![Erectile dysfunction (ED, impotence) is a condition in which men have trouble getting or maintaining an erection. It is possible to cure or reverse erectile dysfunction, but it depends on the cause. Treatment may include medications, injections, treating the underlying disease causing it, prostheses, surgery, and others.](https://images.medicinenet.com/images/mobile/hp_promo/sex-and-heart-attacks.jpg?output-quality=75)
Erectile dysfunction (also called ED, or impotence) describes a condition in which men cannot acquire or maintain an erection.
Treatment for erectile dysfunction is aimed at enabling a man to achieve and maintain an erection for sexual intercourse. It may be possible to cure or reverse erectile dysfunction, depending on the cause. If erectile dysfunction is the result of an underlying medical condition, treating that condition often reverses the ED.
If the cause of erectile dysfunction is from limited blood flow to the penis due to lifestyle habits such as smoking, obesity, or high blood pressure (hypertension), lifestyle modifications to treat and possibly cure ED may include:
- Weight loss in men who are obese
- Exercise regularly
- Eat a healthy, balanced diet
- Don’t smoke
- Limit or avoid alcohol
- Talk to your doctor about using different medications to treat hypertension and pain
- Do not stop taking any prescribed medication without first talking to your doctor
For men who have diabetes and erectile dysfunction, pelvic floor exercises may be used to help manage sexual dysfunction.
If erectile dysfunction is caused by depression or anxiety, treatment that may help cure ED includes:
- Psychotherapy
- Medications for depression and/or anxiety
- Counseling with a sex therapist for men with performance anxiety
Medications used to treat erectile dysfunction may include:
- Phosphodiesterase-5 inhibitors
- Sildenafil (Viagra)
- Vardenafil (Levitra)
- Tadalafil (Cialis)
- Avanafil (Stendra)
- Testosterone replacement therapy
- Used when man's testes do not make enough of the hormone testosterone
- Does not work to improve sexual function in men who produce normal amounts of testosterone
Medical treatments used to treat erectile dysfunction may include:
- Penile self-injection in which a man injects a medication (alprostadil or papaverine) into the two chambers of the penis that are filled with spongy tissue and blood (corpora cavernosa) to cause an erection by allowing the blood vessels within the penis to expand so the penis swells and stiffens to create a fully rigid erection
- Intraurethral alprostadil (MUSE) uses the same medication (alprostadil) as penile self-injection but instead a man inserts a device with an alprostadil pellet (suppository) into the urethra to create an erection
- Vacuum-assisted erection devices involve placing the penis in a plastic cylinder and creating a vacuum around the penis to increase blood flow into the penis. A rigid ring is placed at the base of the penis to hold the blood inside the penis, keeping it erect.
- Penile prostheses are surgically implanted devices that inflate to allow the penis to become erect
- Revascularization is a surgical procedure used for young men who have experienced pelvic trauma
What Causes Erectile Dysfunction?
Causes of erectile dysfunction include:
- Limited blood flow to the penis
- Cigarette smoking
- Obesity
- Diabetes
- High blood pressure (hypertension)
- Aging
- Prescription medications, such as antihypertensive medications
- Neurological causes
- Diabetes
- Stroke
- Prostate surgery that damage nerves to the penis
- Pelvic trauma
- Spinal cord or back injury
- Multiple sclerosis
- Dementia
- Previous episodes of prolonged erection (priapism)
- Drugs that affect the nervous system or that lower testosterone levels or inhibit testosterone action
- Nicotine
- Alcohol
- Opioids
- Blood pressure medications, such as beta-blockers
- Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs)
- Spironolactone
- Sympathetic blockers such as clonidine, guanethidine, or methyldopa
- Thiazide diuretics
- Ketoconazole
- Cimetidine
- Recreational drugs, such as cocaine and heroin
- Psychological causes
- Depression, which may include loss of sex drive
- Performance anxiety
- Lack of focus
- Other risk factors
- Chronic kidney disease
- Peripheral neuropathy
- Autonomic dysfunction
- Peripheral vascular disease
- Hypogonadism
- Endocrine disorders
- Bicycling
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https://www.uptodate.com/contents/overview-of-male-sexual-dysfunction?search=Erectile%20Dysfunction&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H2095608
https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/symptoms-causes
https://pubmed.ncbi.nlm.nih.gov/20522020/