By asking questions and running tests, your doctor, urologist, or other specialist should be able to find the source of your problem and suggest a course of treatment.
The solution may be as straightforward as changing your prescription medicines. If that doesn’t do the trick, there are other treatments that can help. For example:
* Sildenafil (Viagra). This drug, which enhances blood flow to the penis, has proven effective for treating erectile dysfunction. (To clear up some common misconceptions, Viagra doesn’t increase a man’s sexual appetite , or libido, and it can only cause an erection if he’s mentally aroused.) In a recent study of 267 men conducted at Johns Hopkins University, 65% of those taking sildenafil said they were pleased with the results. In general, the drug is least effective for men with severe impotence or those whose problems stem from nerve damage caused by diabetes or prostate surgery.
You may have heard that sildenafil can be dangerous for people with heart trouble. While there are some risks, most heart patients can take the drug safely. The only patients who absolutely should not take sildenafil are those who take nitrate drugs for heart disease, since combining these medicines can lead to dangerously low blood pressure. Also, men should use sildenafil with caution if they take medicines for hypertension, suffer from coronary ischemia (blockage of an artery supplying blood to the heart), or have a combination of congestive heart failure and low blood pressure. In addition, the drug can interact with some antibiotics like erythromycin and acid-blocking stomach medications like Tagamet. Because Viagra is a prescription drug, your doctor should discuss all these issues with you before giving you the go-ahead to take it.
For inactive heart patients, the exertion of sex may be far more dangerous than sildenafil itself. In some cases, doctors will have a patient take a stress test before prescribing the drug.
* Other drugs. If sildenafil isn’t right for you, there are other prescription medicines available - but you’ll need to do more than just pop a pill. Drugs such as papaverine and phentolamine can cause near-instant erections, but they have to be injected into the penis. (Aside from the obvious drawback of sticking a needle into one’s penis, there is also the chance of priapism, a painful erection that won’t go away without medical assistance.)
Men can also use a new needle-free device to insert a pellet of the drug alprostadil into the urethra (the tube through which urine passes) through the tip of the penis. Erections usually begin eight to 10 minutes later and last 30 to 60 minutes. The treatment can cause some pain in the penis and testicles; some patients may also feel lightheaded or dizzy. But this medicine isn’t recommended for anyone who is taking blood thinners or at risk for blood clots.
* Testosterone. For older men who have low testosterone levels, replacement hormone shots, pills, or a patch might quickly resolve erection problems. But for those who have had prostate cancer, this is not a good option, since testosterone can cause cancer to grow.
* Psychotherapy. If your physician doesn’t suspect a physical cause for your erectile dysfunction, he or she may suggest counseling - for you, or you and your partner together. A psychotherapist trained in the treatment of sexual problems can teach you techniques to help stay relaxed and responsive during intimate moments. Psychotherapy can also help men cope with the depression and anxiety that often accompanies erectile dysfunction, regardless of the cause.
* Vacuum devices. These devices consist of a plastic cylinder that fits over the penis and a pump that creates a partial vacuum. The vacuum pulls blood into the penis, causing an erection. Since the plastic cylinder isn’t exactly conducive to intercourse, the man removes the device after placing an elastic band around the base of his penis to maintain the erection during sexual activity.
* Surgery. In cases where injury has hindered nerve or blood vessel function, surgeons can sometimes reconstruct arteries that feed blood to the penis. This technique works best for younger men who have erectile dysfunction because of minor pelvic injuries. Surgeons can also block the veins that drain blood from the penis, although some experts question whether this is a good long-term solution.
Doctors can also surgically insert implants to make the penis stiff all the time, or just on demand. The implant might be a semi-rigid rod that can be bent into shape, or it might use inflatable cylinders. A man can fill the cylinders with fluid by squeezing a small pump that’s embedded in his scrotum. Thanks to recent advances, today’s implants are extremely effective and carry only a small risk of infection and mechanical breakdown.
SOURCE: BJU International
Revision date: July 4, 2011
Last revised: by Jorge P. Ribeiro, MD