Erectile dysfunction: Symptoms, Diagnosis, Treatments

Single-phase flow with minimal or absent diastole when the penis is flaccid. There are many possible causes of erectile dysfunction, both physical and psychological, including: Urology 2020; 83: Birthi P, Nagar VR, Nickerson R et al: Recognize that this is hard to talk about, even embarrassing, but important—for both of you.

  • In fact, a 2020 study of 65 men between 24 and 60 years old found that sexual function increased significantly after a 12-week program of yoga sessions.
  • 140 Baltaci, S.

Treatment options can include the following: As a man’s penis is visible to both the man and his partner, the occurrence—or absence—of an erection is a known event, which increases focus on performance. Increased incidence of depressive symptoms in men with erectile dysfunction. J Androl 2020; 33: Additional laboratory evaluation commonly includes a urinalysis, PSA, thyroid studies, fasting lipid profile, liver function studies, screening for diabetes and a complete blood count (CBC). This manuscript discusses the current status and future outlook of stem cell therapy for erectile dysfunction treatment.

Small testicles, lack of facial hair, and enlarged breasts (gynecomastia) can point to hormonal problems such as hypogonadism with low testosterone levels.

Impact of Prostate Cancer Treatments on Sexual Health

Increasing the dose of vardenafil on a daily basis does not improve erectile function after unilateral nerve-sparing radical prostatectomy. Studies have shown that targeting factors associated with erectile problems, such as smoking, obesity, alcohol consumption, and physical activity reduces the rate of sexual dysfunction. Erectile dysfunction, morgentaler A, Bruning CO 3rd, DeWolf WC. Many experts believe that atrophy, a partial or complete wasting away of tissue, and fibrosis, the growth of excess tissue, of the smooth muscle tissue in the body of the penis (cavernous smooth muscle) triggers problems with being able to maintain a firm erection. So, although it may not at first seem connected, a previous head injury can in fact lead to ED. This holds the blood in the penis (and keeps it hard) for up to 30 minutes. Perhaps that’s because ED is a subject that is not often talked about—it can be awkward and embarrassing for both and men and women to discuss, even with a healthcare provider. Aerobic exercise Moderate to vigorous exercise is not only good for your overall health, but also can increase blood flow, possibly helping with ED.

’ Most guys feel isolated and alone with this problem, in large part because despite the frequent commercials, most men don’t talk about it. After 6 months in total had elapsed, 40 percent of all participants (including some men who had belonged to the second group) had regained normal erectile function. Isidori AM, Corona G, Aversa A et al: It often has a profound effect on intimate relationships, quality of life, and overall self-esteem. 19 A meta-analysis published in 2020 clearly demonstrated increased efficacy over placebo for all PDE5 inhibitors. But what — exactly — happens? 170 Manning, M. Use of sildenafil for safe improvement of erectile function and quality of life in men with New York Heart Association classes II and III congestive heart failure:

JAMA 2020;291: Approximately a third of men in the European Male Aging Study demonstrated low testosterone, suggesting that hypogonadism is overrepresented among men with ED. He says there are three questions you can ask to help determine if you have erectile dysfunction.

An open-label, long-term evaluation of the safety, efficacy and tolerability of avanafil in male patients with mild to severe erectile dysfunction.


AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. Laboratory tests. Reasons for high drop-out rate with self-injection therapy for impotence. Six months of daily treatment with vardenafil improves parameters of endothelial inflammation and of hypogonadism in male patients with type 2 diabetes and erectile dysfunction: Because efficacy is very similar amongst the three agents, side effects and time-to-onset will be the main distinguishing factors. Erectile dysfunction may be a symptom of underlying medical conditions, which if not detected may cause further medical problems.

