WHAT IS ERECTILE DYSFUNCTION?
Most men have problems with erections from time to time. In some men, these problems are regular and more severe. Erectile dysfunction, or ED, is when it is hard to get or keep an erection that’s firm enough for sex. Erectile dysfunction affects as many as 30 million men.
CAUSES OF ERECTILE DYSFUNCTION
Erectile dysfunction is increasingly common as men become older, but it is not the source of the problem. Erectile dysfunction might be a symptom of a more serious underlying health issue. Your overall health and well-being can be improved by identifying and treating the cause(s) of your erectile dysfunction.
Erectile dysfunction can result from health or emotional problems, or a combination of both. Reduced blood flow or harm to nerves in the penis can result in erection problems. These can be caused by heart disease, high blood pressure, high blood sugar, surgery, injuries and even smoking. Some medicine, as well as alcohol or other drugs may also cause erection problems. Emotional (depression, stress or worry) or relationship problems can cause or worsen erectile dysfunction.
DO I HAVE ERECTILE DYSFUNCTION?
The Sexual Health Inventory for Men (SHIM) Questionnaire below can help you and your doctor determine if you have symptoms of ED (erectile dysfunction).
For each question, note your answer by circling the number that approximates your belief. Add your numbers together and refer to the table below to see what your score may mean.
OVER THE PAST SIX MONTHS…
1) HOW DO YOU RATE YOUR CONFIDENCE THAT YOU COULD GET AND KEEP AN ERECTION?
1. Very low – 2. Low – 3. Moderate – 4. High- 5. Very high
2) WHEN YOU HAD ERECTIONS WITH SEXUAL STIMULATION, HOW OFTEN WERE YOUR ERECTIONS HARD ENOUGH FOR PENETRATION (ENTERING YOUR PARTNER)?
1. Very low – 2. Low – 3. Moderate – 4. High- 5. Very high
3) DURING SEXUAL INTERCOURSE, HOW OFTEN WERE YOU ABLE TO MAINTAIN YOUR ERECTION AFTER YOU HAD PENETRATED (ENTERED) YOUR PARTNER?
1. Very low – 2. Low – 3. Moderate – 4. High- 5. Very high
4) DURING SEXUAL INTERCOURSE, HOW DIFFICULT WAS IT TO MAINTAIN YOUR ERECTION TO COMPLETION OF INTERCOURSE?
1. Very low – 2. Low – 3. Moderate – 4. High- 5. Very high
5) WHEN YOU ATTEMPTED SEXUAL INTERCOURSE, HOW OFTEN WAS IT SATISFACTORY FOR YOU?
1. Very low – 2. Low – 3. Moderate – 4. High- 5. Very high
SCORE:
1-7: Servere ED
8-11: Moderate
12-16: Mild to Moderate ED
17 – 21: Mild ED
22-25: No signs of ED
HOW IS ERECTILE DYSFUNCTION TREATED?
Dr. Nimeh may need to treat the root causes to improve erection problems. You may need to change certain habits (such as quitting smoking or drinking) or treat emotional problems, such as relationship conflicts, depression or performance anxiety. Cutting back on or changing certain meds can often improve erectile dysfunction, but do not stop taking your medicine or change any meds without talking to Dr. Nimeh first.
If a blood test shows low testosterone levels (low T), testosterone replacement therapy (TRT) may help. However, if a blood test shows you have normal testosterone levels, adding TRT will not help your erection problems.
OTHER ERECTILE DYSFUNCTION TREATMENT CHOICES ARE:
- Oral drugs, known as PDE-5 inhibitors. These drugs relax muscle cells in the penis and increase blood flow.
- A vacuum erection device which pulls blood into the penis, causing an erection. An elastic ring is then slipped onto the base of the penis. This holds the blood in the penis (and keeps it hard) for up to 30 minutes.
- Self-injection therapy. By injecting this medication into the penis with a very fine needle, an erection is created.
- Intraurethral therapy. Patients place a tiny medicated pellet of the drug alprostadil into their urethra. (The urethra is the tube that carries urine out of the body). This causes an erection.
- Penile prostheses, surgically implanted by a urologist.
Ask Dr. Nimeh which treatment is right for you. Dietary supplements (often called “herbal remedies”) for erectile dysfunction are popular but may not be safe or even work. Check with your health care provider before you take any supplements or medicine to treat your erectile dysfunction. The good news for many men is that erectile dysfunction can be treated safely, and treatments can work well. If you have erectile dysfunction, there is hope. There is help. Talk to your health care provider to see if one of these treatment choices will work for you.
SURGICAL TREATMENT FOR ERECTILE DYSFUNCTION
Because of new treatments, today urologists are helping men with erectile dysfunction perform better and longer. When other treatments do not improve erectile dysfunction, Dr. Nimeh may offer you surgery as a treatment choice. Surgery to fix problems with blood vessels in the penis may help in rare cases. Young men who have had injuries to the pelvis or penis are most likely to be helped by this treatment.
PENILE PROSTHESES
Penile prostheses are devices implanted inside the penis that allow men with ED to have an erection. Penile prostheses, which provide firm erections, are a good treatment choice for some men. One type of implant uses two bendable rods placed in the penis during a surgery. To have an erection, a man bends his penis upward into an erect position.
With an inflatable implant, a pair of rods is placed lengthwise in the penis. The rods fill with fluid when a pump hidden in the body is pressed. This fluid makes the penis hard. Penile implants are placed during a several-hour surgery. There is a risk of infection and a risk that the device will fail.
Most men with penile implants and their partners say they’re satisfied with the results. However, once a prosthesis is placed, other non-surgical treatments will no longer work if the prosthesis is removed.
RESOURCES
American Association of Sexuality Educators, Counselors, and Therapists Find a certified sex therapist/counselor near you www.aasect.org, click on “Locate a Professional”
Frank Talk Peer support to help men deal with ED www.FrankTalk.org
Hormone Health Network In English: www.hormone.org/diseases-and-conditions/ mens-health/erectile-dysfunction