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Erectile dysfunction or male impotence is when a man has trouble achieving and/or maintaining an erection. While ED is more common in older men, it is not a normal part of the aging process.  An erection usually begins with sexual arousal from something that a man thinks, feels, hears, smells or tastes. Signals are transmitted from the brain to the penis, causing more blood to flow into the penis. It is the hydraulic effect of the blood entering and being trapped in the penis that results in an erection.  WHAT CAUSES ED The 4 most common causes of ED are diabetes, high blood pressure, high cholesterol and smoking cigarettes. All of these cause atherosclerotic changes and/or vascular damage in one way or another. It is the vascular damage or damage to the blood vessels that supply the penis that is most often the cause of a man's ED.  Most surgery, radiation and procedures on the prostate cause some trauma or damage to the nerves and blood vessels that supply the penis, often causing ED.  Many medications result in ED. Some injuries to a man's groin or pelvis can cause ED.  Psychological problems like depression and anxiety can also cause ED, particularly in younger men.  Men who have had a stroke, brain or spinal cord injuries, and nerve disorders like Alzheimer's disease, multiple sclerosis and Parkinson's disease are more likely to have ED. Men who have sleep apnea or sleep disorders or who have been sexually abused as a child often have ED. Men who are troubled by premature ejaculation sometimes have a high enough level of anxiety to cause some degree of ED. Men who are obese, sedentary, smoke cigarettes and use drugs are more likely to have ED.  Men who do a large amount of bicycle riding on a narrow seat are more likely to have ED.  Men with low testosterone or other hormonal abnormalities often have ED. The penis thrives on use. Men who are not sexually active for a long period of time - bad marriage, no partner, prison - have a higher incidence of ED.  DIAGNOSING ED A thorough history and physical examination is essential in diagnosing ED. An ultrasound examination of the penis will often be used to evaluate penile blood flow. A vibration test, biothesiometry is used to evaluate sensitivity and nerve function. Blood tests are often performed to evaluate hormone levels and to check for diabetes. TREATMENT Lifestyle recommendations are often made in the treatment of erectile dysfunction, such as stopping smoking, drug use and the excessive intake of alcohol. Regular aerobic exercise will go a long way to a healthier mind and body.  Making sure that underlying medical issues like high cholesterol, high blood pressure and diabetes are well controlled. Men with a psychological component of their ED often improve after sex therapy, marriage therapy, or after seeing a psychologist or psychiatrist.  There are many medications used to treat ED. Oral medications like Viagra, Cialis and Levitra. Urethral suppositories like MUSE. Penile injection therapy with some combination of prostaglandin, papaverine and phentolamine.  Vascular surgery is sometimes an option for a recent onset of ED in a fairly young patient. This is particularly helpful if the ED is as a result of a recent trauma or accident.  Testosterone replacement therapy is sometimes effective if the cause of a man's ED is his low testosterone levels. Vacuum therapy is when an external device called a vacuum constriction device or a penis pump is placed over the penis. This creates a vacuum and draws blood into the penis. A constriction band or ring then traps the blood in the penis after an erection is achieved.  Implant surgery is a viable option when a patient either cannot tolerate other forms of ED treatment or if they do not work for him. This involves a malleable or inflatable device being surgically inserted into the shaft of the penis. We consider this surgery to be an appropriate choice for a patient if no other method of treatment is effective. While we do not perform implant surgery in our practice, there are several excellent surgeons who frequently perform this surgery in the NY metro area. SUCCESS RATE More than 90% of our patients are able to achieve a good solid usable erection without the need for surgery.  |
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