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A man has erection problems if he cannot get or keep an erection that is firm enough for him to have sex. Erection problems are also called erectile dysfunction or impotence.
Most men have erection problems every now and then. This is normal. These problems can occur at any age. But they are more common in older men, who often have other health problems. Treatment can help both older and younger men.
Erection problems can have many causes. These include:
The only symptom of an erection problem is being unable to get and keep an erection that is firm enough to have sex. But even with an erection problem, a man may still have sexual desire and be able to have an orgasm and to ejaculate.
Your doctor can find out if you have an erection problem by asking questions about your health and doing a physical exam. Your doctor will want to know how often the problem happens. The exam, lab tests, and sometimes mental health tests can help find out the cause of the problem.
Doctors usually start with lifestyle changes and medicines. They usually don't advise surgery or other treatments unless those first steps don't help.
Treatment can include:
Erection problems are most often caused by a physical problem. So it's important to eat healthy foods and get enough exercise to help you stay in good health.
To reduce your risk of having an erection problem, don't smoke, drink too much alcohol, or use illegal drugs.
You may be able to avoid erection problems related to anxiety and stress by talking with your partner about your concerns. This may help you relax.
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Erection problems may be caused by physical problems related to the blood vessels, nerves, and hormones. Or they may be caused by psychological issues.
Normally, an erection occurs when your imagination or senses (vision, hearing, touch, smell, taste) are stimulated and you become aroused. Your central nervous system sends nerve impulses that increase blood flow to your penis.
Physical problems cause about 8 out of 10 cases of erectile dysfunction. Physical problems are often the cause of erection problems in men age 50 or older. They include:
Psychological issues seem to be involved in many cases of erection problems. These mental issues include:
These things interfere with the erection process by distracting the man from things that would normally arouse him.
Erection problems in men younger than 40 who have no physical risk factors are more likely to be caused by mental factors than physical causes.
Symptoms of erection problems include being unable to:
Even with an erection problem, a man may still have sexual desire and be able to have an orgasm and to ejaculate.
Most men have erection problems now and then. But when erection problems are lasting, they can affect your self-image, sex life, and relationship. When you have erection problems often, "performance anxiety" can make the problem worse. If you cannot keep an erection that is firm enough for intercourse, or if you have an orgasm before or right after entering your partner (premature ejaculation), you may feel frustrated and believe you aren't pleasing your partner. All of these things could affect how you view your relationship.
Fortunately, many of the things that cause erection problems can be treated.
Your risk of having an erection problem increases with age. Other things that increase your risk include:
Activities that constrict blood flow to the penis may increase the risk for erection problems. For example, frequent long-distance bicycle riding on a hard, narrow saddle may increase risk. But the possible link between bike riding and erection problems has not been proved. Experts continue to debate this issue.
A vasectomy usually doesn't cause erection problems. But pain after the operation may affect sexual performance for a time. And if a man wasn't comfortable with his decision to have a vasectomy, or if he's having second thoughts, it could affect him psychologically.
Call your doctor now or seek medical care right away if:
Call a doctor if erection problems occur:
If your erection problem happens just now and then, there is no reason to call your doctor. If it happens often and upsets you or your partner, it is okay to call your doctor. If an erection problem doesn't bother you or your partner, you may choose not to call your doctor.
Watchful waiting means a "wait-and-see" approach. A single episode of an erection problem is often a temporary problem that is easy to reverse. Don't assume it will happen again. Try to forget about it, and expect a more successful experience the next time. If you or your partner is concerned about it, talk about the problem. Openly discuss your fears and anxieties.
If self-care has not helped after 2 weeks and you are concerned about your erection problem, see a doctor who has experience in dealing with these problems.
The following health professionals can evaluate symptoms of erection problems:
If it is possible that a psychological problem is contributing to your erection problem, your doctor may refer you to a health professional such as a:
Because both physical and mental factors are often involved, it may be difficult to diagnose the exact cause of your erection problem.
To start, your doctor may:
At this point, pills such as sildenafil (for example, Viagra), tadalafil (for example, Cialis), and vardenafil (for example, Levitra) are often recommended unless an easily treated cause (such as a medicine side effect or testosterone deficiency) has been identified.
If pills don't work or if your doctor feels more testing is needed, he or she may recommend:
An ultrasound may be done if your doctor thinks you may have a circulation problem (peripheral arterial disease).
Treatment for an erection problem depends on the cause of the problem. The cause may be mental, physical, or a combination of both.
Many doctors take a step-by-step approach to treating erection problems. They use the least invasive treatments first. The treatment steps are:
PDE-5 inhibitors have relatively few side effects. But they can be dangerous in certain men. If you are taking nitrate-containing medicines, such as nitroglycerin, you cannot use sildenafil (for example, Viagra), tadalafil (for example, Cialis), or vardenafil (for example, Levitra).
You also should not take certain alpha-blockers—used to lower blood pressure and to treat an enlarged prostate gland—with these medicines. There is a risk of a dangerous drop in blood pressure. Check with your doctor to see whether you can take PDE-5 inhibitors with your alpha-blocker.
Oral medicines are commonly tried first before other medicine or surgery.