The medicine is quickly absorbed into the penis to cause an erection, usually within 10-15 minutes. There are several different ways that erectile dysfunction can be treated. Genital warts, 000 troops to himself, and wei xin had a bit nervous and completely relieved up war to the present wei jun still has 32,000 people, while han jun has only 28. The evaluations for erectile dysfunction include those specific to sexual function:

In some cases, the infected implant must be replaced by a new implant. This is used to measure the blood flow in the penis. Hatzichristou D, Cuzin B, Martin-Morales A et al: Performance anxiety is inherent in most cases of ED. These are placed within the erection chambers of the penis and can be inflated or deflated using a cable that passes through them. Unusual characteristics of the penis itself could suggest the basis of the impotence.

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Glina S, Bertero E, Claro J et al: In the corpora cavernosa, NO activates guanylate cyclase, which in turn increases cyclic guanosine monophosphate (cGMP). Your doctor may point out ‘risk factors' that can be changed or improved. Embarrassing male body problems, defective LOT or Overall Product? “The number one question I get when talking about erectile dysfunction is, ‘Is it common? There are two types of procedures that may be used: As a rule, a psychological cause for the ED is more likely than a physical cause if there are times when you can get a good erection, even though most of the time you cannot.

The effectiveness of psychological interventions for the treatment of erectile dysfunction: These are often associated with women looking to strengthen their pelvic area during pregnancy, but they can be effective for men looking to regain full function of the penis. 130 Stuckey, B. ’ But there’s no paper that says that. Yang Y, Liu R, Jiang H et al: If needed, your doctor may prescribe oral medications such as Viagra, Cialis, Levitra, and Stendra (ask your pharmacist if there's a generic available, as it will cost much less). Int J Impot Res 2020; 15:

Not talking about it is the main barrier to getting treatment. Ultrasound with Doppler imaging (ultrasound plus evaluation of blood flow in the arteries and veins) can provide additional information about blood flow of the penis and may help in the evaluation of patients prior to surgical intervention. Recreational use of ed medications in the elderly, talk to your doctor before you try an alternative treatment for erectile dysfunction — especially if you're taking medications or you have a chronic health problem such as heart disease or diabetes. Martin-Morales A, Sanchez-Cruz JJ, Saenz de Tejada I et al: Sometimes erectile dysfunction develops gradually.

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Likewise, a decline in testosterone as a result of fatherhood and aging, along with the stress and sleep deprivation that comes with raising children, may play a role dads, but not necessarily. Drug-induced ED. A comparative, crossover study of the efficacy and safety of sildenafil and apomorphine in men with evidence of arteriogenic erectile dysfunction.

Turk S, Karalezli G, Tonbul HZ et al:

(3), 320–327 (2020). Use of sildenafil citrate in treatment of Taiwanese men with erectile dysfunction: 191, e526 (2020). The penis is placed in to pump (a tube, or cylinder).

Marks LS, Duda C, Dorey FJ et al: Fagelman E, Fagelman A and Shabsigh R: Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Members, in any case, you should talk to your doctor if you are encountering sexual problems. This may include a fasting serum glucose level and lipid panel, thyroid-stimulating hormone test, and morning total testosterone level. Both ED and low testosterone (hypogonadism) increase with age. The inability to maintain an erection suitable for intercourse. Vardenafil improves penile erection in type 2 diabetes mellitus patients with erectile dysfunction:

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It's normal to feel embarrassed discussing such an intimate and personal issue, but your health care provider is a professional who is there to help you, not judge you. Yu H, Wu H and Rao D: The impact of treatment choice for localized prostate cancer on response to phosphodiesterase inhibitors. Hatzichristou D, Vardi Y, Papp G et al: Damage to the nerves that deliver signals from the brain to the penis can occur due to diabetes, multiple sclerosis (MS) spinal cord injuries, pelvic or prostate surgery, radiation therapy, or pelvic trauma. 33 Leungwattanakij, S.

Staying at the cutting edge:

Lee LK, Goren A, Boytsov NN et al: Tsertsvadze A, Yazdi F, Fink HA et al: 26, 539–550 (2020). “So if under any circumstances, it could even be drinking a lot of alcohol or being nervous about their first time with a new partner. So, even if the nerves or blood vessels going to your penis are not working so well, a tablet can cause the blood flow to increase in your penis and cause an erection. Treatment options for ED have evolved considerably over the past decade to encompass psychological counseling; oral, topical, intraurethral, and intracavernosal vasoactive therapy; oral therapies with other or unknown mechanisms; hormone replacement; vacuum constriction devices; and surgery, including vascular bypass procedures and penile implants.

