Impotence Pictures Slideshow: A Visual Guide to Erectile Dysfunction

What Is Erectile Dysfunction (ED)?

Erectile dysfunction (ED) is when a man has persistent problems sustaining an erection. ED can make sexual intercourse impossible without treatment. ED can first emerge in a man as early as 40 according to the Massachusetts Male Aging Study on sexual dysfunction. They also found that an estimated 18 to 30 million men are affected by ED.

Does ED Mean Poor Libido?

ED refers specifically to problems achieving or maintaining an erection. Other forms of male sexual dysfunction include poor libido and problems with ejaculation. Men with ED often have a healthy libido, but their bodies fail to respond in the sexual encounter by producing an erection. Usually there is a physical basis for the problem.

ED Symptoms

Symptoms of ED include erections that are too soft for sexual intercourse, erections that last only briefly, and an inability to achieve erections. Men who cannot have or maintain an erection at least 75% of the time that they attempt sex are considered to have ED.

Who Can Get ED?

Sexual dysfunction is more common as men age. According to the Massachusetts Male Aging Study, about 40% of men experience some degree of inability to have or maintain an erection at age 40 compared with 70% of men at age 70. And the percentage of men with ED increases from 5% to 15% as age increases from 40 to 70 years. ED can be treated at any age.

The Mechanics Behind ED

When blood fills two chambers in the penis (known as the corpora cavernosa) an erection occurs. This causes the penis to expand and stiffen, much like a balloon as it is filled with water. The process is triggered by nerve impulses from the brain and genital area. Anything that interferes with these impulses or restricts blood flow to the penis can result in ED.

ED Causes: Chronic Disease

The link between underlying chronic disease and ED is most striking with diabetes. Approximately half of the men with diabetes experience ED. Nevertheless, good blood sugar control can minimize this risk. Of note, cardiovascular disease, atherosclerosis (hardening of the arteries), kidney disease, and multiple sclerosis each can lead to ED. Each of these illnesses lead to ED by interfering with blood flow or nerve impulses throughout the body.

ED Causes: Lifestyle

Lifestyle choices, such as smoking, alcohol abuse, and obesity can impair blood circulation and lead to ED. Smoking, excessive drinking, and drug abuse may damage the blood vessels and reduce blood flow to the penis. Smoking makes men with atherosclerosis even more vulnerable to ED. Smokers have almost twice the risk of ED compared with nonsmokers. Being overweight and getting too little exercise also contribute to ED. Men who exercise regularly have a lower risk of ED.

ED Causes: Surgery

Surgical or radiation treatments for prostate cancer, bladder cancer, or prostate enlargement (BPH) can sometimes damage nerves and blood vessels near the penis. Occasionally, the nerve damage is permanent and requires treatment to achieve an erection. Sometimes, surgery causes temporary ED that improves on its own after 6 to 18 months.

ED Causes: Medication

Many medications can cause ED, including certain blood pressure drugs, antidepressants, and tranquilizers. Men with ED should talk with their doctor if they suspect a prescription or over-the-counter drug may be causing erectile problems.

ED Causes: Psychological

It is common for men with ED to have an underlying physical basis for it, particularly in older men. However, psychological factors may be present in 10% to 20% of men with ED. Experts say stress, depression, poor self-esteem, and performance anxiety can impair the ability to have an erection. These factors can also make ED worse in men whose sexual dysfunction stems from something physical.

Cyclists and ED

Avid cyclists suffer more ED than other athletes because the shape of some bicycle seats causes pressure on the nerves that are vital to sexual arousal. Cyclists who ride for many hours each week may benefit from seats designed to protect the perineum.

ED Diagnosis: Physical Exam

To diagnose ED, the doctor will ask questions about the symptoms and medical history. A complete physical exam is done to detect poor circulation or nerve trouble. The physician will look for abnormalities of the genital area that could cause problems with erections.

ED Diagnosis: Lab Tests

Many lab tests can be helpful in diagnosing male sexual problems. Measuring testosterone levels can determine whether there is a hormonal imbalance, which is often linked to decreased desire. Blood cell counts, cholesterol levels, blood sugar levels, and liver function tests can reveal medical conditions that may account for ED.

