Erectile dysfunction (patient information)

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Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

Overview
An erection problem is the inability to get or maintain an erection that is firm enough for a man to have satisfactory intercourse. You may be unable to get an erection at all, or you may lose the erection during intercourse before you are ready. If the condition persists, the medical term is erectile dysfunction.

What are the symptoms of Erectile dysfunction?
The patient with Erectile dysfunction can have the following symptoms:
 * Failure to have an erection.
 * Failure to maintain an erection.
 * Reduced sexual desire.

What causes Erectile dysfunction?
An erection requires the interaction of your brain, nerves, hormones, and blood vessels. Anything that interferes with the normal process can lead to a problem.

Common causes of erection problems include:


 * Diseases and conditions such as diabetes, high blood pressure, heart or thyroid conditions, poor blood flow, depression, or neurologic disorders (such as multiple *sclerosis or Parkinson's disease)
 * Medications such as blood pressure medications (especially beta-blockers), heart medications (such as digoxin), some peptic ulcer medications, sleeping pills, and *antidepressants
 * Nerve damage from prostate surgery
 * Nicotine, alcohol, or cocaine use
 * Poor communication with your partner
 * Repeated feelings of doubt and failure or negative communication that reinforce the erection problems
 * Spinal cord injury
 * Stress, fear, anxiety, or anger
 * Unrealistic sexual expectations, which make sex a task rather than a pleasure

Who is at highest risk?
Erection problems tend to become more common as you age, but they can affect men at any age and at any time in their lives. Physical causes are more common in older men, while psychological causes are more common in younger men.

Low levels of testosterone rarely lead to erection problems, but may reduce a man's sex drive.

When to seek urgent medical care?
Call your doctor if: If erection problems seem to be caused by a medication you are taking for an unrelated condition, consult your doctor. You may benefit from reducing the dose of the drug or changing to another drug that has the same result but not the same side effects. DO NOT change or stop taking any medications without first talking to your doctor.
 * The problem does not go away with self-care measures -- effective treatments are available
 * The problem begins after an injury or prostate surgery
 * You have other symptoms like low back pain, abdominal pain, or change in urination

Talk to your health care provider if your erection problems are related to fear of recurring heart problems. Sexual intercourse is usually safe in these circumstances.

Call your doctor immediately or go to an emergency room if medication for erection problems give you an unwanted erection that lasts more than 4 hours. Permanent impotence or other lasting damage to your penis may result from this condition.

Diagnosis
Your doctor will perform a physical examination, which will likely include: Tests that may be done include:
 * Checking your blood flow (circulation)
 * Exam of your penis
 * Neurological exam
 * Rectal exam
 * Blood tests, including complete blood count, metabolic panel, hormone profile, and PSA
 * Neurological (nerve) testing
 * Nocturnal penile tumescence (NPT) to check for normal nighttime erections
 * Penile ultrasound to check for blood vessel or blood flow problems
 * Psychometric testing
 * Rigidity monitoring
 * Urine analysis

Treatment options
The treatment may depend on the cause. For example, if the problem is caused by a hormonal imbalance, medication to treat the underlying endocrine disorder will be prescribed. However, the same treatment may be used for many different causes. Consult your health care provider for appropriate evaluation and management.

There are many treatment options today. These include medicines taken by mouth, injections into the penis, medicines inserted into the urethra (urinary channel), vacuum devices, and surgery. In order to treat erectile dysfunction effectively, you must be aware of and comfortable with the possible side effects and complications that may occur with each therapy.


 * Sildenafil, vardenafil, and tadalafil are medicines prescribed for erection difficulties caused by either physical or psychological problems. The drugs work only when the man is sexually aroused. The effect is usually seen within 15 - 45 minutes.

These drugs are called phosphodiesterase-5 (PDE5) inhibitors.

Although these drugs have become extremely popular, they do not enhance erections if you are not impotent. And they DO have side effects, which can be as serious as a heart attack or as minor as muscle pain or facial flushing.

These drugs should not be used with certain other medications, including nitroglycerin. When taken with nitroglycerin, a man's blood pressure can become dangerously low. Some men have died after taking these drugs with nitroglycerin.

PDE5 inhibitors should be used with caution if you have any of the following conditions:

If pills do not work, options such as the following are available.
 * Recent stroke
 * Severe heart disease, such as unstable angina, a recent heart attack, or arrhythmia
 * Severe heart failure
 * Uncontrolled hypertension (high blood pressure)
 * Uncontrolled diabetes
 * Very low blood pressure (hypotension)

Testosterone replacement using skin patches, topical gel, or injections into the muscle may be prescribed if your blood testosterone level is low. A medicine called alprostadil, injected into the penis or inserted into the urethra, improves blood flow to the penis. This usually works better than medications taken by mouth. An external vacuum device can be used to pull blood into the penis. A special rubber band is then used to maintain the erection during intercourse. For some patients, a surgically-placed penile implant (prosthesis) may also be recommended or needed. Many herbs and dietary supplements are marketed to help sexual performance or desire. There are several special concerns for people taking alternative remedies for erectile dysfunction. Also, none of these remedies have been proven effective for treating erectile dysfunction.

Consult your health care provider to see if one of these treatments is right for you.

Where to find medical care for Erectile dysfunction?
Directions to Hospitals Treating Erectile dysfunction

What to expect (Outlook/Prognosis)?
ED is significantly associated with increased all-cause mortality.

Possible complications
As it decrease the sex drive, so it can cause
 * An unsatisfactory sex life
 * Stress or anxiety
 * Low self-esteem
 * Marital or relationship problems
 * The inability to get your partner pregnant

Prevention

 * Have a healthy lifestyle choices and to manage any existing health problems.
 * Work with your doctor to manage diabetes, heart disease or other chronic health problems.
 * See your doctor for regular checkups and medical screening tests.
 * Stop smoking, limit or avoid alcohol, and don't use street drugs.
 * Exercise regularly.
 * Reduce stress if any.
 * Get help for anxiety or depression.