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History of surgery (for example, for prostate enlargement, prostate or rectal cancer, or blood vessel disorders) History of injury (for example, a broken pelvic bone or a back injury) Symptoms of disorders of the blood vessels (for example, pain in the calves when walking or coolness, numbness, or blue color of the feet) Symptoms of nerve disorders (for example, numbness, tingling, weakness, incontinence, or falling) Symptoms of hormonal disorders (for example, loss of sex drive, increased size of breasts, decreased size of testes, loss of body hair, tremor, changes in weight or appetite, or difficulty tolerating heat or cold) Symptoms of psychologic disorders, particularly depression.

Sexual dysfunction (for example, vaginitis or depression) in the man's partner.

Even though men may be embarrassed to talk to their doctors about some of these subjects, the information is important in determining the cause of ED.

The physical examination focuses on the genitals and prostate, but doctors also look for signs of hormonal, nerve, and blood vessel disorders and examine the rectum.

For example, ED may occur soon after prostate surgery or beginning a new drug. One important clue is whether erections are present at night or on awakening. When erections are present, a physical cause is less likely than a psychologic cause because physical causes typically inhibit erections at all times.

Other factors that suggest a psychologic cause are sudden development in a young healthy man, occurrence of symptoms only in certain situations, and resolution of ED without any treatment. Claudication or coolness or a blue color in the toes or feet may indicate a problem with the blood vessels such as peripheral vascular disease or vascular disease caused by diabetes.

Common Causes and Features of Erectile Dysfunction. Claudication (painful, aching, cramping, or tired feeling in the muscles of the legs that occurs regularly and predictably during physical activity but is relieved promptly by rest) Usually risk factors (for example, high blood pressure, diabetes, or abnormal blood levels of cholesterol and lipids) Comparison of blood pressures measured in the ankle and arm at the same time (called the ankle-brachial index) Testing for risk factors (for example, elevated blood

glucose

Venous leak (when the veins in the penis cannot prevent blood from leaving the penis during an erection, as they normally do) Erections that occur but cannot be sustained. Ultrasonographic testing of the arteries of the penis.

Nerve damage caused by diabetes (diabetic neuropathy) Sometimes numbness, burning, or other pains of the feet.

Sometimes electromyography and nerve conduction studies.

Intermittent episodes of weakness or numbness in different parts of the body at different times. Sometimes spinal tap (lumbar puncture) and tests of spinal fluid. Nerve injury during pelvic surgery or radiation therapy. Known surgery (such as radical prostatectomy) or radiation therapy.

Spinal cord disorders (such as tumors or injuries) Numbness in the area between the penis and anus.

Usually other symptoms of spinal cord disorder (for example, numbness and weakness of legs and incontinence) Prolonged pressure in the buttocks and genital area (the so-called saddle area), as occurs when riding a bicycle or a horse. Usually competitive athletes who bicycle for long periods. Prostatitis (inflammation of the prostate) Pain in the pelvic or groin area and bothersome urinary symptoms, such as pain, a burning sensation, blood in the urine, having to urinate frequently, or having difficulty starting to urinate.

Hypogonadism ( testosterone deficiency) Loss of sex drive, sleep disturbances, and depression or mood changes. Eventually, decreases in the size of muscles and testes, bone density, and body hair.

Eventually, an increase in body fat and breast size. Measurement of the testosterone level in the blood. Round face, increased body fat in the trunk, purple streaks on the abdomen, high blood pressure, and mood changes.

Severe hyperthyroidism (thyroid hormone excess) Restlessness, increased heart rate and blood pressure, tremor, weight loss, and inability to tolerate heat. Measurement of levels of thyroid hormone in the blood.

Severe hypothyroidism (thyroid hormone deficiency) Sluggishness, decreased heart rate and blood pressure, thickened skin, decreased appetite, weight gain, and inability to tolerate cold. Measurement of levels of thyroid hormone in the blood.

Peyronie disease (formation of scar tissue in the erectile tissue of the penis) Firm tissue in the penis. Ultrasonography of the penis to detect scar tissue.

Microphallus (a birth defect) Abnormally small penis.

