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| Erectile Dysfunction |
Many men struggle with impotence, the inability to attain or maintain an erection that is satisfactory for both partners. If you suffer from impotence, also called erectile dysfunction, you are not alone. The American Foundation for Urologic Disorders estimates that impotence affects nearly 20 million men in the United States. It is not only an embarrassing problem, but can also be damaging to self-esteem. If you are having trouble with erection a significant percent of the time, you should consider treatment for impotence.
| Possible Causes |
Stress, fatigue, or relationship problems are all factors that can contribute to erectile dysfunction. Certain medicines like tranquilizers, antihistamines, diuretics, high blood pressure medication, and medication for depression can also lead to impotence. The use of alcohol and tobacco can be contributing factors as well. Impotence might also occur because of diabetes or atherosclerosis, which can block the blood flow to the penis. In younger men, psychological problems tend to more commonly be the cause of impotence, though other causes need to be investigated.
| Evaluation |
It is important for the urologist to take a complete history of the patient's sexual difficulty, including factors that may make things better or worse. A physical exam sometimes reveals a problem that could contribute to erectile dysfunction. Laboratory evaluation, including blood and urine testing, can scan for some of the diseases that cause the condition. Specialized testing may be indicated, though these tests are not likely to affect the treatment decision.
| Treatment |
Whatever the reason for your erectile dysfunction, there are methods to treat it. Methods such as oral medications, vacuum devices, penile injections, urethral medications, and surgical implantation of a penile prosthesis can correct the physical problems that cause impotence. Success rates as high as 90% are possible depending on the reason and severity of impotence. If the erectile dysfunction is due to psychological problems, psychotherapy or counseling may help.
| Drugs |
Oral drugs such as pentoxifylline, yohimbine, and sildenafil (Viagra) can be taken an hour before sexual intercourse. These drugs are designed to improve blood flow to the penis. Alprostadil (PGE) is available as a urethral insert or as an injectable medication. Other medications are used less commonly, and more drugs should be released in the near future.
| Vacuum Therapy |
The vacuum is regarded as the safest treatment for impotence. Success rates as high as 90% are reported. The vacuum instrument is placed over the penis, and the vacuum pulls blood into the penis. A rubber ring is slipped over the penis to help maintain the erection. The ring is removed after intercourse.
| Penile Implants |
Penile implants are typically a last resort, because it is the most complex and expensive treatment. Several types of implants are available, including the semi-rigid prosthesis that helps the penis maintain a constant erection. A more complicated type of implant is one that can be inflated and deflated by working a pump implanted in the scrotum. The advantage of this type is that it is more concealed when deflated and can be larger and more rigid when inflated. Selecting the best prosthesis requires discussion between the urologist and patient to answer all questions before surgery.
| Surgery |
Surgery may be required when the cause of erectile dysfunction is a correctable problem with the anatomy of the penis.
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