, and do not use any
more than the doctor-recommended dose. This could result in permanent damage to
your penis.
When using a
suppository form of alprostadil, it is advisable to use a condom if having
sexual intercourse with a pregnant woman. While it is unlikely that a fetus
will be harmed by the medication, the condom will protect it from exposure. The
effects of alprostadil on early pregnancy are still unknown.
Possible side
effects include mild bleeding or spotting from the urethra and stinging of the
urethra. Contact your doctor if you experience curving of the penis with pain
during an erection, an erection that lasts four to six hours with pain,
swelling of or pain in the testes, dizziness, faintness, pelvic pain, or
flulike symptoms.
Men who do
not have erectile dysfunction should not use alprostadil as a sexual aid. If
this medicine is not used properly, permanent damage to the penis and loss of
the ability to have erections could result.
Injections
In
intracavernosal injection therapy, more commonly called penile self-injection,
a man injects a small amount of medicine into the side of his penis using a
tiny needle and syringe. The medicine, usually prostaglandin E1, papaverine,
phentolamine, or combinations of these drugs, relaxes the blood vessels,
allowing blood to flow into the penis. Injection therapy is effective in
treating a wide variety of erection problems caused by blood vessel, nerve, and
psychological conditions. The most common adverse side effects are pain and
penile scarring (fibrosis). Patients with cerebral vascular disease or severe
cardiovascular disease might not be able to tolerate the dizziness and high
blood pressure occasionally encountered with injection therapy. Painful
erections that last longer than two to three hours can usually be controlled by
proper dosing and by following treatment guidelines.
The drug
alprostadil, which relaxes and expands the blood vessels (allowing more blood
to flow into the penis), comes in several mixtures that can be injected into
the base or the side of the penis with a fine needle. An erection usually
occurs within 20 minutes.
Be sure that
you know which product you are using and that you fully understand the proper
way to mix the injection. Do not use alprostadil more often than your doctor
has ordered or in larger amount; misuse could cause permanent damage to the
penis.
After an
injection is mixed, alprostadil must be used immediately. Throw away any unused
mixture in the syringe; it cannot be stored for later injection. Do not reuse
your needles.
Contact your
doctor if any of the following symptoms become worse or do not go away:
bleeding at the site of injection, pain at the site of injection, painful erection,
bruising or clotted blood in the area of the injection (usually caused by an
incorrect injection). Also, report curving of the penis with pain during an
erection, an erection that lasts four to six hours with pain, swelling of or
pain in the testes, dizziness, faintness, pelvic pain, or flulike symptoms.
Men who do
not have erectile dysfunction should not use alprostadil as a sexual aid. If
this medicine is not used properly, permanent damage to the penis and loss of
the ability to have erections could result.
Vacuum constriction device
The vacuum
constriction device is a cylinder that is placed over the penis. When the air
is pumped out of the cylinder, blood is drawn in, causing an erection. The user
then maintains an erection by slipping a band off the cylinder and onto the
base of the penis. The band can stay in place up to 20 minutes.
The vacuum
device can be safely used to treat most causes of erectile failure. A lack of
spontaneity and the fact that using the device can be cumbersome and may cause
some discomfort seem to be the biggest concerns of patients.
Surgery
When there is
a clear medical cause for erectile dysfunction that is unlikely to resolve or
improve naturally, another treatment option for men might be a surgical penile
implant or vascular reconstruction.
Penile
implant. The simplest type of prosthesis consists of a pair of malleable rods
surgically implanted within the spongy erection chambers of the penis. Today,
many men instead choose a hydraulic, inflatable prosthesis that allows a man to
have an erection whenever he chooses. The penile prosthesis is also an option
for men whose erections are curved because of scarring.
The
inflatable penile prosthesis consists of two cylinders that are inserted in the
penis and connected by tubing to a separate reservoir of fluid implanted under
the groin muscles. A pump is also connected to the system and sits under the
loose skin of the scrotal sac, between the testicles. To inflate the
prosthesis, the man presses on the pump (which does not require putting
pressure on the testicles). The pump transfers fluid from the reservoir to the
cylinders in the penis, inflating them. Pressing on a deflation valve above the
pump returns the fluid to the reservoir, deflating the penis.
The
prosthesis does not change sensation on the skin of the penis, a man's ability
to reach orgasm, or ejaculation. Scars from the surgery are small; most people
won't notice that a man had an inflatable penile implant. Between 90 and 95
percent of inflatable prosthesis surgeries result in implants that produce
erections suitable for intercourse. Possible complications from the surgery
include uncontrolled bleeding, infection, scar tissue formation, and mechanical
failure. Men usually cannot get an erection without inflating the implant, and
if the implant is removed, the man may never again have natural erections.
Vascular
reconstructive surgery. During this procedure, an option when blood flow to the
penis is blocked, surgeons transfer an artery from an abdominal muscle to the
penis. This technique creates a path for blood to flow to the penis that
bypasses the area of blockage.