Sadness, helplessness, hopelessness, loss of appetite, and problems sleeping. Sometimes ED occurring only with certain partners or in certain situations. Hypoxemia (chronically low blood oxygen levels) Usually a chronic lung disorder (for example, chronic obstructive pulmonary disease) Pulse oximetry (measurement of the level of oxygen in the blood) * Features include symptoms and the results of the doctor's examination.

Features mentioned are typical but not always present.

If the level is low, doctors measure levels of other hormones. ED = erectile dysfunction; MRI = magnetic resonance imaging.

Some Commonly Used Drugs That Can Cause Erectile Dysfunction. Drugs to treat high blood pressure (antihypertensives) Beta-blockers (such as atenolol , carvedilol , metoprolol , and propranolol ) Diuretics (such as furosemide , hydrochlorothiazide , and chlorthalidone ) Alpha-adrenergic blockers (such as terazosin , doxazosin , tamsulosin , and silodosin ) 5-Alpha-reductase inhibitors (such as finasteride and dutasteride ) Hormonal drugs (such as leuprolide , triptorelin, and goserelin ) Drugs that affect the central nervous system.

Benzodiazepines (such as alprazolam , chlordiazepoxide , diazepam , and lorazepam ) Cocaine or amphetamines, with chronic use. Monoamine oxidase inhibitors (such as phenelzine , selegiline , and tranylcypromine ) Opioids (such as codeine , heroin, hydromorphone , methadone , morphine , or oxycodone ), if used chronically.

Selective serotonin reuptake inhibitors (such as citalopram , escitalopram , fluoxetine , paroxetine , and sertraline ) Tricyclic antidepressants (such as amitriptyline , desipramine , imipramine , and nortriptyline ) Androgen antagonists (such as megestrol ) Anticancer drugs (most cancer chemotherapy drugs) Drugs with anticholinergic effects (such as many antihistamines and some antidepressants) Testing.

Laboratory tests include the measurement of the level of testosterone in the blood. If the testosterone level is low, doctors measure additional hormones. Depending on the results of the history and physical examination, blood tests may also be done to check for previously unrecognized diabetes, thyroid disorders, and lipid disorders.

Usually, these tests provide doctors with enough information to plan treatment. Occasionally, doctors inject a drug into the penis that stimulates erection and then use ultrasonography to assess blood flow in the arteries and veins of the penis. Rarely, doctors may recommend the use of a home monitor that detects and records erections during sleep. Sometimes other drugs, mechanical devices, or surgery. Any underlying disorder is treated, and doctors often stop drugs that may be causing erectile dysfunction (ED) or switch the man to a different drug.

However, men should talk with their doctor before they stop taking any drug.

Excess weight is a risk factor for many disorders that may cause ED, so weight loss may improve erectile function. Smoking is a risk factor for atherosclerosis, so stopping smoking may also improve erectile function.

Stopping or decreasing alcohol use, if excessive, can also help.

Even ED caused by a physical disorder usually has a psychologic component, so doctors offer reassurance and education (including of the man's partner whenever possible). Couples counseling by a qualified sex therapist can help improve partner communication, reduce performance pressure, and resolve interpersonal conflicts that contribute to ED. Supplemental testosterone can help restore erections in men with low testosterone levels. These testosterone preparations can be applied daily as a patch or a gel. Testosterone nasal products and below-the-skin implants are also sometimes recommended.

Men generic viagra mail order with very low testosterone levels may need testosterone injections twice per month. Noninvasive methods (mechanical devices and drugs) are tried first. Sometimes men must try the method a few times before doctors can determine whether it is effective.

Drugs injected into the penis just before intercourse are effective and often tried second.

Although most men prefer drugs to other methods of treating ED, mechanical devices have the advantages of being highly effective and, because they are free of drug side effects, usually very safe. Penile implant surgery with an inflatable prosthesis is the last used, but most effective, way to achieve intercourse. Men who can develop but not sustain an erection may use a constriction ring.

As soon as erection occurs, an elastic ring is placed around the base of the penis, helping prevent blood from flowing out and maintaining the firmness of the penis.

If the man cannot develop an erection, a hand-held vacuum erection device can be applied over the penis. This device draws blood into the penis by exerting a gentle vacuum effect, after which the ring is placed on the base of the penis to retain the erection.

Bruising of the penis, coldness of the tip of the penis, and lack of spontaneity are some drawbacks to this method.

