Erectile dysfunction (ED) is the inability to obtain or maintain an erection sufficient for sexual intercourse more than 50% of the time. It is also referred to as impotence. ED has many causes including decreased blood flow, neurological problems, psychological problems, and medications. The most common causes of decreased blood flow in the penis include smoking, diabetes, high blood pressure, high cholesterol, and aging. The most common causes of neurological problems in the penis include diabetes, stroke, spinal cord injury, and prostate surgery. The most common psychological problems leading to ED include depression and performance anxiety. The most common medications that cause ED include medications that affect the nervous system, medications that lower or inhibit testosterone, and opioid pain medications.
Erectile dysfunction is diagnosed by obtaining a sexual history, performing a physical exam, and obtaining blood tests to determine if other medical conditions are contributing to the ED. Rarely, more specialized tests such as ultrasound are used to evaluate penile blood flow.
The goal of treatment for erectile dysfunction is to enable a man to obtain and maintain an erections sufficient for sexual intercourse. Lifestyle modification such as exercise, smoking cessation, and weight loss can improve erections without medications or procedures. Adjusting or stopping certain medications may also help improve erections. The main treatment options for ED include oral medications, vacuum assisted erection devices, intraurethral suppository medications, penile self-injection medications, penile prosthesis surgery, and psychological therapy. Side effects associated with ED treatments will vary by treatment method but may include flushing, headache, sudden loss of hearing or vision, or priapism (an erection lasting longer than 4 hours). Let your provider know if you have chest pain, shortness of breath, or take nitrates such as nitroglycerin prior to treatment.