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Medical Author:

Dennis Lee, MD

Dennis Lee, MD

Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.

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Medical Author:

Siamak T. Nabili, MD, MPH

Siamak T. Nabili, MD, MPH

Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

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Medical Editor:

Jay W. Marks, MD

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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Medical Editor:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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In this Article

• What is erectile dysfunction?
• How common is erectile dysfunction?
• What is normal penis anatomy?
• How does erection occur?
• How is erection sustained?
• What are some of the risk factors for erectile dysfunction?
• What are the causes of erectile dysfunction?
• How is erectile dysfunction diagnosed?
• What are the treatments for erectile dysfunction?
• What medications are used to treat erectile dysfunction?
• Oral phosphodiesterase type 5 (PDE5) inhibitors
• Sildenafil (Viagra)
• Vardenafil (Levitra)
• Tadalafil (Cialis)
• Intracavernosal injections
• Intraurethral suppositories
• How effective is testosterone in treating erectile dysfunction?
• Can low testosterone level be replaced?
• Vacuum devices
• Surgery for erectile dysfunction
• What will the future bring for erectile dysfunction?
• Erectile Dysfunction At A Glance
• Impotence (Erectile Dysfunction, ED) FAQs
• Patient Comments: Erectile Dysfunction (Impotence) - Treatments
• Patient Comments: Erectile Dysfunction (Impotence) - Share Your Experience
• Find a local Urologist in your town
• Impotence (ED) Index

Combination therapy for the treatment of erectile dysfunction has been under investigation. Most of these studies have been small trials, and long-term data regarding their effectiveness and safety are lacking. However, with thorough evaluation and counseling, there may be a use for combination therapy for certain individuals with ED.

Yohimbine is an older medication used for erectile dysfunction, but the data to support its effectiveness remain mixed. In practice, clinicians sometimes choose yohimbine in the setting of psychogenic erectile dysfunction.

Melanocortin receptor agonists are a new set of medications being developed in the field of erectile dysfunction. Their action is on the nervous system rather than the vascular system. PT-141 is a nasal preparation which appears to be effective alone or in combination with PDE5 inhibitors. The main side effects include flushing and nausea. These drugs are currently not approved for commercial use.

Several other medications are being studied for treating erectile dysfunction; these include IC351 (another PDE5 inhibitor), sublingual apomorphine, and the combination of yohimbine and L-arginine. Scientists also are researching gene therapy to treat erectile dysfunction.

• Erectile dysfunction (ED), also known as impotence, is the inability to achieve or sustain an erection for satisfactory sexual activity.
• Erectile dysfunction is common; experts have estimated that erectile dysfunction affects 30 million men in the Untied States.
• The causes of erectile dysfunction include aging, high blood pressure, diabetes mellitus, cigarette smoking, atherosclerosis, depression, nerve or spinal cord damage, medication side effects, alcoholism or other substance abuse, and low testosterone levels.
• Erectile dysfunction is treatable in all age groups.
• Treatments include psychotherapy, adopting a healthy lifestyle, oral PDE5 inhibitors (Viagra, Levitra, and Cialis), intraurethral medications, intracavernosal injections, vacuum devices, surgery, and working with doctors to avoid medications that can impair erectile function.
• New research is ongoing in the field of erectile dysfunction to find more improved and effective therapies.

Portions of the above information has been provided by the National Institutes of Health (www.nih.gov).

REFERENCES:

Brosman, Stanley A. "Erectile Dysfunction." eMedicine.com. July 22, 2009. <http://emedicine.medscape.com/article/444220-overview>.

Diamond, L.E., D.C. Earle, W.D. Garcia, and C. Spana. "Co-administration of Low Doses of Intranasal PT-141, a Melanocortin Receptor Agonist, and Sildenafil to Men with Erectile Dysfunction Results in an Enhanced Erectile Response." Urology 65 (2005): 755.

Ellsworth, Pamela, and Eileen M. Kirshenbaum. "Current Concepts in the Evaluation and Management of Erectile Dysfunction." eMedicine.com. Nov. 26, 2008. <http://www.medscape.com/viewarticle/583062>.