ED can be successfully treated even without the knowledge of the precise nature of its cause.

24, 239–245 (2020). The most recent study to investigate this found that there was no link between riding a bike and ED, but it did find an association between longer hours of cycling and the risk of prostate cancer. Efficacy and safety of flexible-dose vardenafil in men with type 1 diabetes and erectile dysfunction. Medicine-induced impotence. ED itself is often related to an underlying problem such as heart disease, diabetes, liver disease, or other health conditions. Efficacy of sildenafil in erectile dysfunction after radical prostatectomy. 30 However, satisfaction with this treatment modality typically wanes with time, as patients report dissatisfaction with how cumbersome or unnatural the devices are to use, hinging or buckling of the erection with thrusting, and dissatisfaction with the fact that the erection is ischemic and therefore cold, which can be off-putting to the partner. You'll still need a prescription to get these medicines.


A randomised controlled trial of a couples-based sexuality intervention for men with localised prostate cancer and their female partners. Nerves that send impulses to the penis can become damaged from stroke, diabetes, or other causes. Vacuum devices. Membership, its biotechnology trade magazine, Genetic Engineering & Biotechnology News (GEN), was the first in its field and is today the industry's most widely read publication worldwide. “I’ve always had a bit of anxiety about my performance, so she hit a bit of a bedrock there, because I had been thinking about it before. Prospective pilot study of sildenafil for treatment of postradiotherapy erectile dysfunction in patients with prostate cancer. Newton says while many medical conditions have a genetic aspect, erectile dysfunction does not follow that trend. Update on corpus cavernosum smooth muscle contractile pathways in erectile function:

Vardenafil improves erectile function in men with erectile dysfunction irrespective of disease severity and disease classification. This is most often caused by stress. Genital warts, they are not recommended. Int J Impot Res 2020; 15 Suppl 1:

Performance anxiety is a form of psychogenic impotence, usually caused by stress.

To maintain the erection, the man will place a ring around the base of the penis. For example, serum testosterone (and sometimes prolactin) is typically only useful when the patient demonstrates hypogonadal features or testicular atrophy, or when clinical history is suggestive. The correlation between high sensitivity C-reactive protein and erectile dysfunction patients with hypertension treated with vardenafil. Role of coronary clinical presentation and extent of coronary vessels involvement: If the patient has not been evaluated with a lipid panel and hyperlipidemia is suspected, measurement and appropriate referral to internal medicine or cardiology is recommended.

The most sophisticated (expensive) type can be inflated with an inbuilt pump to cause an erection.


Risk exposure is important to consider in the PDE5 inhibitors. Researchers are investigating the application of gene therapy principles to the treatment of ED. A surgical algorithm for the treatment of Peyronie's disease.

174, 662–667 (2020). Efficacy and safety of sildenafil citrate (Viagra) in black and Hispanic American men. Sensate focus is considered to be the cornerstone of sex therapy.

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The PDE5 inhibitors sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are prescription drugs which are taken by mouth. In patients who take 50 mg of sildenafil or more and use alpha blockers, sildenafil dosing should be avoided for at least 4 hours after the dose of the alpha blocker. Obesity, sedentary lifestyle, and smoking greatly increase the risk of ED. Oral sildenafil (Viagra) in male erectile dysfunction: Data from references 20-23. Gans WH, Zaslau S, Wheeler S et al: Long-term safety and efficacy of tadalafil 5 mg dosed once daily in men with erectile dysfunction. ’ This means that erectile function has been normal, but becomes problematic.

Many men do experience occasional failure to achieve erection, which can occur for a variety of reasons, such as drinking too much alcohol, stress, relationship problems, or from being extremely tired.

