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Our Erectile Dysfunction Specialists
Dr. Korman, Howard
Dr. Kearney, David
Erectile dysfunction, or ED, is the most common sex problem that men report to their doctor. It affects as many as 30 million men.
ED is defined as trouble getting or keeping an erection that’s firm enough for sex.
Though it’s not rare for a man to have some problems with erections from time to time, ED that is progressive or happens routinely with sex is not normal, and it should be treated.
ED can happen:
- Most often when blood flow in the penis is limited or nerves are harmed
- With stress or emotional reasons
- As an early warning of a more serious illness, like: atherosclerosis (hardening or blocked arteries), heart disease, high blood pressure or high blood sugar from Diabetes
Finding the cause(s) of your ED will help treat the problem and help with your overall well-being. As a rule, what’s good for your heart health is good for your sex health.
With Erectile Dysfunction (ED), it is hard to get or keep an erection that is firm enough for sex. When ED becomes a routine and bothersome problem, your primary care provider or a Urologist can help.
ED may be a major warning sign of cardiovascular disease indicating blockages are building in a man’s vascular system. Some studies have shown men with ED are at significant risk of getting a heart attack, stroke or circulatory problems in the legs. ED also causes:
- Low self-esteem
- Distress for the man and his partner
If ED is affecting a man’s well-being or his relationships, it should be treated. Treatment aims to fix or enhance erectile function, help circulatory health and help the quality of a man’s life.
ED can result from health problems, emotional issues, or from both. Some known risk factors are:
- Being over age 50
- Having high blood sugar (Diabetes)
- Having high blood pressure
- Having cardiovascular disease
- Having high cholesterol
- Using drugs or drinking too much alcohol
- Being obese
- Lacking exercise
- Side effects from medications such as antidepressants or antihistamines
Even though ED becomes more common as men age, growing old is not always going to cause ED. Some men stay sexually functional into their 80s. Aging increases the chance of developing the above causes of erectile dysfunction, but age in itself should not be considered a cause of ED. Moreover, there is no reason that getting older should prohibit an active sex life. ED can be an early sign of a more serious health problem. Finding and treating the reason for ED is a vital first step.
Physical Causes of ED
ED happens when:
- There is not enough blood flows into the penis
Many health issues can reduce blood flow into the penis, such as hardened arteries, heart disease, high blood sugar (Diabetes) and smoking.
- The penis cannot trap blood during an erection
If blood does not stay in the penis, a man cannot keep an erection. This issue can happen at any age.
- Nerve signals from the brain or spinal cord do not reach the penis
Certain diseases, injury or surgery in the pelvic area can harm nerves to the penis.
- Diabetes can cause small vessel disease or nerve damage to the penis
- Cancer treatments near the pelvis can affect the penis’ functionality
Surgery and or radiation for cancers in the lower abdomen or pelvis can cause ED. Treating prostate, colon-rectal or bladder cancer often leaves men with ED. Cancer survivors should see a Urologist for sexual health concerns.
- Drugs used to treat other health problems can negatively impact erections
Patients should talk about drug side effects with their primary care doctors.
Emotional Causes of ED
Normal sex needs the mind and body working together. Emotional or relationship problems can cause or worsen ED.
Some emotional issues that can cause ED are:
- Relationship conflicts
- Stress at home or work
- Stress from social, cultural or religious conflicts
- Worry about sex performance
What Questions Will the Health Care Provider Ask?
Questions about your health:
- What prescription drugs, over-the-counter drugs or supplements do you take?
- Do you use recreational drugs?
- Do you smoke?
- How much alcohol do you drink?
- Have you had surgery or radiation therapy in the pelvic area?
- Do you have any urinary problems?
- Do you have other health problems (treated or untreated)?
Questions About ED
Knowing about your history of ED will help your health provider learn if your problems are because of your desire for sex, erection function, ejaculation, or orgasm (climax). Some of these questions may seem private or even embarrassing. However, be assured that your doctor is a professional and your honest answers will help find the cause and best treatment for you.
