Erectile Dysfunction

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Erectile dysfunction takes more than a physical toll. The emotional impact on a man and his partner can prove just as difficult. It is common for men with ED to feel anger, frustration, sadness, or a lack of confidence. However, the condition can be treated.

The first step in addressing your concerns about ED is to be honest with yourself, your partner, and your doctor. Once you have brought ED out into the open, coping with it as you go through treatment will be easier and less stressful. Communication is essential to successful diagnosis and treatment as well as to helping your partner understand your feelings.

While you are being treated for ED, it is important to be patient with your progress. A treatment that works for one person may not work for another. It is also important to know that the treatment you choose may not work the first time or may not work every time. For some couples, sex therapy may help partners support each other and maintain intimacy while coping with ED. It may also help to learn more about others' experiences with ED. Contact your doctor about support groups in your area.

Talking to your partner

If you are diagnosed with erectile dysfunction, feelings of anger and resentment that you may naturally experience may harm your relationship with your partner unless you find a way to communicate them. While these emotions are understandable, it is important to take into account that your partner is also affected by your ED. Moreover, feeling comfortable talking about your relationship

treatment. A man who has difficulty sharing and resolving his feelings about ED may make the problem worse.

The best way to communicate with your partner is to try to get past the initial embarrassment and awkwardness and confront the problem head-on. If you have difficulty discussing the topic, counseling may help.

For some couples, sex therapy may help partners support each other and maintain intimacy while coping with ED.

A partner of someone experiencing ED can help by discussing feelings honestly while showing care and concern. Rather than assigning blame, it can be much more effective to take the approach that dealing with the problem will be a team effort. Meantime, you can together explore alternative techniques to find sexual pleasure so that there's no pressure to "perform." Focus on ways to solve ED, rather than how ED affects your relationship. Give your partner positive feedback so that he's willing to discuss his feelings. Remind him that there are many options for successful treatment. If your partner does not succeed initially, encourage him to continue to visit the doctor and explore other options.

Lifestyle changes

Men can often improve their erectile function by making changes in their daily habits. Further, these steps help men lead healthier lives overall.

Men who maintain a healthy weight, who exercise regularly, and who reduce stress and anxiety lower their risk of erectile dysfunction. Men with high cholesterol may damage the linings of blood vessels throughout the body, including those in the penis. Cholesterol can also harden, narrow, or block these arteries, leading to erectile dysfunction. You can lower your cholesterol through diet, exercise, and medication.

Nonsmokers have a lower risk of atherosclerosis (hardening of the arteries), and men who quit smoking may partly or fully restore erectile function. Excess drinking can inhibit erectile functioning and can affect production of the hormone testosterone, affecting sex drive and erections. More than 80 percent of chronic alcoholics have chronic ED. Illegal drugs can also cause impotence. Men with diabetes risk damaging the arteries and nerve endings serving the penis if their diabetes is out of control. Diet, exercise, and medical control for diabetes can all help men avoid risk of diabetes-related ED.

Nonsurgical treatments

The first step in treating ED is to find the underlying cause; the doctor can then decide what sort of treatment is likely to work. If the problem continues, a number of nonsurgical options can help a man gain and maintain erections.

Oral medications

Sildenafil (Viagra) was the first oral medicine approved to treat erectile dysfunction. It works by increasing the flow of blood to the penis so that a man can get an erection when he is sexually stimulated. Though the directions advise men to take the drug one hour before sexual activity, research indicates that the drug can sometimes work when taken from 30 minutes to eight hours before intercourse.

Take Viagra exactly as directed. Do not increase or decrease the dosage of Viagra or take the drug more often than prescribed by your doctor. Do not take Viagra more than once a day. Men who are on nitrate medications such as nitroglycerine should not take Viagra, since the combination of Viagra and nitrates can cause blood pressure to dip too low (hypotension). The most common side effects of Viagra are dyspepsia (indigestion), nasal congestion, flushing, headaches, and transient visual disturbance.

