Erectile Dysfunction (ED), often called impotence, has been defined by the NIH (National Institutes of Health) as the inability to sustain or achieve an erection sufficient for satisfactory sexual activity. That means that virtually every man will at some time have what could be called ED; virtually every man will, at some time, be unable to “perform” sexually.
ED should be thought of as a medical problem only when it happens regularly, consistently, over a considerable period of time, and begins to affect a man emotionally and psychologically, harming his self-esteem as well as his sexual activity. This form of ED is actually very common—and very treatable. The NIH estimated, in 2002, that chronic erectile dysfunction affects between 15 million to 30 million men in the U.S. alone. Unfortunately, because of reluctance to discuss the subject with their doctors only about 10% seek treatment.
But there is evidence that this is changing. Certainly the publicity around the introduction of new drug therapies for erectile dysfunction a few years ago stimulated more open discussion of the problem.
The fact is, it’s important to consult your doctor if you do have chronic ED. That’s because many of its causes are physical and not only can they be successfully treated, but if they’re not treated they may lead to other problems.
Erectile Dysfunction and Aging
Erectile dysfunction is not an inevitable result of aging. As men age, they do normally experience changes in their erectile function. It may take a longer time and greater stimulation to get an erection, orgasms may be less intense, and the time between erections may increase. But chronic ED is not inevitable, and age is not a reason to avoid treatment.
Common symptoms of erectile dysfunction are:
- Recurring inability to have an erection
- Recurring inability to maintain an erection sufficient for satisfactory sexual activity
- Total inability to have an erection
Consult a urologist or your own doctor if these symptoms persist for more than several months.
Diagnosis of erectile dysfunction usually begins with the doctor taking your medical and sexual history, asking questions about how often you experience symptoms, your general physical and emotional state, and any drugs you’re currently taking that might cause erectile dysfunction. This will be followed by a physical exam and routine blood and urine tests that, among other things, can check your level of male hormones, cholesterol, blood sugar, and liver, kidney and thyroid function. The physical exam could include an examination of your prostate (called a digital rectal exam or DRE) in which the doctor physically feels the size, shape, and consistency of your prostate by inserting a gloved, lubricated finger into your rectum. An enlarged prostate can interfere with blood flow and nerve impulses in the penis.
There are several other diagnostic tests that can evaluate blood flow into and out of the penis and measure the blood pressure in it (normally and during erection) and evaluate the sensitivity and nerve function of the penis. Among the most common are:
- Ultrasound. Uses sound waves projected into the body to create pictures of the organs and areas being examined; ultrasound of the genitals can show if there’s any problem with blood flow to the penis.
- Neurologic Exam. Tests the nerve function in the penis and checks for possible nerve damage in the genital area.
- Nocturnal Penile Tumescence (NPT) Test. Measures the number and strength of the erections you have during sleep; there are several simple methods for doing this.
Although they may not be aware of it, men normally have several (perhaps five or six) erections while they sleep, especially during rapid eye movement (REM) sleep. These erections are “automatic” and have absolutely nothing to do with the content of your dreams. (You don’t need to be dreaming about sex to have them). They happen about every 90 minutes and last for about 30 minutes. If you do not have them, or if they are especially weak, there may be a problem with the nerve function or blood supply in your penis.
Treatment for erectile dysfunction depends on its causes and severity. Options range from medication to surgery to psychotherapy and could include:
- Oral Medications
- Injection Therapy
- Intraurethral Therapy
- Hormone Medications
- Vacuum Devices
- Penile Implants (prostheses)
- Surgical Treatment
- Counseling and Psychotherapy