Questions about your ED symptoms:
- How long have you had these symptoms? Did they start slowly or all at once?
- Do you wake up in the morning or during the night with an erection?
- If you do have erections, how firm are they? Is penetration difficult?
- Do your erections change at different times, like when going in a partner, during stimulation by mouth, or with masturbation?
- Do you have problems with sex drive or arousal?
- Do you have problems with ejaculation or orgasm (climax)?
- How is this problem changing the way you enjoy sex?
- Do you have painful with erections, feel a lump or bump in the penis or have penile curvature? These are signs of Peyronie’s Disease which can be treated but calls for an expert in urology to assess and manage.
Questions About Stress and Emotional Health
Your health care provider may ask you questions about depression or anxiety. He or she may ask about problems in your relationship with a partner. Some health care providers may also ask if they may talk to your sex partner.
- Are you often under a lot of stress, or has something recently upset you?
- Do you have any anxiety, depression or other mental health issues?
- Are you taking any drugs for your mental health?
- How satisfied are you with your sex life? Has there been any changes lately?
- How is your relationship with your partner? Has there been any changes lately?
Testing and Treatment
Diagnosing erectile dysfunction involves a discussion of your medical history and symptoms; a physical examination to look for signs of problems with your circulatory, nervous, and endocrine system; and routine lab tests to check for underlying conditions such as heart disease, diabetes, and low testosterone.
- Medication Adjustments: Adjusting a medicine that is triggering ED may be all you need to do
- Behavioral Changes: The first step in treating ED is to eliminate possible reversible causes. These changes include controlling hypertension and diabetes. Quitting smoking, exercising, or losing weight can improve ED.
- Counseling: This can help if your ED is affected by stress, depression or anxiety
- Medications: Sildenafil (Viagra®) is an oral medication that revolutionized the treatment of erectile dysfunction. It and newer medications of the same class work by preventing the breakdown of cyclic GMP, a molecule in the penile blood vessels involved in normal erections. It augments and prolongs the normal penile mechanism and is generally very safe. It does, however, interfere with nitrate metabolism; therefore, if a patient takes any form of nitroglycerin, he cannot take Viagra. It requires intact penile and pelvic nerves to work.
- Vacuum Erection Device: Also called a penis pump, this device draws blood into your penis using a plastic tube and pump. A constriction ring/band at the base of your penis helps you keep the erection. The band can be left in place for half an hour. These devices require practice but are safe and reliable.
- Penile injections and Suppositories: Various medicines can be injected into the penis to cause an erection. These medications act as direct penile vascular tissue relaxants, bypassing the need for nerves and relaxing penile blood vessels allowing inflow of blood. The needle used is small and is inserted with minimal discomfort. An erection occurs in 5-15 minutes and may last for an hour.In pellet therapy, rice-sized pellets are inserted into the urethra relax the muscles and blood vessels in your penis to allow blood to flow in to create an erection.
- Surgery/Penile Implant: When other treatments have not worked, the surgical placement of a penile implant or penile prosthesis can allow men to be sexually intimate. Sensation and orgasm do not change with the placement of a penile implant.
- NEW! ShockWave Therapy: We are pleased to introduce Low-intensity extracorporeal ShockWave therapy for the treatment of erectile dysfunction. The ideal patient to receive this type of therapy has mild to moderate erectile dysfunction; however, it has also been shown to be effective in patients with severe ED who respond poorly to traditional medication. ShockWave therapy requires six treatments in the clinic. While the therapy is not currently FDA-approved, ShockWave technology has been peer-reviewed and shows encouraging results.
Frequently Asked Questions
In a word, no. Over-the-counter pills sold on late night TV and in men’s magazines are herbal supplements that are not regulated by the FDA and have not been shown to be effective for erectile dysfunction or penile enlargement.
Start the conversation by acknowledging that this is a hard subject for you to talk about. You might also mention that you’re concerned about erectile dysfunction being an early indicator of a more severe problem like cardiovascular disease or diabetes. Your urologist will discuss your concerns with the professionalism you’d expect when discussing any other medical condition and will help put you at ease.
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