Before taking Viagra, tell your doctor if you:

  • Are allergic to Viagra or any other drugs
  • Are taking any prescription or over-the-counter medications including herbal and dietary supplements
  • Are scheduled for surgery
  • Take nitroglycerin or a long-acting nitrate to treat chest pain. The combination of Viagra and these drugs can cause dangerously low blood pressure.
  • Have ever had a heart attack, heart disease, angina (chest pain associated with heart disease), stroke, or retinitis pigmentosa (a rare disease of the eye that causes vision loss)
  • Other oral medications that work in a similar fashion are tadalafil (Cialis) and vardenafil (Levitra). These two drugs are in the same class of medications that includes sildenafil (Viagra) and have generally similar success rates and side effects. Cialis (tadalafil), however, has a longer duration of action, up to 36 hours.


    For this treatment, known as "transurethral pharmacotherapy or MUSE," the man with erectile dysfunction places a suppository into the urinary tube (urethra) using a plastic applicator. The suppository contains the medicine alprostadil, which is absorbed into the nearby erection chambers (corpora cavernosa). Alprostadil belongs to a group of drugs called vasodilators --drugs that increase blood flow by relaxing and expanding blood vessels. It is identical to a naturally occurring substance found in the body that helps keep the blood vessels open, and it helps treat ED by increasing the blood flow to the penis.

    Though suppositories appear to be less effective than either injections or vacuum therapy, the drug can be used to treat erectile dysfunction due to a wide variety of causes.

    Before inserting the suppository, you should urinate; the small amount of urine left in the urethra will help dissolve the suppository after you insert it. To help dissolve the suppository, roll your penis between your hands for 10 seconds. If you feel any stinging, continue this motion to help stop it. Sitting, standing, or walking for 10 minutes while an erection develops can help increase the blood flow to your penis to gain a proper erection. Alprostadil usually begins to work in about five to 10 minutes. Intercourse should be attempted within 10 to 30 minutes of using this medication. An erection may continue after ejaculation.

    Do not insert more than two doses of alprostadil within a 24-hour period, and do not use any more than the doctor-recommended dose. This could result in permanent damage to your penis.

    When using a suppository form of alprostadil, it is advisable to use a condom if having sexual intercourse with a pregnant woman. While it is unlikely that a fetus will be harmed by the medication, the condom will protect it from exposure. The effects of alprostadil on early pregnancy are still unknown.

    Possible side effects include mild bleeding or spotting from the urethra and stinging of the urethra. Contact your doctor if you experience curving of the penis with pain during an erection, an erection that lasts four to six hours with pain, swelling of or pain in the testes, dizziness, faintness, pelvic pain, or flulike symptoms.

    Men who do not have erectile dysfunction should not use alprostadil as a sexual aid. If this medicine is not used properly, permanent damage to the penis and loss of the ability to have erections could result.


    In intracavernosal injection therapy, more commonly called penile self-injection, a man injects a small amount of medicine into the side of his penis using a tiny needle and syringe. The medicine, usually prostaglandin E1, papaverine, phentolamine, or combinations of these drugs, relaxes the blood vessels, allowing blood to flow into the penis. Injection therapy is effective in treating a wide variety of erection problems caused by blood vessel, nerve, and psychological conditions. The most common adverse side effects are pain and penile scarring (fibrosis). Patients with cerebral vascular disease or severe cardiovascular disease might not be able to tolerate the dizziness and high blood pressure occasionally encountered with injection therapy. Painful erections that last longer than two to three hours can usually be controlled by proper dosing and by following treatment guidelines.

    The drug alprostadil, which relaxes and expands the blood vessels (allowing more blood to flow into the penis), comes in several mixtures that can be injected into the base or the side of the penis with a fine needle. An erection usually occurs within 20 minutes.

