Erectile Dysfunction Treatment

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Erectile Dysfunction


Erectile dysfunction (impotence) is the inability to get and keep an erection rigid enough during intercourse.

In other words, erectile dysfunction (ED) is the difficulty in getting and maintaining an erection hard enough to perform a sexual intercourse.

The problem of erectile dysfunction is reported by 1 in 5 men, and that number gets bigger with age.



Erectile dysfunction (ED) has to be treated quickly before it leads to an irreversible damage in the penis and because it can cause:

  • Low self-esteem
  • Embarrassment
  • Loss of self-confidence
  • Depression
  • Distress for the man and his female partner
  • Inability to make the partner pregnant (infertility)



The mechanism of erectile dysfunction:

During sexual arousal the blood flow increases in the penis. You get an erection when blood fills two chambers known as the “corpus cavernosum” which is a spongy muscle chamber. This causes the penis to expand and stiffen. During erection the spongy tissue relaxes and traps the blood. The pressure inside the chambers causes the stiffness of the erection. When a man gets an orgasm the muscular tissue contracts causing blood to be released back into the man’s blood circulation and the erection comes down.

Impulses from the brain and genital nerves start the process.

Anything that blocks these impulses or restricts blood flow to the penis can cause erectile dysfunction.

This means that erectile dysfunction happens in case:


  • There is not enough blood flow into the penis. Many health problems might reduce the blood flow into the penis such as hardened arteries (atherosclerosis), heart diseases, high blood pressure, diabetes, obesity and high Cholesterol.
  • The penis cannot trap the blood during an erection. If blood doesn’t stay in the penis, the man loses his erection.
  • Nerve signals from the brain or spinal cord doesn’t reach the penis. Certain diseases, injuries, or surgeries in the pelvic region might harm the nerves reaching to the penis.
  • Diabetes can cause damage of the small vessels and nerves of the penis.
  • Cancer treatments near the pelvis can affect the function of the penis. Surgery and radiation for cancers in the lower abdomen or pelvic region can cause erectile dysfunction. Treating prostate, colon-rectal, or bladder cancer often causes erectile dysfunction in men.
  • Some medications used to treat other health problems can negatively impact the erection. Including antidepressants, antihistamines and medications to treat high blood pressure, pain or prostate conditions. 




How do I know that I have erectile dysfunction?

Symptoms of ED include:

  • An erection which is too soft for sex.
  • An erection which doesn’t last long enough for sex.
  • An inability to get an erection.
  • Morning stiffness of the penis starts to happen less and less.
  • Decreased sexual desire (lack of libido)

If you can’t get or keep an erection that lasts long enough or is rigid enough for sex, you have erectile dysfunction.



What causes erectile dysfunction (ED)?

  • Having high blood sugar (diabetes)
  • Having high blood pressure (Hypertension)
  • Having cardiovascular diseases
  • Having high Cholesterol and high triglycerides
  • Smoking
  • Obesity
  • Being over 50
  • Lack of exercise
  • Kidney disease
  • Multiple sclerosis
  • Using drugs or drinking too much alcohol
  • Emotional causes:
  •    Depression
  •    Anxiety
  •    Relationship conflicts
  •    Stress
  •    Religious prohibitions
  •    Worry about sexual performance (performance anxiety)
  •    Low self-esteem




Diagnosis of erectile dysfunction:


A physical exam and answering some specific questions (medical history) are all what’s needed for a doctor to diagnose erectile dysfunction and recommend a treatment.

If you have chronic health conditions or your doctor suspects that an underlying condition might be involved, you might need further tests or a consultation with a specialist.

Tests for underlying conditions might include:

  • Physical exam. This might include careful examination of your penis and testicles and checking your nerves for sensation.
  • Blood tests. A sample of your blood might be taken to check for signs of heart disease, diabetes, low testosterone levels and other health conditions.
  • Urine tests (urinalysis).  Urine tests are used to look for signs of diabetes and other underlying health conditions such as infections.
  • Ultrasound + Doppler: This test is usually performed by a specialist in a clinic. It is done to check the blood vessels that supply the penis. It allows a doctor to see if you have blood flow problems. This test is sometimes done in combination with an injection of medications into the penis to stimulate blood flow and produce an erection.
  • Psychological exam. The doctor might ask some questions to check on signs of depression and other possible psychological causes of erectile dysfunction.




Erectile dysfunction trearment: Oral Medications


The oral medications known as Phosphodiesterase type 5 Inhibitors (PDE5 inhibitors) are the 1st line of treatment in erectile dysfunction.

This class of drugs includes Sildenafil, Avanafil, Tadalafil, and Vardenafil. All work by improving blood flow to the penis during arousal. Those drugs need normal nerve function to the penis. They're generally taken 1 hour – 2 hours before sexual activity and should not be used more than once a day. You can take tadalafil up to 36 hours before sexual activity. It also comes in a lower, daily dose. All oral treatments for erectile dysfunction require a prescription by a doctor for safety.

IF YOU ARE TAKING NITRATES FOR YOUR HEART, YOU SHOULD NOT TAKE ANY PDE5 INHIBITORS. Always consult a doctor before using any PDE5 inhibitor.

Pills are an easy way to treat erectile dysfunction, but they have some mild side effects:

  • Headache
  • Facial flushing
  •  Muscle aches
  • Indigestion
  • Stuffy nose




Erectile dysfunction treatment: Injections; Intra-cavernosal Injections (ICI)


Self-injection therapy:


Pills are an easy way to treat ED, but you might get a stronger erection from injecting medication directly into your penis. That’s because these drugs widen your blood vessels so your penis fills with blood.

Alprostadil is injected into the side of the penis with a very fine needle. Before starting any injections in the penis, a specialized experienced doctor has to explain to you how to do it by yourself exactly. And the specialist has to prescribe you the needed dosages.

Alprostadil injections can be used as a mixture with 2 other components to treat erectile dysfunction. This combination therapy called “Trimix” is much stronger than Alprostadil alone and has become a standard treatment for erectile dysfunction. The Alprostadil component is FDA approved for erectile dysfunction treatment. The amount of each drug in this mixture can be changed and adapted upon each individual need. The mixture and the amount of the ingredients in the “TRIMIX” can be regulated based on the severity of your erectile dysfunction individually. You will be trained how to self-make the injection, how much to inject (individualized dosage) and how to safely increase the drug dosage whenever needed.

“Trimix” injections produce a reliable erection within 15 minutes. You can keep the erection usually for 30 – 90 minutes. Since this erection produced by the “Trimix” is not regulated by your penile nerves, you should keep your erection even after the orgasm.

The most common side effect of “ICI” therapy by the Trimix is prolonged erection more than 90 minutes. Prolonged erection which is called priapism (> 1 hour and a half) can be reversed by a 2nd injection (antidote) in the clinic if needed. There are other ways to make the erection fall without the need of this antidote injection. The doctor will explain to you what to do in this case. Men who will have a prolonged erection lasting more than 2 – 4 hours should seek medical care by his doctor. Priapism is a prolonged erection lasting more than 4 hours. Failure to undo priapism will cause an irreversible damage to the penis. That’s why you have to consult an experienced specialist who will help you avoid priapism by finding the exact dosage to each individual case.



Erectile dysfunction treatment: Psychotherapy


Even when erectile dysfunction has a physical cause, psychotherapy can help. A therapist can teach the man and his partner techniques to reduce performance anxiety and improve intimacy.


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