It is important to involve your partner in your decision, regardless of the treatment you choose.
Many men overestimate how important being able to have erections is to their relationships. Some men find that when they are able to have erections again, the hassle of using the treatment isn't worth the effort. Other men may find that being able to have erections doesn't change their relationship as much as they or their partners had expected.
You may be able to avoid erection problems related to anxiety and stress by taking a more relaxed approach to sex. Talk to your partner about your problems and concerns. Sexual intimacy is a form of communication. If you and your partner talk about sex, it will help reduce your stress and anxiety. And you may become more relaxed.
Erections may gradually become more difficult to get and keep as you get older. But foreplay—erotic stimulation before intercourse—and the right environment can help increase your ability to have an erection, regardless of your age.
Here are some other things you can do that may reduce your risk for erection problems:
In some cases, occasional episodes of erection problems can be treated at home, without a doctor's help. But do involve your partner in the process. And don't be embarrassed about seeking professional help if erection problems are consistent and troublesome. You may be able to help yourself by:
Some men may try methods available in health food stores or through magazine ads. Most of these methods have never been medically proved to work. They may be unsafe, and they are often expensive. They are not recommended.
Making lifestyle changes such as quitting smoking and drinking less alcohol can also help make erection problems less likely. To learn more, see Prevention.
Medicines that can help produce an erection may be used to treat erection problems that are caused by blood vessel (vascular), hormonal, nervous system, or psychological problems. They also may be used along with counseling to treat erection problems that have psychological causes.
Commonly used oral medicines include:
Other medicines that may be used include:
Hormones and other medicines may be prescribed for men who have low testosterone or high prolactin levels.
Although oral medicines for erection problems can be purchased over the Internet, you need to talk with your doctor before using this medicine. This is especially important if you have a heart problem.
PDE-5 inhibitors should never be used if you may need to take a nitrate-containing medicine, such as nitroglycerin. Taking nitroglycerin and a PDE-5 inhibitor within 24 hours of each other may greatly lower your blood pressure. This could lead to a heart attack, stroke, or death.
Talk with your doctor about whether medicines for erection problems are safe for you if you:
If you are taking a PDE-5 inhibitor and are going to have a test for heart disease, make sure that your doctor knows you are taking it. You should not take sildenafil (for example, Viagra) or vardenafil (for example, Levitra) for 24 hours before the test. Do not take tadalafil (for example, Cialis) for at least 48 hours before the test. Then if you have a problem during the test, it will be safe to use nitrate-containing medicines such as nitroglycerin.
If you are using a combination of drugs for high blood pressure, PDE-5 inhibitors could cause low blood pressure (hypotension). Also for this reason, you should not take alpha blockers—used to lower blood pressure and to treat an enlarged prostate—with these medicines without talking to your doctor. The combination could cause a dangerous drop in blood pressure.
Sexual activity is exercise. If you have a heart condition and have not been sexually active for a while, talk with your doctor to make sure you can engage in sexual activity safely.
In a few cases, surgery may be an option to treat erection problems. Surgery will rarely be recommended before nonsurgical treatment and counseling have been tried.
Think carefully about nonsurgical options and about the possible risks of surgery. Include your partner in your decision.
Doctors who specialize in conditions of the urinary tract (urologists) do most penile implants. Specially trained urologic surgeons usually do blood vessel repair surgery.
Counseling also may be used with medicine treatment or vacuum devices for erection problems that have psychological and physical causes.
Medicines are usually the main treatment for erection problems. But some men try complementary therapies. If you don't want to use medicine, or if medicine doesn't work for you, you may want to talk with your doctor about some of the following options. Most of these treatments need more research before doctors can know if they work for sure.footnote 2 Treatments include:
Melnik T, et al. (2007). Psychosocial interventions for erectile dysfunction. Cochrane Database of Systematic Reviews (3).
Burnett AL (2012). Evaluation and management of erectile dysfunction. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 1, pp. 721–748. Philadelphia: Saunders.
Other Works Consulted
American Urological Association (2005, reviewed and confirmed 2011). Management of Erectile Dysfunction: An Update. Baltimore: American Urological Association. Also available online: http://www.auanet.org/content/clinical-practice-guidelines/clinical-guidelines.cfm?sub=ed.
Cheitlin MD, et al. (1999). Use of sildenafil (Viagra) in patients with cardiovascular disease. ACC/AHA expert consensus document. Circulation, 99(1): 168–177.
Esposito K, et al. (2004). Effect of lifestyle changes on erectile dysfunction in obese men. JAMA, 291(24): 2978–2984.
Montague DK (2012). Prosthetic surgery for erectile dysfunction. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 1, pp. 780–791. Philadelphia: Saunders.
Schulman SP, et al. (2006). L-arginine therapy in acute myocardial infarction. JAMA, 295(1): 58–64.
Current as ofSeptember 26, 2018
Author: Healthwise StaffMedical Review: E. Gregory Thompson, MD - Internal MedicineAdam Husney, MD - Family MedicineChristopher G. Wood, MD, FACS - Urology
Current as of:
September 26, 2018
Medical Review:E. Gregory Thompson, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Christopher G. Wood, MD, FACS - Urology
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