This article is based on scientific evidence, written by experts and fact checked by our trained editorial staff. Note that the numbers in parentheses (1, 2, etc.) are clickable links to medically peer-reviewed studies.
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What Is Erectile Dysfunction (ED)? Symptoms, Causes, Diagnosis, Treatment, and PreventionBy Julie Lynn MarksNovember 24, 2020
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This is usually caused by stress, tiredness, anxiety or drinking too much alcohol, and it's nothing to worry about.
Many men experience erectile dysfunction intermittently, especially during times of stress. If it is a recurring event, however, it can signal an underlying medical or emotional issue. This should be addressed by a healthcare professional.
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A wealth of research has gone into finding effective treatments for male sexual health issues. Evidence-based methods of treatment for both erectile dysfunction and premature ejaculation are widely available and can even be purchased online.
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However, an enzyme known as PDE5 normally breaks cGMP down, restricting blood flow and causing the erection to subside.
Recently, the US Food and Drug Administration (FDA) has issued a safety announcement regarding TRT. In part it reads ‘The benefit and safety of these medications have not been established. We are also requiring these manufacturers to add information to the labeling about a possible increased risk of heart attacks and strokes in patients taking testosterone.’37
It can be embarrassing to discuss sexual matters with your doctor. Yet a doctor’s appointment is neccessary if you want to get treatment for ED. Here’s how to prepare for your doctor visit.
A hollow tube is placed over the penis and the air inside the tube is vacuumed out (manually or battery operated) using a pump. The vacuum pulls blood into the penis, leading to an erection. Once the erection is achieved, a tension ring is placed at the base of the penis to keep the blood in the penis to maintain and erection.
Yohimbe. Before Viagra and the other prescription erectile dysfunction drugs became available, doctors sometimes prescribed a derivative of the herb yohimbe (yohimbine hydrochloride) to their patients suffering from ED. But experts say the medication is not particularly effective, and it can cause jitteriness and other problems. "It's not a great drug," says McCullough. "And I suspect the herb is not as potent as the pharmaceutical version." What's more, evidence shows that yohimbe is associated with high blood pressure, anxiety, headache, and other health problems. Experts discourage its use.
Rose essential oil works to fight stress and anxiety, two causes of erectile dysfunction. It’s also known to help balance sex hormones and improve libido. A 2015 double-blind, randomized and placebo-controlled clinical trial that was published in Neuropsychiatric Disease and Treatment found that rose essential oil was able to improve sexual function in males with SSRI-induced sexual dysfunction and major depressive disorder. Using rose oil improved the participant’s self-rated symptoms of depression and helped to improve sexual dysfunction that was caused by medication use. (30)
Geo Espinosa, ND, director, Integrative Urological Center, NYU Langone Medical Center.
It’s important to distinguish shockwave therapy from radial wave therapy, which is commonly advertised as a noninvasive treatment for erectile dysfunction available at both medical and non-medical facilities. Here are some key differences: Shockwave therapy Data shows it can stimulate blood flow and potentially help grow new blood vessels. A licensed medical professional with professional training is required to administer this treatment. It is not yet approved by the Food and Drug Administration (FDA) for use in treating erectile dysfunction. Radial wave therapy There is no data to support claims that it can help with erectile dysfunction. It is not regulated by the FDA because it is a Class I medical device. No medical license or professional training is required to administer this treatment. Shockwave Therapy Cost
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29. Andersson DP, Landucci L, Lagerros YT, et al. Association of phosphodiesterase-5 inhibitors versus alprostadil with survival in men with coronary artery disease. J Am Coll Cardiol. 2021;77(12):1535-1550.
There are several potential causes of ED, including underlying health issues such as heart disease or diabetes, so it’s important to speak to your healthcare provider as soon as possible if you’re experiencing symptoms.
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heart problems (chest pain, a heart rhythm disorder, heart attack);high or low blood pressure;blood circulation problems;retinitis pigmentosa (an inherited condition of the eye);blindness in one or both eyes;bleeding problems;a stomach ulcer;pulmonary veno-occlusive disease (PVOD);liver or kidney disease;a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia;a physical deformity of the penis (such as Peyronie's disease); orif you have been told you should not have sexual intercourse for health reasons.