Is ED a Sign of Heart Disease?

ED can be a warning sign of serious underlying disease. Research has found that ED is a strong predictor of heart attack, stroke, and even death from cardiovascular disease. All men with ED should be evaluated for cardiovascular disease. Notably, this does not mean every man with ED will develop heart disease, or that every man with heart disease has ED; however, ED patients should be aware of the link.

ED Treatment: Lifestyle Changes

Often men with ED are able to improve sexual function by making a few lifestyle changes. Stopping smoking, losing weight, and exercising regularly can help by improving blood flow. If you suspect a medication could be contributing to ED, talk to your doctor about it.

ED Treatment: Oral Medications

While popularized in the media, Viagra is not the only pill for ED. This class of drugs also includes Cialis, Levitra, Staxyn, and Stendra. These medications work by improving blood flow to the penis during arousal and are taken 30 to 60 minutes before sexual activity. They should not be used more than once a day. Cialis can be taken up to 36 hours before sexual activity and also comes in a lower, daily dose. Staxyn dissolves in the mouth. All require a doctor’s prescription for safety.

ED Treatment: Injections

There are also injectable drugs for ED. Some men sustain stronger erections by injecting these medications directly into the penis. These drugs work by widening the blood vessels, causing the penis to become engorged with blood. Another option is a medicated pellet that is inserted into the urethra and can trigger an erection within 10 minutes.

ED Treatment: Vacuum Devices (Pumps)

Vacuum devices for ED, also called pumps, offer an alternative to medication. To use a pump, the penis is placed inside a cylinder. Then the pump draws air out of the cylinder to create a partial vacuum around the penis causing it to fill with blood, leading to an erection. An elastic band worn around the base of the penis is used to maintain the erection during intercourse.

ED Treatment: Surgery

If ED is caused by a blockage in an artery leading to the penis, surgery can be used to restore blood flow. Optimal candidates are typically younger men whose blockage stems from an injury to the crotch or pelvis. The surgery is not recommended for older men with widespread narrowing of the arteries throughout their bodies.

ED Treatment: Implants

For those men with persistent ED, a penile implant can restore sexual function. An inflatable implant uses two cylinders that are surgically placed inside the penis. When an erection is desired, the man uses a pump to fill the cylinders with pressurized fluid. Alternatively, a malleable implant with surgically implanted rods can be used to bolsters erections.

ED Treatment: Psychotherapy

Psychotherapy can be beneficial for men with ED even when ED has a known physical cause. The therapist can instruct the man and his partner in techniques to reduce performance anxiety and improve intimacy. Therapy can also help couples adjust to the use of vacuum devices and implants.

ED Treatment: Alternative Therapies

Men with ED should talk with their doctors before trying supplements for ED. They can contain 10 or more ingredients and may complicate other health conditions. Asian ginseng and ginkgo biloba (seen here) are popular, but there isn't a lot of good research on their effectiveness. Some men find that taking a DHEA supplement improves their ability to have an erection. Unfortunately, the long-term safety of DHEA supplements is unknown. Most doctors do not recommend using it.

ED Treatment: Buyer Beware

There are dozens of "dietary supplements" that claim to treat ED, but the FDA warns that many of these are not what they seem. One investigation discovered that supplements for ED can often contain prescription drugs not listed on the label, including the active ingredient in Viagra. These can put the man at risk for dangerous drug interactions.

Reducing Your Risk of ED

To reduce your risk of ED, exercise and maintain a healthy weight, stop smoking, avoid alcohol and substance abuse, and keep your diabetes under control, if you have it.

Discussing ED With Your Partner

It's natural to feel angry or embarrassed when confronted with ED. Remember too that your partner is also affected. Talking openly about ED with your partner will help them understand the diagnosis and treatment options (and will reassure your partner that you haven't lost interest).

Reviewed by William C. Shiel Jr., MD, FACP, FACR on Saturday, July 13, 2013

Impotence Pictures Slideshow: A Visual Guide to Erectile Dysfunction

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