Sometimes a constriction ring and vacuum device are combined with drug therapy.

The primary drugs for ED are oral phosphodiesterase inhibitors. Other drugs include prostaglandins that are injected into the penis or inserted into the urethra. Oral phosphodiesterase inhibitors are used much more often than other drugs because they are simple to use and allow spontaneity in intercourse.

Over-the-counter herbal remedies are sold for ED, but they are usually ineffective, contain hidden doses of a phosphodiesterase inhibitor, or both.

The hidden phosphodiesterase inhibitor may expose the man to a drug with possible side effects.

Oral phosphodiesterase inhibitors ( sildenafil , vardenafil , avanafil , and tadalafil ) increase blood flow to the penis.

These drugs work in the same way, but differ as to how long the effect lasts, their side effects, and their interactions with food.

The effect of tadalafil lasts longer than those of the other drugs (up to 36 hours), which some men prefer. Most phosphodiesterase inhibitors work best when taken on an empty stomach and at least 1 hour before sexual intercourse. Men who are taking nitrates (most often nitroglycerin for the treatment of angina but also recreational amyl nitrate ["poppers"]) should not take phosphodiesterase inhibitors because the combination can cause blood pressure to drop to unsafe levels.

Other temporary side effects of phosphodiesterase inhibitors include flushing, vision abnormalities (including abnormal color perception), and headache.

Priapism (prolonged erection) develops very rarely and may require emergency medical treatment.

In rare instances, men have reported blindness or hearing loss after taking phosphodiesterase inhibitors, but it is not clear whether the phosphodiesterase inhibitors have been the cause. Alprostadil (the prostaglandin PGE1) alone or in combination with papaverine and phentolamine may be directly injected into the side of the penis using a very thin needle, causing a suitable erection in most men. Alprostadil suppository may be inserted into the urethra using a straw-like applicator. These therapies may cause priapism and penile pain. Usually, the doctor guides the man to administer the drug himself during an office visit. After this, men may give themselves these drugs at home. Alprostadil suppository may be combined with an oral phosphodiesterase inhibitor for men in whom oral drugs are not effective. For some men, drug therapy is not effective or acceptable.

In these men, surgery to implant a penile prosthesis may be done. Prostheses can take the form of rigid silicone rods or hydraulically operated devices that can be inflated and deflated. Both involve the risks of general anesthesia, infection, and prosthetic malfunction.

Although erectile dysfunction (ED) does increase with aging, it need not be accepted as a normal part of aging.

Rather, because older men are more likely to have medical conditions that affect the blood vessels they are also more likely to have ED. Many older couples engage in satisfying sexual activity without erections or intercourse and may not choose to seek treatment.

Nevertheless, treatment of ED can be appropriate for older men.

ED commonly results from psychologic, nervous system, or blood vessel disorders, from injury, or from the side effects of some drugs or surgery.

When considering the causes, doctors consider psychologic and interpersonal factors.

Testosterone therapy may help restore erectile function in men with low serum testosterone levels and ED, but a low testosterone level is not a common cause of ED. Most men with ED may be successfully treated with an oral phosphodiesterase inhibitor such as sildenafil , vardenafil , avanafil , or tadalafil .

Most men who do not respond to therapy with oral phosphodiesterase inhibitors can achieve erections with injections of alprostadil , either alone or combined with an oral phosphodiesterase inhibitor.

Vacuum erection devices and penile prosthesis surgery are effective treatments for men with severe ED. To review contemporary knowledge concerning the innovative trends and perspectives in the treatment of erectile dysfunction (ED). Medline was reviewed for English-language

journal

In all, 114 original articles and 16 review articles were found to be relevant. Of the 76 cited papers that met the inclusion criteria, 51 papers had level of evidence of 1a–2b, whilst 25 had level of evidence of 3–4. Criteria included all pertinent review articles, randomised controlled trials with tight methodological design, cohort studies, and retrospective analyses.

We also manually reviewed references from selected articles.

Several interesting studies have addressed novel phosphodiesterase type 5 inhibitors (PDE5Is), orodispersible tablets, their recent chronic use, and combination with other agents. A few controlled studies have addressed herbal medicine as a sole or additional treatment for ED.

Experimental studies and exciting review papers have addressed stem cells as novel players in the field of ED treatment.