Epidemiology of erectile dysfunction: Systematic review of randomised controlled trials of sildenafil (Viagra) in the treatment of male erectile dysfunction. ED may result from organic causes (e. )Several restorative or regenerative treatments are under investigation for the future treatment of ED: Glina S, Damiao R, Abdo C et al: 15 Schouten, B. For 2025, the prevalence of ED is predicted to be approximately 322 million worldwide. Enhanced pharmacological testing in patients with erectile dysfunction.

Comprehensive questionnaires have been developed (e. )Efficacy and safety of tadalafil 5, 10, and 20 mg in Japanese men with erectile dysfunction: Instead, bring the muscles together in a squeezing motion. Efficacy and safety of oral tadalafil in the treatment of men in Canada with erectile dysfunction: Know why a test or procedure is recommended and what the results could mean. Hatzichristou D, Montorsi F, Buvat J et al: There is evidence to support this: 18, 146–149 (2020).

What Questions Will the Health Care Provider Ask?

Talk to your doctor if you have any side effect that bothers you. Many men like to talk about sex, but like women, they may find it harder to talk about sex when it is not going well. 62 di Villa, B. 170, 159–163 (2020).

Psychiatric morbidity is frequently undetected in patients with erectile dysfunction. In older men, ED usually has a physical cause, such as a drug side effect, disease or injury. Bullying, [93] The potentiation of the pressor effect of tyramine by moclobemide is only one seventh to one tenth of that of irreversible MAOIs. Int J Clin Pract 2020; 59: Jarow JP, Burnett AL and Geringer AM: Endogenous blockers of this pathway have been identified. Rosen R, Shabsigh R, Berber M et al: 145, 287–292; discussion 292–293 (1991).

But as with oral medications, this therapy is not right for all men. Comparative cross-over study of sildenafil and apomorphine for treating erectile dysfunction. Secondary erectile dysfunction, the much more common type, is when a man has had erections before but now fails to have one more than 25% of the time.

Less commonly, psychological factors cause or contribute to ED, with factors ranging from treatable mental health illnesses to everyday emotional states that most people experience at some time.

Connected Topics

Postnatal penile length and growth rate correlate to serum testosterone levels: 10, 893–906 (2020). Urologists have seen the impact first hand, with more and more men in their thirties and forties coming into their offices concerned about erectile dysfunction, or ED.

PLoS ONE 7, e4367 (2020).

This is particularly important for people with heart disease or another underlying condition that could be aggravated by vigorous activity. These could suggest the cause of ED. Int J Clin Pract 2020; 66: 159, 2164–2171 (1998). Allogeneic human bone marrow derived mesenchymal stem cells in localized prostate cancer (MSC). Efficacy and safety of avanafil for treating erectile dysfunction: Rod implants.

Porst H, Rajfer J, Casabe A et al:

Tadalafil use has been linked with myalgias. Mediterranean diet improves erectile function in subjects with the metabolic syndrome. Goldstein I, Lue TF, Padma-Nathan H et al: Never stop taking a medicine without speaking with your doctor first. Men have demonstrated a strong preference for oral treatments even if they have low efficacy. Higher rates of reporting, diagnosis, and treatment of ED have been driven by effective treatments, direct to consumer advertising, and screening by health care providers. With an inflatable implant , fluid-filled cylinders are placed lengthwise in the penis.

  • 40, 6729–6735 (2020).
  • Erectile dysfunction affects older men more than younger men.
  • All of them increase blood flow to the penis, which produces an erection.
  • 6, 2340–2340 (2020).
  • 26 Some sources show that vascular reconstructive surgeries are viable options for some people.

Surgery Can Cause Erectile Dysfunction

181 de Boer, B. Seftel AD, Sun P and Swindle R: 110 Maiorino, M. Shemtov OM, Radomski SB and Crook J: Derry FA, Dinsmore WW, Fraser M et al: This manuscript details how erectile dysfunction is an early symptom of cardiovascular disease.

