Erectile dysfunction affects approximately 30 million men in the United States. It is defined as the inability to maintain an erection sufficient for sexual intercourse. There are many causes of erectile dysfunction, some of which include vascular disease, neurologic problems, diabetes, smoking, medication, previous surgery, or psychological factors. Psychological factors are thought to cause less than 10% of cases.
The cause of the erectile dysfunction must usually be determined in order to effectively treat it. The physician will obtaining a history from the patient which includes recent surgeries, current medications, and whether there are any other medical problems. There are also a number of tests the doctor may order to determine the cause, such as monitoring penile erections that occur throughout the night to determine whether or not erections occur and how rigid they are. Duplex ultrasonography is a test to monitor blood flow into the penis; cavernosometry is used to measure pressure in the penis; and cavernosography is used to visualize possible leaks of blood through the veins during erection.
With the currently available treatment techniques, all men who desire to restore erectile function should be able to do so.
The treatment of erectile dysfunction depends upon the cause of the dysfunction, and is influenced by the patient's age or other medical problems. For most patients treatment options include medication, vacuum erection devices, injections, or penile prostheses.
- Medication currently available includes Viagra. Viagra is most effective for mild erectile dysfunction. Viagra works by helping the small arteries in the penis open as much as possible, thus increasing the blood in the penis. Viagra is not recommend for patients with hypertension, a history of heart attacks, chest pain, or those who are taking nitrate medications.
- A vacuum erection device creates a suction which causes blood flow into the penis. When sufficient blood has entered the penis, the patient places a ring at the base of the penis which traps the blood in the penis and maintains the erection.
- Injections of vasoactive drugs are supplied to the patient in a kit. Prior to sexual activity the drug is injected into the penis using a small needle.
- Penile prostheses are devices that are implanted into the penis. One type of prosthesis consists of cylinders which can be filled with fluid. The patient can control when the cylinders are filled, which results in an erection. The other type of prosthetic implant results in a constantly rigid penis.