Other recent articles have revised the current status of low-intensity extracorporeal shockwave therapy in the field of ED.

A few articles without long-term data have addressed new technologies that included: external penile support devices, penile vibrators, tissue engineering, nanotechnology, and endovascular tools for ED treatment.

The current treatment of ED is still far from ideal.

We expect to see new drugs and technologies that may revolutionise ED treatment, especially in complex cases. Erectile dysfunction, sometimes called impotence, is a common and treatable condition. It refers to a man’s inability to achieve or sustain an erection, and it is estimated to affect nearly 30 million American men. Many men may experience erectile dysfunction from time to time, but for some men, it is an ongoing problem.

Fortunately, many safe and effective treatments are available for erectile dysfunction. Several factors can contribute to a man’s risk of erectile dysfunction, and it may have more than one cause.

Some conditions that can contribute to or cause erectile dysfunction, include: Age Certain medications High blood pressure High cholesterol Diabetes Depression Smoking Heart disease Alcohol or substance abuse Hormonal imbalance Trauma or injury (including spinal cord injury) Stress or psychological factors Other health conditions. Erectile dysfunction can be a sign of other serious health conditions, so it’s important to be evaluated by a trained physician. A thorough physical exam and health history, including all medications, are important first steps in diagnosing the cause.

Blood tests and sometimes, a blood flow test may also help with diagnosis.

The Men’s Reproductive and Sexual Health Program is one of only a few in the country to have two fellowship-trained, nationally recognized specialists in andrology, which includes male infertility and male sexual dysfunction.

Our specialists treat erectile dysfunction and related conditions every day. They have the experience, expertise and compassion to handle each patient’s needs individually with dignity and respect. Treatment options include lifestyle changes, as well as medications and devices to help sustain an erection.

Every treatment for erectile dysfunction has its risks and benefits.

You should understand your diagnosis and all of your options in order to make an informed decision. Lifestyle changes – Quitting smoking and moderating alcohol intake can help reduce the risk of erectile dysfunction.

Controlling diabetes and high blood pressure, being treated for depression, and maintaining a healthy weight can also help. Counseling – Psychological counseling for depression, anxiety or other conditions can help resolve impotence.

Medical management – Adjusting other medications that can cause impotence is sometimes an effective treatment.

Andrology specialists work collaboratively with your primary care or referring physician to provide consultation, diagnosis, treatment and follow-up communication.

Oral medications – Oral medications are one common treatment for erectile dysfunction, and several different drugs – known as phosphodiesterase type 5 (PDE-5) inhibitors – are available. However, these medications do not work for about 30 percent of men. Self-injection therapy – Self-injections, done with a tiny needle, allow men to inject medication(s) directly into the penis. The medication relaxes the penile blood vessels and smooth muscle to produce an erection.

Testosterone replacement therapy – If erectile dysfunction is caused by a hormonal imbalance, testosterone replacement therapy may be one treatment option.

Testosterone therapy can be administered several ways – injections, gel applied to the skin, or a patch worn on the skin. Vacuum erection therapy – A vacuum erection device uses a plastic tube that fits over the penis.

A pump then creates a gentle vacuum to increase blood flow to the penis and produce an erection.

Constriction therapy – Constriction therapy can be used to treat venous leak syndrome.

A band or tension ring is placed around the base of the penis to keep blood from flowing out of the penis during an erection. Surgery – In some cases, such as injury or congenital defect, the underlying cause of erectile dysfunction can be treated with vascular surgery.

Penile implants – A penile implant – a surgically implanted penile prosthesis – is another treatment option for some men.

You may have erectile dysfunction if you have trouble becoming or staying erect during sex. Erectile dysfunction affects up to 10 percent of men.

It has many causes, including: High blood pressure Diabetes High cholesterol Obesity Smoking Some prescription medicines Alcohol or substance abuse Sleep problems Stress, anxiety, or relationship problems.

Your University of Miami Health System urologist can help you find the right treatment for the cause of your condition.

Our team of urology experts delivers advanced care for all urologic conditions. We use the latest research and the least invasive procedures to help you feel better and recover more quickly.

Our experienced urologists design a personalized treatment plan to give you the best possible results. Our urologists are dedicated to men’s health and conduct innovative research into many conditions.