    Be sure that you know which product you are using and that you fully understand the proper way to mix the injection. Do not use alprostadil more often than your doctor has ordered or in larger amount; misuse could cause permanent damage to the penis.

    After an injection is mixed, alprostadil must be used immediately. Throw away any unused mixture in the syringe; it cannot be stored for later injection. Do not reuse your needles.

    Contact your doctor if any of the following symptoms become worse or do not go away: bleeding at the site of injection, pain at the site of injection, painful erection, bruising or clotted blood in the area of the injection (usually caused by an incorrect injection). Also, report curving of the penis with pain during an erection, an erection that lasts four to six hours with pain, swelling of or pain in the testes, dizziness, faintness, pelvic pain, or flulike symptoms.

    Men who do not have erectile dysfunction should not use alprostadil as a sexual aid. If this medicine is not used properly, permanent damage to the penis and loss of the ability to have erections could result.

    Vacuum constriction device

    The vacuum constriction device is a cylinder that is placed over the penis. When the air is pumped out of the cylinder, blood is drawn in, causing an erection. The user then maintains an erection by slipping a band off the cylinder and onto the base of the penis. The band can stay in place up to 20 minutes.

    The vacuum device can be safely used to treat most causes of erectile failure. A lack of spontaneity and the fact that using the device can be cumbersome and may cause some discomfort seem to be the biggest concerns of patients.


    When there is a clear medical cause for erectile dysfunction that is unlikely to resolve or improve naturally, another treatment option for men might be a surgical penile implant or vascular reconstruction.

    Penile implant. The simplest type of prosthesis consists of a pair of malleable rods surgically implanted within the spongy erection chambers of the penis. Today, many men instead choose a hydraulic, inflatable prosthesis that allows a man to have an erection whenever he chooses. The penile prosthesis is also an option for men whose erections are curved because of scarring.

    The inflatable penile prosthesis consists of two cylinders that are inserted in the penis and connected by tubing to a separate reservoir of fluid implanted under the groin muscles. A pump is also connected to the system and sits under the loose skin of the scrotal sac, between the testicles. To inflate the prosthesis, the man presses on the pump (which does not require putting pressure on the testicles). The pump transfers fluid from the reservoir to the cylinders in the penis, inflating them. Pressing on a deflation valve above the pump returns the fluid to the reservoir, deflating the penis.

    The prosthesis does not change sensation on the skin of the penis, a man's ability to reach orgasm, or ejaculation. Scars from the surgery are small; most people won't notice that a man had an inflatable penile implant. Between 90 and 95 percent of inflatable prosthesis surgeries result in implants that produce erections suitable for intercourse. Possible complications from the surgery include uncontrolled bleeding, infection, scar tissue formation, and mechanical failure. Men usually cannot get an erection without inflating the implant, and if the implant is removed, the man may never again have natural erections.

    Vascular reconstructive surgery. During this procedure, an option when blood flow to the penis is blocked, surgeons transfer an artery from an abdominal muscle to the penis. This technique creates a path for blood to flow to the penis that bypasses the area of blockage.

    Only a small percentage of men, mostly young men with trauma leading to the penis, may be candidates for this surgery. The technique is technically difficult, costly, and not always effective.

    Sex therapy

    A patient whose erectile failure has a clear psychological cause should undergo sex counseling before he pursues any invasive treatments. Sex therapy works best to treat erectile dysfunction if a man is generally healthy and has normal erections during sleep, normal blood tests, and a normal physical exam. Therapy can also help when ED is caused by stress from work, finances, relationship problems, or poor sexual communication.

    Treatment is a short-term form of counseling, generally involving five to 20 sessions. (If a man drops out of therapy after only one or two sessions, successful treatment of ED is unlikely.) During the sessions, the counselor will give the patient "assignments" to do at home, such as practicing sexual communication skills, reading books about sexuality, and touching exercises that are designed to take away the pressure to perform during sex.

