The Journal of Clinical Endocrinology & Metabolism Vol. 90, No. 12 0
Copyright © 2005 by The Endocrine Society
Patient Information Page from The Hormone Foundation |
Erectile Dysfunction
Bradley D. Anawalt, MD,
Glenn R. Cunningham, MD and
Alvin M. Matsumoto, MD
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What is erectile dysfunction?
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Erectile dysfunction (ED), or impotence, is the inability to get or keep an erection (hard penis) for enough time to have satisfactory sex. To maintain an erection, blood must be able to flow into and stay in the penis until orgasm.
Men commonly have problems with their erections once in a while. If ED occurs often, medical therapy may be helpful.
About 15 to 30 million men in the United States have ED. It can happen at any age, but is more common in men older than 65. Physical problems cause about 70 out of 100 cases (or 70%); emotional issues cause about 10 to 20 out of 100 cases (or 10% to 20%); and 10 to 20% have a mixed physical and emotional cause.
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What causes erectile dysfunction?
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Any physical or emotional condition that interferes with sexual desire or blood flow or nerve signals to the penis can cause ED.
The most common causes are conditions that affect blood vessels and blood flow in the penis, such as hardening of the arteries (atherosclerosis) that is linked to diabetes, smoking, high blood pressure and high cholesterol. Other common causes can include medications (e.g., antidepressants, sleeping pills, and drugs to treat high blood pressure, pain or prostate cancer), as well as alcohol, tobacco, and illegal drugs.
Other less common causes for ED can include:
- A lack of sexual desire due to depression, anxiety, brain diseases (e.g., stroke) and low testosterone (the male sex hormone).
- Multiple Sclerosis (MS), spinal cord injuries, pelvic surgery or trauma, or diabetes, which can affect nerves and prevent brain signals from reaching the blood vessels of the penis.
- Hormone imbalances such as low testosterone, high prolactin and abnormal thyroid hormone levels.
- Chronic kidney and liver disease (which affect blood vessels, nerves and hormone levels).
- Rarely, scarring of the penis that causes a severe curving (Peyronie’s disease) that interferes with normal erections.
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How is erectile dysfunction diagnosed?
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To determine the cause of ED, your doctor will take a history of when you started to have problems with erections, your medications, illnesses or injuries that could cause ED, and any recent physical or emotional changes in your life. The evaluation also includes a physical exam and a blood testosterone level.
Depending on your medical history, physical exam and testosterone test, your doctor may also order blood tests for luteinizing hormone (LH), prolactin, fasting blood sugar and cholesterol, and also test for liver, kidney, and thyroid function. Rarely, your doctor may also do special tests of check nerve function, and blood vessels and blood flow.
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How is erectile dysfunction treated?
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The treatment for ED will depend on the cause and how serious your condition is. Treatment options can include: - Oral medication. There are three drugs available—sildenafil, talafadil, and vardenafil. All three work by increasing blood flow to the penis during sexual stimulation.
- Penile therapies. Medications that may be injected into the penis or inserted into the urethra to increase blood flow. (These may work when the oral medications do not.)
- Testosterone replacement therapy. Testosterone can be replaced through injections, pills, patches and gels in men with low testosterone.
- Vacuum device. An external plastic cylinder and vacuum pump that pulls blood into the penis and then uses a ring around the base of the penis to prevent blood from flowing back into the body.
- Surgery. Penile implants are used for the rare patient who does not respond well to other therapies. Implants are expensive, can lead to infections and may not work in the long term. (Surgery is rarely used to correct a blockage of penile blood flow.
- The best candidates for surgery are young men with limited blockage.)
- Psychological counseling. If a relationship or an emotional problem is the cause of your ED, your doctor may recommend that you (and your partner) see a sex therapist.
All treatment options have risks. Finding the right treatment for you may take several tries. Your doctor will work with you to find the best treatment option for you.
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What should I do with this information?
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If you have been experiencing ED for more than two months, you should see a doctor to determine the cause. A healthy lifestyle that includes regular exercise, good nutrition, no tobacco and limited alcohol is helpful in preventing some of the conditions that can cause ED. If the cause of your ED is related to a hormone imbalance, you may need to consult a specialist such as an endocrinologist.
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Resources
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- Find-an-Endocrinologist: www.hormone.org or call 1-800-HORMONE (800-467-6663)
- Family Doctor (AAFP): http://familydoctor.org/109.xml
- Medline Plus: http://www.nlm.nih.gov/medlineplus/erectiledysfunction.html
- National Kidney and Urologic Diseases Information Clearinghouse: http://kidney.niddk.nih.gov/kudiseases/pubs/impotence/
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Footnotes
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For more information on how to find an endocrinologist, download free publications, translate this fact sheet into other languages, or make a contribution to The Hormone Foundation, visit www.hormone.org/bilingual or call 1-800-HORMONE. The Hormone Foundation, the public education affiliate of The Endocrine Society (www.endo-society.org), serves as a resource for the public by promoting the prevention, treatment, and cure of hormone-related conditions. This page may be reproduced non-commercially by health care professionals and health educators to share with patients and students. © The Hormone Foundation 2005
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What is erectile dysfunction?
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