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Correlation between peak systolic velocity and diameter of cavernosal arteries in flaccid versus dynamic state for the evaluation of erectile dysfunction. Air is manually pumped up, stimulating blood flow to the penis, which helps bring on an erection. Rarely, PDE5 inhibitors cause priapism. Vardenafil improved erectile function in a "real-life" broad population study of men with moderate to severe erectile dysfunction in Australia and New Zealand. The more he imposes a demand on himself, and the more that demand is not met, the more disturbed he becomes. Know the reason for your visit and what you want to happen.

What ED Treatment Options Are Available? 8 , 9 , 11 – 14 The AUA and World Health Organization recommend limited diagnostic testing in men with ED. Other psychosocial factors can contribute to the development and maintenance of ED. Sexually transmitted diseases, erectile dysfunction might occur earlier in men with diabetes than in men without the disease. ≈ 4 hours Tadalafil 10‒20 mg 60 minutes Duration of action: Brock G, Nehra A, Lipshultz LI et al: Blood and urine tests can also help providers figure out what’s going on. 104 Althof, S.

Inside Pain:

If there seems to be a psychological cause contributing to your erectile dysfunction, the doctor may ask the patient questions to help determine stressor, events, and relationship issues that may be causing your erectile troubles. Patients should know that many over-the-counter drugs have been found on drug testing to have ‘bootlegged' PDE 5 Inhibitors as their main ingredient. 17, 527–534 (2020). Such patients are at an increased risk of developing NAION again. The following are some leading causes of erectile dysfunction: 117 Pourmand, G. Low testosterone, high prolactin, and abnormal thyroid hormone levels can cause ED. If the answer is yes to any of these questions, it’s a great idea to talk to your doctor.

Smoking and other lifestyle factors in relation to erectile dysfunction.

The combination of the medications can cause a severe drop in blood pressure.


Although the condition is called venous leak, the real problem is not with the veins but malfunction of the smooth muscle that surrounds the veins. Eardley I, Morgan R, Dinsmore W et al: N Engl J Med 2020; 363: PDE-5 inhibitors for erectile dysfunction. Hormonal problems (e. )Sildenafil (brand name: )Systemic disease-induced (state of the entire system) - Possible causes include chronic renal failure, coronary heart disease, congestive heart failure, recent heart attack CHF and liver failure. Porst H, Rosen R, Padma-Nathan H et al:

MSD and the MSD Manuals

After the first week, over- the-counter pain drugs (such as acetaminophen or ibuprofen) may be substituted for narcotic pain drugs. 16 In addition, multivariate analysis found obesity is associated with erectile dysfunction with an approximately 50% increase in ED in obese men as compared with normal weight men. Characteristics of secondary, primary, and compensated hypogonadism in aging men:

16, 581–591 (2020). Improvements in sexual quality of life after moderate weight loss. You may be interested in our book, Sex and Diabetes: 154, 125–129 (2020).

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Initial diagnostic workup should usually be limited to a fasting serum glucose level and lipid panel, thyroid-stimulating hormone test, and morning total testosterone level. Long-term effect of sildenafil citrate on erectile dysfunction after radical prostatectomy: Edwards D, Hackett G, Collins O et al: These conditions include unstable or refractory angina, myocardial infarction or cerebrovascular accident within the past 2 weeks, uncontrolled hypertension, New York Heart Association (NYHA) Functional Classification III-IV congestive heart failure, high-risk arrhythmias, hypertrophic obstructive cardiomyopathies, and moderate-to-severe valvular disease. Three types of implants are used to treat ED, including: “He said he’d been struggling, he’d been freaking out, and he’d gone from using Viagra when he was a bit blasted, to taking it all the time.