    Not only does sex therapy work best when a man's sexual partner gets involved with the treatment; the therapy also helps a man's partner cope with the problem. When a partner gets involved with therapy, men resolve stress-related erectile dysfunction 50 to 70 percent of the time. When a man goes through counseling alone, the success rate is lower.

    Even when erectile dysfunction has a clear physical cause, psychological problems sometimes contribute to erectile failure. Several sessions of sexual counseling can help a man who is going to receive medical or surgical treatment for erectile dysfunction. A counselor can guide a couple as they decide on a particular treatment, or the counselor can help the couple improve their sexual communication and lovemaking skills. A man who is single may benefit from counseling on how to talk to a new partner about penile injections or a vacuum constriction device.

    Testosterone replacement therapy

    The male hormone testosterone is produced by the testicles and is responsible for the proper development of male sexual characteristics. It is also important for maintaining muscle bulk, red blood cells, bone growth, sense of well-being, and sexual function. Though inadequate testosterone production is not a common cause of erectile dysfunction, some men with low testosterone might see increased sexual functioning from testosterone replacement therapy.

    As a man ages, the amount of testosterone in his body gradually declines, starting after age 30. Other causes of testosterone deficiency include injury or infection to the testicles, chemotherapy or radiation treatment for cancer, genetic abnormalities, hemochromatosis (too much iron), pituitary gland dysfunction, medications including prostate drugs and steroids, AIDS, stress, and alcoholism. Testosterone deficiency can cause decreased sex drive, decreased sense of well-being, depression, concentration and memory difficulties, and erectile dysfunction.

    Testosterone levels fluctuate in the body throughout the day, and a doctor may test the amount of the hormone in your blood several times to diagnose low testosterone. If your testosterone levels are low, your doctor may prescribe one of several different types of testosterone replacement: intramuscular injections, testosterone patches, or testosterone gels. Because oral hormones may lead to liver abnormalities, no pills exist in the United States that provide adequate levels of testosterone replacement.

    Though testosterone replacement therapy is generally safe, it is associated with several conditions including acne, oily skin, mild fluid retention, stimulation of prostate tissue and increased urination, breast enlargement, worsening of sleep apnea, and decreased testicular size. Some laboratory side effects of testosterone replacement therapy include changes in blood cholesterol, increased red cell count, and a decrease in sperm count (which can produce infertility, especially in younger men).

    Since testosterone may stimulate prostate growth, the hormone can also accelerate the growth of prostate cancer. It is important for all men considering testosterone replacement therapy to undergo screening for prostate cancer before starting treatment. Further, men with breast cancer should not take testosterone replacement therapy.

    Alternative treatments

    Some men with erectile dysfunction choose to treat their condition with alternative medicines or techniques. These alternative treatments, which include nutritional supplements, herbal remedies, and acupuncture, fall outside standard western medical practice; many have not been evaluated for effectiveness in clinical trials. It is important to consult a physician about erectile dysfunction to determine the cause and receive appropriate treatment for the condition. Men considering alternative treatments should seek the advice of a healthcare provider.

    Popular nutritional supplements to treat erectile dysfunction include bioflavonoids, zinc, vitamin C, vitamin E, and flaxseed meal. Supplemental doses of the amino acid arginine have helped some men with ED, according to research. Some people claim that herbal remedies such as Asian ginseng and Ginkgo biloba help improve sexual functioning. You should consult a doctor before taking any herbal supplement to weigh the risks and potential benefits of herbal remedies.

    Although some ED patients have shown improvement from low levels of the hormone dehydroepiandrosterone (DHEA), experts have expressed concerns about the drug's long-term safety.

    Acupuncture, a technique that involves sticking very fine needles into specific points on the body, is believed by some to stimulate the body's ability to resist or overcome illnesses and conditions. Acupuncture has helped some men with erectile dysfunction.

    Last reviewed on 08/13/2008

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