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Tadalafil (5mg only) is the only medicine in it’s group (phosphodiesterase 5 (PDE5) inhibitors) that treats an enlarged prostate.
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Among the most popular treatment options for erectile dysfunction are pharmaceuticals. Drugs such as Viagra (Sildenafil), Levitra (Vardenafil), and Cialis (Tadalafil) are popular and boast an 80% success rate. These drugs are classified as phosphodiesterase-5 inhibitors (PDE-5) – which enable an erection, temporarily, but are not the best for maintaining an erection over time.
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Your doctor will do a physical exam and ask you questions about your symptoms. He or she may do a blood or urine test. Your doctor may consider other tests to rule out other conditions.
In particular, pelvic floor exercises improve blood flow to the genitals and may help treat erectile dysfunction when used alone or with other treatments. An experienced pelvic floor therapist can teach these exercises and ensure you’re performing them correctly so that you benefit.
It is important to understand that ED is frequently, if not usually, directly related to endothelial dysfunction, and that the release of NO by the vasculature of the penile arteries is directly related to the function of intact, healthy endothelium. In the face of endothelial dysfunction, the process of erection fails to occur in a normal fashion.16
Usually you’ll only need a handful of sessions. You may want to include your partner, as well.
Erectile dysfunction is common for some men, therefore, frequent occurrence of erection problems is not considered as an extreme case. Erectile dysfunction might result in stress, reduction in self-esteem, loss of confidence, and possible crashing of relationships.
Because a man’s brain, heart, nerves, muscles, emotions, and more all factor into his ability to get an erection, many things can cause ED. This includes: DiabetesHeart diseaseHigh blood pressureMetabolic syndromeObesityLow testosteroneStress and anxietyDepressionRelationship challenges
Commercials for drugs to improve “low T,” or testosterone, the male hormone, are now vying for airtime, but they address desire, not performance. "Male hormone is not an approved treatment for erectile dysfunction," notes Bennett. "It may be used to increase desire in men who have low testosterone, but it doesn’t improve blood flow to an erection." A doctor can do a blood test to check you for low testosterone, but it is a rare cause of ED. Hormone therapy with injections, patches, or gels applied to the skin may improve mood and sex drive, but it likely won’t fix any mechanical issues. Also, testosterone drugs should not be used by men with prostate cancer. Side effects include acne, breast enlargement, prostate enlargement, and fluid retention.
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Knoblovits P, Suarez SM, Scaglia HE, et al. Hypothalamic-pituitary-gonadal axis function in men with type 2 diabetes mellitus. Endo Reviews 2011; 32: Meeting Abstract 0163-769X.
A more advanced level of practice for premature ejaculation is to learn how to stop your arousal mentally and then start it up again. This helps you match up the psychological and physical sensations that go with your arousal and ejaculation. To do this, bring yourself to the brink of orgasm and stop just before ejaculation.
Gupta BP, Murad MH, Clifton MM, et al. The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis. Arch Intern Med 2011; 171: 1797–803. doi:10.1001/archinternmed.2011.440
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Testosterone replacement is associated with polycythaemia and liver dysfunction, so long-term monitoring is required. Finally, as the prostate is an androgen-dependant organ, there are concerns that testosterone replacement might result in testosterone-induced prostate hypertrophy and cancer. Six-monthly review of testosterone and PSA is recommended, and where there are any doubts, a urologist should perform a digital rectal examination. Studies to date have not, however, confirmed any link between testosterone replacement and prostate cancer, as outlined in a recent review by Landau and colleagues.13
Appropriate treatment options should be applied in a step-wise fashion, balancing invasiveness and risk versus efficacy. If possible, the partner should be involved in the decision-making. The decision depends on the patient preferences and expectations as well as the experience and judgment of the physician. Oral phosphodiesterase type-5 inhibitors are first line therapy.