Tadalafil citrate (Cialis). Inside the cell, NOS catalyzes the oxidation of L-arginine to NO and L-citrulline. Read, watch, listen, each drug works differently, but they all improve sexual activity by stimulating blood flow to the penis. There are several underlying causes that contribute to ED:

173 Araujo, A. The efficacy and safety of tadalafil in United States and Puerto Rican men with erectile dysfunction. Prediction of cardiovascular events and all-cause mortality with erectile dysfunction:

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A health care professional may prescribe you an oral medicine, or medicine you take by mouth, such as one of the following, to help you get and maintain an erection: A 2020 literature review also concluded that pelvic floor exercises were effective at treating both ED and premature ejaculation. There are several different devices. Assessment of the efficacy and safety of Viagra (sildenafil citrate) in men with erectile dysfunction during long-term treatment. Efficacy and safety of tadalafil across ethnic groups and various risk factors in men with erectile dysfunction: Again, this is not for patients on blood thinners. Site information & policies, a current drug recognised as associated with ED. But it can happen at any age. Int J Impot Res 2020; 19:

8, 1880–1889 (2020). Efficacy and safety of flexible-dose oral sildenafil citrate (Viagra) in the treatment of erectile dysfunction in Brazilian and Mexican men. The cylinder can then be removed and the patient can engage in intercourse with the constriction band at the base of the penis maintaining the erection. 112 Hannan, J. 13 The Sexual Health Inventory for Men is a short-form, 5-item questionnaire developed to monitor treatment progress. Reviewing your medicines. Bekkering GE, Abou-Setta AM and Kleijnen J:

Doing the following can help: Proper evaluation includes a careful history, physical examination, and evaluation for possible endocrine causes (eg, low testosterone, high prolactin levels). “Men are notorious for underestimating their sexual difficulties in self-report surveys. However, prostate surgery to remove the cancer and radiation therapy to treat prostate cancer can cause ED. Erectile dysfunction (ED) is the inability to get and keep an erection firm enough for sexual intercourse. Porst H, Roehrborn CG, Secrest RJ et al: Erectile dysfunction (ED) or impotence means you can’t get an erection. If you would like to ask a question, please write [email protected]

316, 703–708 (2020).

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Miner MM, Barnes A and Janning S: Anxiety and erectile dysfunction: For some men, simply losing weight may help. An injury could contribute to symptoms of ED. Efficacy and safety of vardenafil in renal transplant recipients with erectile dysfunction.

It is recommended that prior to proceeding with other therapies, patients reporting failure of their PDE5 inhibitors should be evaluated to determine whether the trial was adequate.

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Saline is infused under pressure into the corpus cavernosum with a butterfly needle, and the flow rate needed to maintain an erection indicates the degree of venous leakage. “In many cases, losing weight and exercising regularly can improve blood flow and erectile dysfunction,” Dr. The problem with ED is that men can literally think themselves into having it: Other causes may include diabetes.

Assessment of the impact of sildenafil citrate on lower urinary tract symptoms in men with erectile dysfunction. Andrologia 2020; 49: There is generally no change to a man's feeling or orgasm. When speaking to a doctor, however, they are more likely to be truthful,” says clinical psychologist Daniel Sher. 28 Saenz de Tejada, I.


In summary, men at high-risk for cardiovascular disease with congestive heart failure or unstable angina should not receive treatment for sexual dysfunction until their cardiac condition has stabilized. Devices 10, 353–366 (2020). The diuretic may be withdrawn, but a trial of oral ED therapy can be initiated during the observation period while the patient is waiting to see if any spontaneous improvement in ED occurs after drug withdrawal. For example, elderly patients may be less willing to undergo invasive testing for the evaluation and treatment of ED. Analysis of the therapeutic effect of tadalafil on male ED after transurethral resection of prostate. “One partner I had was fully aware of his ED, but because apps are very transactional, he felt like he didn’t have to explain himself to me. Goldstein I, Jones LA, Belkoff LH et al:

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Ogura K, Ichioka K, Terada N et al: 4 Blumenthal, S. 166, 1624–1632 (2020). More, in most cases, a tentative diagnosis can be established with a complete sexual and medical history, physical examination, and limited or no laboratory testing. Comparative efficacy of tadalafil once daily in men with erectile dysfunction who demonstrated previous partial responses to as-needed sildenafil, tadalafil, or vardenafil.