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Health Topics A-Z
Erectile Dysfunction
What Are the Treatments?
If you are troubled by occasional erectile dysfunction, remember that arousal takes longer as you get older and that satisfaction should not be equated with performance. If your dysfunction is severe and persistent, you should seek medical help. The number of treatment options has increased in recent years.
Many doctors will recommend changes in lifestyle as a first step toward. Cutting back on alcohol, tobacco, and illegal drug use can help alleviate the problem. Changing prescription medications under your doctor's guidance might be in order, as some medicines not only interfere with achieving erection but can also decrease your interest in sex and the ability to reach orgasm. Reducing stress, eating well, and exercising may also be helpful.
Conventional Medicine
The most common treatments used now are the medications sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). It is effective in about seven out of 10 men who use it. The pill is taken one hour before intercourse and, when effective, allows a normal erection with stimulation. It is not to be used by men who take any kind of nitroglycerin or nitrate drugs because the combination can result in dangerously low blood pressure. Another option for the treatment of erectile dysfunction is a vacuum inflation device. This instrument draws blood into the penis by creating negative pressure around it; a rubber ring is then slipped over the base of the penis to maintain the erection. The ring should be removed after 30 minutes to restore circulation and prevent damage to the penile tissues.
An erection can also be produced by self-injection of medications before sex into the side of the penis; these drugs may also improve long-term potency and penile blood flow. Prostaglandin suppositories can also be inserted into the urethra to produce erections. Medically administered testosterone shots or patches help some men, but no specific level of the hormone guarantees potency.
A special type of exercise can help those whose erectile dysfunction is caused by leaking veins: Kegel exercises. Often prescribed for women with urinary incontinence, these exercises consist of contracting and relaxing the pelvic muscles -- the same ones that let you stop urinating in mid-flow. By strengthening these muscles, men may be able to achieve erection without resorting to surgery.
For certain blood-vessel problems, vascular surgery to open arteries leading to the penis may be of benefit. The effectiveness of such surgery can be quite variable and for the most part is not a main treatment option.
When none of these therapies work, some men choose a penile implant. The least expensive is a semirigid type that produces a permanent erection. More sophisticated and expensive implants are inflated by a pump mechanism placed beneath the skin of the scrotum. These are very effective, with very high patient/partner satisfaction.
If the cause is judged to be psychological, it is crucial to review your relationship with your partner and to examine other possible sources of stress or tension in your life. A trained therapist can aid in these matters and may help unearth problems such as unreasonable guilt, performance anxiety, or inhibiting attitudes toward sex that were learned at an early age.
Alternative Medicine
Acupuncture
Men whose dysfunction has psychological foundations may be helped by acupuncture, which in traditional terms releases and rebalances the qi, or life force, by placing needles at specific "meridians" of the body. Medically the mechanism isn't known but involves the release of various nerve chemicals.
Aromatherapy
The scents employed in aromatherapy may relax the amorously inclined and put you in the mood. Some evidence shows aromatherapy may actually increase blood flow to the penis. No specific scent has been proven to affect all men, so try several to find one that works for you.
Herbs and Supplements
There's little evidence yet to support the use of herbs for treating erectile dysfunction. If you do choose to try herbs and supplements, inform your doctor and proceed with caution. Ginkgo has been shown to increase blood flow, but there is no direct proof that this leads to regained function for men. Ginseng and saw palmetto are two other popular herbs whose claims regarding erectile function have yet to be well proven. The amino acid arginine is being studied and may show promise in some cases of erectile dysfunction, but more research is needed. Because so many herbs can interfere with medications, check with your doctor before starting any herbal therapy.
Therapies That May Harm You
Cell therapy (which, in the case of erectile dysfunction, involves transferring cells from a pig's gonads into humans) is hardly likely to work, very expensive, and illegal in the United States. Chelation therapy, a form of chemical purging supposedly good for improving vascular circulation, is unproven and may be dangerous. Magnetic field therapy may have some applications, but there is no evidence that it cures erectile dysfunction.
The herb yohimbe has also been purported to improve erectile dysfunction, but due to potential serious side effects, it cannot be sold over the counter in the United States. In its prescription drug form, benefits are uncertain.
SOURCES: National Institute of Diabetes and Digestive and Kidney Diseases. American Academy of Family Physicians. The Mayo Clinic. WebMD Medical Reference: "Erectile Dysfunction Health Center."