Only a small
percentage of men, mostly young men with trauma leading to the penis, may be
candidates for this surgery. The technique is technically difficult, costly,
and not always effective.
Sex therapy
A patient
whose erectile failure has a clear psychological cause should undergo sex
counseling before he pursues any invasive treatments. Sex therapy works best to
treat erectile dysfunction if a man is generally healthy and has normal
erections during sleep, normal blood tests, and a normal physical exam. Therapy
can also help when ED is caused by stress from work, finances, relationship
problems, or poor sexual communication.
Treatment is
a short-term form of counseling, generally involving five to 20 sessions. (If a
man drops out of therapy after only one or two sessions, successful treatment
of ED is unlikely.) During the sessions, the counselor will give the patient
"assignments" to do at home, such as practicing sexual communication
skills, reading books about sexuality, and touching exercises that are designed
to take away the pressure to perform during sex.
Not only does
sex therapy work best when a man's sexual partner gets involved with the
treatment; the therapy also helps a man's partner cope with the problem. When a
partner gets involved with therapy, men resolve stress-related erectile
dysfunction 50 to 70 percent of the time. When a man goes through counseling
alone, the success rate is lower.
Even when
erectile dysfunction has a clear physical cause, psychological problems
sometimes contribute to erectile failure. Several sessions of sexual counseling
can help a man who is going to receive medical or surgical treatment for erectile
dysfunction. A counselor can guide a couple as they decide on a particular
treatment, or the counselor can help the couple improve their sexual
communication and lovemaking skills. A man who is single may benefit from
counseling on how to talk to a new partner about penile injections or a vacuum
constriction device.
Testosterone replacement therapy
The male
hormone testosterone is produced by the testicles and is responsible for the
proper development of male sexual characteristics. It is also important for
maintaining muscle bulk, red blood cells, bone growth, sense of well-being, and
sexual function. Though inadequate testosterone production is not a common
cause of erectile dysfunction, some men with low testosterone might see
increased sexual functioning from testosterone replacement therapy.
As a man
ages, the amount of testosterone in his body gradually declines, starting after
age 30. Other causes of testosterone deficiency include injury or infection to
the testicles, chemotherapy or radiation treatment for cancer, genetic
abnormalities, hemochromatosis (too much iron), pituitary gland dysfunction,
medications including prostate drugs and steroids, AIDS, stress, and
alcoholism. Testosterone deficiency can cause decreased sex drive, decreased
sense of well-being, depression, concentration and memory difficulties, and
erectile dysfunction.
Testosterone
levels fluctuate in the body throughout the day, and a doctor may test the
amount of the hormone in your blood several times to diagnose low testosterone.
If your testosterone levels are low, your doctor may prescribe one of several
different types of testosterone replacement: intramuscular injections,
testosterone patches, or testosterone gels. Because oral hormones may lead to
liver abnormalities, no pills exist in the United States that provide adequate
levels of testosterone replacement.
Though
testosterone replacement therapy is generally safe, it is associated with
several conditions including acne, oily skin, mild fluid retention, stimulation
of prostate tissue and increased urination, breast enlargement, worsening of
sleep apnea, and decreased testicular size. Some laboratory side effects of
testosterone replacement therapy include changes in blood cholesterol,
increased red cell count, and a decrease in sperm count (which can produce infertility,
especially in younger men).
Since
testosterone may stimulate prostate growth, the hormone can also accelerate the
growth of prostate cancer. It is important for all men considering testosterone
replacement therapy to undergo screening for prostate cancer before starting
treatment. Further, men with breast cancer should not take testosterone
replacement therapy.
Alternative treatments
Some men with
erectile dysfunction choose to treat their condition with alternative medicines
or techniques. These alternative treatments, which include nutritional
supplements, herbal remedies, and acupuncture, fall outside standard western
medical practice; many have not been evaluated for effectiveness in clinical
trials. It is important to consult a physician about erectile dysfunction to
determine the cause and receive appropriate treatment for the condition. Men
considering alternative treatments should seek the advice of a healthcare
provider.
Popular
nutritional supplements to treat erectile dysfunction include bioflavonoids,
zinc, vitamin C, vitamin E, and flaxseed meal. Supplemental doses of the amino
acid arginine have helped some men with ED, according to research. Some people
claim that herbal remedies such as Asian ginseng and Ginkgo biloba help improve
sexual functioning. You should consult a doctor before taking any herbal
supplement to weigh the risks and potential benefits of herbal remedies.
Although some
ED patients have shown improvement from low levels of the hormone
dehydroepiandrosterone (DHEA), experts have expressed concerns about the drug's
long-term safety.
Acupuncture,
a technique that involves sticking very fine needles into specific points on
the body, is believed by some to stimulate the body's ability to resist or
overcome illnesses and conditions. Acupuncture has helped some men with
erectile dysfunction.
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