Erectile Dysfunction Overview
What is erectile dysfunction? ED is a condition where there is a failure to achieve an erection. Sporadic episodes are not uncommon and can accompany stress, anxiety, insomnia or insufficient sleep, substance abuse, and poor nutrition (being overweight or underweight). Read more about ED in our erectile dysfunction patient education guide.
Medical conditions linked to erectile dysfunction include:
- High cholesterol
- High blood pressure
- Kidney disease
- Nervous system condition
- Prior pelvic surgery
- Thyroid dysfunction
- Pituitary dysfunction
- Adrenal gland dysfunction
Certain drugs are linked to erectile dysfunction. These include:
- Anti-anxiety medications
- High blood pressure medicine
- Muscle relaxants
- Anti-inflammatory drugs
- Muscle relaxants
- Parkinson’s Disease drugs
Recreational or abused drugs can also cause erection problems. These include:
Often, the general practitioner or family doctor is the first healthcare provider that a man approaches for evaluation and questions about erectile dysfunction.
Additional specialists that provide care for erectile dysfunction or ED include:
- Urologist — a physician who deals with the health and problems of the male and female urinary tract and male fertility and ED
- Endocrinologist — a physician who deals with the health, diagnosis, and treatment of hormonal system disorders such as thyroid imbalances, diabetes, and pituitary problems (a hormonal imbalance can cause irregular or no erections)
- Psychologist — provides therapy for individuals through counseling and psychotherapy, as well as techniques for controlling stress or mood problems
- Psychiatrist — a medical doctor who focuses on health and disorders of the mind and mood; may prescribe medications in addition to providing psychotherapy if imbalances or mental disorders are diagnosed
- Nurse Practitioner — focuses on prevention, wellness, and education of patients about health and health choices
- Nutritionist — a professional who formulates diet plans for both healthy and compromised individuals, in addition to advising which vitamins and supplements would promote good health (nutritional status strongly affects fertility and certain supplements can help improve it; the nutritional status of both partners should be evaluated)
- Holistic Practitioner — views the body overall, considering physical, mental, and spiritual components; considers herbs and nutritional supplements in addition to meditation, cleansing, diet and exercise protocols
How to Prepare for Your Erectile Dysfunction Doctor Visit
When coming to the healthcare office for an ED evaluation, wear comfortable and loose fitting clothing and bring the following items listed in this erectile dysfunction patient education guide:
- A list of medications and the dosages
- A list of medical problems and dates
- A list of past surgeries with dates
- A list of allergies
- A record of sexual encounters and any problems arising
- Results of prior and recent laboratory results
- Radiological and ultrasonic images taken
Questions to Ask Your Doctor About Erectile Dysfunction
Questions About My ED Diagnosis
- What is causing my erectile dysfunction
- Is this a temporary problem that will resolve on its own?
- Are my current medications causing this problem?
- Could there be a medical problem causing this issue?
- What further testing will I need to have?
Questions About My ED Treatment
- What medication can you prescribe to treat my erection problem? How long does the effect last?
- Can I take the drug with my current medications?
- Can I take the drug with my current medical problems?
- What side effects are associated with this drug?
- Are there vitamins or herbs that I can take for this problem?
Questions About My Lifestyle and Family
- Is smoking affecting my erections?
- Can I drink alcoholic beverages without erectile problems? How much can I drink?
- Is there a diet that you advise? Are there foods that I should avoid?
- Does the type of underwear make a difference?
- Does exercise cause a problem? How much can I do? Are there exercises that I should do?
- Does this problem run in families?
Common Tests or Labs to Diagnose Erectile Dysfunction
Prior to extensive testing, a complete physical examination is performed including the blood pressure and assessment of the testicles and penis to rule out any structural problems. A sexual history is reviewed as well as lifestyle history including diet, exercise and any use of substances.
|Test||What is it?||What Happens?||What is Measured?|
|Blood test for hormone levels (prolactin, LH, thyroid, testosterone)
|Looks for hormonal imbalance, which can cause problems.The LH stimulates production of testosterone.
