Erectile Dysfunction Solutions

Sexuality is an important part of the human experience, which is why a diagnosis of erectile dysfunction (ED) can be troubling for men and many couples. The good news is that there are many options to consider.  

“As couples age, they may lose intimacy unnecessarily,” says urologist Stanton Honig, MD, director of the Yale Medicine Male Sexual Medicine Program. “They might not know that there are treatments to help them restore it, especially if oral medications don't work.”

ED, or impotence, is the inability to achieve or sustain an erection long enough for sexual intercourse. While the condition most commonly affects older men (more than 50 percent of men over 40 have ED), it can occur at any age. “I see young men—students in college—all the way to men in their 80s for ED,” says Yale Medicine urologist Harris Foster, MD.

Certain medical conditions can cause ED, including hypertension, diabetes, high cholesterol, coronary artery disease and peripheral artery disease. According to Dr. Foster, these disease processes can damage blood vessels in the penis.

And that’s a problem because erections are a vascular process. Here is how it works: When a man is sexually stimulated, the smooth muscle located inside blood vessels should relax, or dilate. This allows blood to flow into the corpora cavernosa, which are cylinder-shaped erectile bodies in the penis. The result is an erection. As blood continues to flow into the penis, its veins gradually constrict to form a “seal,” which helps to maintain the erection.

Problems in achieving or maintaining an erection are often caused by insufficient blood flow into the penis or by a venous “leak,” which occurs when blood flows into the penis but then seeps out.

Other reasons for ED can include smoking, taking certain prescription antihypertensive or antidepressant medications, prostate removal surgery or nerve damage from a spinal cord injury. Low testosterone can affect sexual interest or libido, but it may also affect erection quality.

For younger men who don’t have other health conditions, ED can be caused by stress. “We know stress can inhibit erectile function,” says Dr. Foster. “Stress or anxiety, which releases adrenaline, constricts blood vessels.” And that means the erectile bodies won’t fill with enough blood.

Doctors often prescribe oral medications (phosphodiesterase type 5 inhibitors) as the first-line treatment for ED. Viagra (sildenafil), Levitra (vardenafil), Stendra (avanafil) and Cialis (tadalafil) work within 30 to 60 minutes and their effects last for between 4 and 8 hours (for Viagra, Levitra and Stendra) or 36 hours (for Cialis). These medications act as a smooth muscle relaxant, allowing increased blood flow to the penis when a man is sexually stimulated.

Although oral ED medications are estimated help 70 percent of men who try them, some may require a stronger dose of medication than is available orally.

“If oral medications aren’t working or right for you, other effective treatments are available,” says Dr. Honig.