Erectile dysfunction (ED) is the inability of a man to attain and/or maintain an erection sufficient for sexual activity. The process leading to an erection is a complex interaction between physical and psychological factors. There have been great advances over the past twenty or so years in the diagnosis and treatment of erectile dysfunction.
ED – What You Need to Know
An estimated 30 million men in the United States, including over half of men between the ages of 40 and 70 years old, are affected by ED to some degree.
Erectile dysfunction is not normal at any age
Erectile dysfunction (ED) may be an indication of other health concerns.
New evidence indicating the role of ED as an early marker of cardiovascular disease highlights the importance of diagnosis and early intervention.
Unfortunately, many men do not seek help because of embarrassment over erectile dysfunction which can lead to emotional and relationship problems.
A diagnosis is made by a thorough medical history, physical examination, and a few routine blood tests to check hormone levels and blood sugar.
Most cases do not require extensive testing before beginning treatment. In some cases, however, the urologist may recommend penile injection or ultrasound testing to better understand the cause of ED,
Treatment options may include
Lifestyle changes such as weight loss, smoking cessation and exercise
Oral medication such as Viagra / Sildenafil and Cialis / Tadalafil.
Medications may not be effective or appropriate for all men, so other equally effective options should be considered. These may include:
At Georgia Urology, our experienced physicians understand the problem and are skilled in the techniques to manage this sensitive condition.
FAQs About Erectile Dysfunction
Is ED in my head?
Psychogenic ED is not uncommon and often happens in younger patients who may not have been able to perform and now have “stage fright.” Others may have a lack of desire or libido. Ultimately, and regardless of the exact cause, most patients will be treated with medications to allow them to feel confident in their ability to achieve an erection.
Could my ED be due to low Testosterone (Low T)
Low testosterone, or hypogonadism, is heavily advertised as a significant concern for middle-aged men. However, the true incidence of hypogonadism is lower than it may seem. The confusion surrounding testosterone is compounded by the fact that what is considered normal can vary dramatically between patients, ranging from 250 to 1000 ng/dL. Ultimately, low testosterone is diagnosed primarily based on symptoms rather than testing. Low testosterone can cause ED by reducing desire or libido but does not cause ED directly.
Testosterone can be increased naturally by improving diet, exercising, and getting appropriate sleep, which many Americans do not do. Testosterone replacement is also an option, but TRT must be monitored closely by a men’s health urologic specialist.
Are there natural ways to regain an erection?
The possibility of restoring erectile function naturally revolves around the cause of ED. Most cases of ED are vascular, meaning a narrowing of the penile arteries limits blood flow and, thus, proper function. Any food or supplement that increases blood flow can theoretically improve ED, but these gains are likely temporary and limited. As a matter of course, losing weight through improved diet and exercise can improve erectile function or slow its progression. If lifestyle changes are not made, function diminishes progressively. While certain supplements and foods are claimed to improve function, they are unlikely to work. However, taking high-quality, safe supplements at the correct dosage may have a placebo effect, so we do not necessarily discourage patients adamant about taking them.
Should I use an online service to get my ED meds?
Online sellers of ED medications have popped up seemingly everywhere and are spending millions of dollars on advertising. They have a range of brand-name, generic, and even compounded ED medication options. Most of the time, they are offering a rebranding of generic ED meds. While their services are not inherently problematic or dangerous in most cases, it is essential to remember that ED is a continuum of care, and being under the care of a urologist is important, especially when medications cease to function. Understand that there are options beyond medications up to and including a penile implant for severe ED, and as such, a patient with ED should be under the care of a qualified men’s health urologic specialist.
Do chews, mints, and sublingual ED meds work better?
Online sellers of ED medications have launched different formulations of generic drugs for ED as mints, chews, and more. These are not new medications. While there may be some validity to the sublingual route working a bit faster than the typical generic tab, this often comes with significant additional costs. For most patients and uses, regular generic tablets work perfectly well.
Do combination Sildenafil / Tadalafil tablets work better?
While the combination of Sildenafil and Tadalafil may seem appealing, it introduces the side effects of both medications with few upsides and the possibility of too high a dose. We suggest trying one medication for two weeks and the second separately for another two. Whichever works best can be purchased in generic pill form in larger quantities for a lower price.
Should I choose Viagra/Sildenafil or Cialis/Tadalafil?
Viagra, the brand name for sildenafil, and Cialis, the brand name for Tadalafil, are the two most popular PDE-5 inhibitors that help improve blood flow to the penis and help men get a better erection. While the two medications work very similarly, they have different side effect profiles and durations of action. We often suggest that patients try one and then the other to see which is best for them. Learn more about the differences between Viagra/sildenafil and Cialis/Tadalafil.
What about Shockwave Therapy?
Shockwave therapy is a popular but now declining treatment option for erectile dysfunction that continues to be marketed by men’s clinics but has little data to support its efficacy. Shockwave therapy can be costly, and most patients should not expect to receive significant benefits. With that said, if patients have extra income and wish to try it, there do not seem to be many problematic side effects.
What happens when the meds stop working?
Medication is an inexpensive and very reliable way to regain erectile function, but as the vascular issues that cause ED progress, medication may no longer offer the desired effect. At this point, several FDA-approved options are available. Some patients may opt for penile injections with a compounded substance known as Trimix. Another option is a vacuum erection device, which is typically less satisfactory for most patients and their partners. For severe ED, a penile implant is always an option to gain predictable and on-demand function. An experienced and knowledgeable men’s health urologist can ensure that all options are explained and that patients make the most appropriate decision for their situation.
I’ve had prostate cancer treatment – will I ever get my erection back?
Despite the evolution of prostate cancer treatment, including nerve-sparing prostatectomy, the reality is that most patients who undergo a radical prostatectomy or even radiation will experience some degree of erectile dysfunction. This is typically caused by irritation to the tiny nerves near the prostate or damage to nearby blood vessels.
Erectile dysfunction after a radical prostatectomy occurs immediately, while there is a delayed effect for patients undergoing radiation. A comprehensive prostate cancer recovery and rehabilitation program, including the use of ED meds early after surgery or radiation, can help. Erectile function before surgery or radiation also predicts function afterward.
It’s essential to choose a urologic practice with a comprehensive erectile function restoration program.