Thyroid dysfunction can cause a decrease in the testosterone level.
|After a tourniquet is applied to the upper arm, the puncture site of skin is swabbed with alcohol pads and a needle punctures the skin. Blood is then drawn into a syringe for analysis.|| Prolactin < 15 ng/mLLH= 2-14 U/L
Serum thyroxin –T4
Thyroxine-biding globulin- TBG
Thyroid stimulating hormone- TSH
Normal Range 866-956 ng/dL
(varies with age)
|Complete Blood Count||Looking to rule out anemia||After a tourniquet is applied to the upper arm, the puncture site of skin is swabbed with alcohol pads and a needle punctures the skin. Blood is then drawn into a syringe for analysis.|| WBC=4.5-11RBC: Male = 4.5-5.3
Hemoglobin: Male = 13-16
Hematocrit: Male = 37%-49%
|Cholesterol Panel||High cholesterol can lead to blood vessel damage in the body, including blood vessels that transport blood to the penis. The vessel strictures lead to erectile dysfunction due to the impedance of blood flow to and within the penis.||After a tourniquet is applied to the upper arm, the puncture site of skin is swabbed with alcohol pads and a needle punctures the skin. Blood is then drawn into a syringe for analysis.|| Cholesterol Panel:Total < 200mg
LDL <100 mg
HDL > 60 mg
|Glucose||Screening for diabetes||Fasting > 8hrs.= < 100 mg/dlRandom level is low to mid 100s|
|Ultrasound||Looks for scarring, abnormalities in blood flow, stricture of urethra and musculature of penis||An erection is induced either naturally or with injection of a natural compound into the penis. An ultrasound makes an image from echoes detected with sound waves emitted from a transducer wand as it is passed over the male genitalia.||Normal blood flow, no strictures, obstructions, tumors or cysts are visualized|
|Nocturnal Penile Tumescence Test(NPT)||Checks to see if the patient is having normal erections during sleep(if no erection occurs due to a psychological problem, erections still exist during sleep)||Ring like film (snap gauge) is placed around the penis. When the erection occurs, the film snaps.Electronic monitoring records the length and intensity of the erection.
|3-5 full erections during sleep|
|Intracavernosal Injection Test||Look to rule out obstruction or occlusion in an artery or vein of the penis||Medication is injected at the base of the penis or urethra to stimulate an erection. The erection length and fullness is measured.||Normal erections last for 30 minutes|
Lifestyle and Diet Changes
Scientific studies demonstrate that the same risk factors leading to heart attacks due to blood flow compromise, also lead to erectile dysfunction by restricting blood flow to the penis or within it. In order for the penis to become erect, blood flow is crucial.
Poor diets that include fried or fatty foods compromise blood flow over time by constricting blood vessels. The same is true for leading a sedentary lifestyle. Being a “couch potato” decreases your ability to have penile erections over time.
|Actions||How it works|
|Discontinue tobacco use/exposure to smoke||Cigarette smoke is associated with small blood vessel stricture.|
|Stress reduction therapies(includes yoga, meditation, massage)||Erections are hampered in stress. While the mechanisms are not clearly defined, stress may lead to subtle hormonal imbalances.|
|Eat healthy, balanced, and nutritional meals||Studies show that excessive weight or abnormally thin men have lowered erections.|
Common Medications and Treatments for Erectile Dysfunction
As with diet and lifestyle changes, medications that can enhance blood flow to the penis or within the penis will increase erections and lessen the chance of erectile dysfunction. (Erections occur when the penile tubules are engorged with blood)
|Drug/Treatment||How it works|
|Dopamine Stimulators(taken sublingually)||Increased dopamine enhances sexual sensations and interest.|
|Phosphodiesterase inhibitor||Taken orally; relaxes penile smooth muscles to increase blood flow, helping erections with increased erection length and firmness|
|Melanocortin activator||For men with psychological inhibitors of erection|
|Intracavernous drug injection||Drug increases blood flow to the penis, causing an erection|
|Vacuum Device||Increases penile blood flow|
|Surgical vascular reconstruction||Enhances blood flow to the penis and surrounding tissues|
|Surgical implant placement||Inserted into the penis with tubes that are attached to a pump for inflation|