The central nervous system is responsible for releasing nitric oxide, an essential chemical for producing and maintaining an erection, and heavy alcohol consumption depresses the central nervous system, causing it to function less efficiently. Not enough nitric oxide translates to erectile dysfunction.
The FDA warns that some products may contain harmful substances or the active ingredient in some prescription medications.
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This involves listening to the heart rate and the lungs. The blood pressure is checked, the testicles and penis are examined. A rectal exam can be done to test for prostate.
A penile implant is often recommended for men who have tried other treatments without success. This device, on the market for 30 years, basically gives men an erection at their discretion but does not affect the ability to ejaculate or feel orgasm.
National Center for Complementary and Alternative Medicine: "Aromatherapy May Make Good Scents, But Does It Work?" "Ginkgo," "Asian Ginseng." Erectile Dysfunction Guide Overview Symptoms & Risk Factors Testing &Treatment Living & Managing
This can be useful even if there is a medical cause, as it gives you a chance to talk about how you feel about having erectile dysfunction. If there is an underlying psychological reason for the difficulty, this is a safe place to explore what this might be and what you can do about it. This is generally not available as a funded service and you would normally need to pay for this privately. If you have been sexually abused, then you may be able to access free counselling through ACC.
Keeping yourself hydrated is one of the factors for maintaining a firm penis. Undergoing stress maintenance is also good for healthy sex life alongside exercises.
“There is a huge placebo effect with erectile dysfunction,” he says. “I could give you anything and tell you it’ll work and it will in the short term.” For that reason, he says, what little studies that have been done on herbal remedies are less than convincing.
Hypogonadism is common in patients with type 2 diabetes, more so if ‘metabolic syndrome’ or obesity is present. The Endocrine Society recommends routine measurement of testosterone levels in patients with type 2 diabetes, but even diabetologists can be tardy in checking this.2 Studies to date have demonstrated strong benefits resulting from testosterone replacement, but this treatment should be individualised and under specialist supervision until long-term studies fully establish its benefits and risks.
The causes of erectile dysfunction are many, including physical problems like diabetes, heart disease, obesity, high blood pressure, high cholesterol, and even sleep disorders. Medication taken for health conditions can result in erectile dysfunction, as can alcohol and smoking.
“We listen to the patient and partner, understand the cause of the problem and work with the couple to start treatment that works best for the patient,” says Dr. Honig. PDE-5 inhibitors (phosphodiesterase type 5 inhibitors): These are medicines which relax muscle cells in the penis and increase blood flow. Vacuum erection device: This pulls blood into the penis, causing an erection. The erection is maintained by placing an elastic ring at the base of the penis. Injection therapy: Doctors use a very small needle to inject medication directly into the side of the penis. This relaxes the muscle allowing for blood flow and is a highly successful. Minimally invasive penile implant surgery: which our experienced physicians routinely perform. Most patients recover full sexual function in six to eight weeks. Yale Medicine Urology has extensive experience in standard and complicated penile implant surgery.
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For men searching for ED medication, there are many newer erectile dysfunction treatments (all prescription drugs) that help you get an erection firm enough to have sex, and most have few side effects.
Knoblovits P, Suarez SM, Scaglia HE, et al. Hypothalamic-pituitary-gonadal axis function in men with type 2 diabetes mellitus. Endo Reviews 2011; 32: Meeting Abstract 0163-769X.
Men who have ED should not ignore the ailment. After all, more than 40 percent of men over the age of 40 struggle with ED. Men struggling with ED should talk to their doctor about potential causes and treatment options, as well as make lifestyle changes to reduce incidence. Young men should take preventive steps, including the development of healthy lifestyle habits, like eating a balanced diet and maintaining a healthy weight, which can reduce their risk of ED.
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Hormone imbalance, particularly low testosterone, can also play a role in ED. Men can naturally increase testosterone levels by routinely engaging in weight training exercises. For aging men whose testosterone levels have dipped, hormone therapy is a safe and effective treatment option.
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Do you know about all the serious issues with Viagra, Cialis, and all their generic substitutes? Learn how men are able to regain full function without pills, shots, or surgery and go back to being intimate the natural way.
