If a man finds it difficult to have or keep a firm erection enough to be able to have sexual intercourse, then he is said to have erectile dysfunction which is one of the male sexual problems. Occasionally, most men have experienced difficulty with their penis staying firm. However, if sexual performance is found impossible on a number of occasions for some time and it is an ongoing issue, then only erectile dysfunction (ED) is considered a concern and an urologist must be consulted. Stress, lack of self-confidence, and relationship problems can be caused by it. An underlying health condition that needs treatment and a risk factor for heart disease can be denoted by problems in getting or keeping an erection.

Some important facts about erectile dysfunction:

  • A persistent difficulty in achieving and maintaining sufficient erection to have sex is called erectile dysfunction (ED).

  • Besides medical causes, there can also be psychological causes for this.

  • An underlying medical condition affecting the blood vessels or nerves supplying the penis is normally the cause of organic causes.
  • The cause of erectile dysfunction can be numerous prescription drugs, recreational drugs, alcohol and smoking.

Causes

The process of male sexual arousal is very complex. The brain, hormones, emotions, nerves, muscles and blood vessels are involved in it. If there is a problem in any of these, it may result in erectile dysfunction. Similarly, other factors which can cause or worsen erectile dysfunction are stress and mental health concerns. The exact cause in your case can be ascertained by your urologist.
Erectile dysfunction can sometimes also happen because of a combination of physical and psychological issues. Suppose, your sexual response is slowed by a minor physical condition and this might cause anxiety about maintaining an erection. Erectile dysfunction can worsen because of this anxiety. Its treatment must be done by done by an experienced erectile dysfunction doctor.

Physical causes

Common physical causes of erectile dysfunction are:

  • Heart disease

  • Atherosclerosis or clogged blood vessels
  • High cholesterol
  • High blood pressure

  • Diabetes

  • Obesity
  • Metabolic syndrome – a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol

  • Parkinson’s disease

  • Multiple sclerosis
  • Certain prescription medications
  • Tobacco use

  • Peyronie’s disease in which scar tissue develops inside the penis

  • Various forms of substance abuse including alcoholism

  • Sleep disorders

  • Treatments for prostate cancer or enlarged prostate

  • Surgeries or injuries affecting the pelvic area or spinal cord

Psychological causes

In triggering the series of physical events causing an erection, which starts with feelings of sexual excitement, a key role is played by the brain. There are a number of things that can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:

  • Depression, anxiety or other mental health conditions
  • Stress
  • Relationship problems

Diagnosis

To diagnose erectile dysfunction and recommend a treatment, an urologist needs to do a physical exam and get answers to questions (medical history). You might need further tests or a consultation with a specialist if you have chronic health conditions or your doctor suspects that an underlying condition might be involved. For diagnosis of underlying conditions some tests are done which might include:

  • Physical exam. Your penis and testicles are carefully examined and your nerves are checked for sensation.

  • Blood tests. To check for signs of heart disease, diabetes, low testosterone levels and other health conditions, a sample of your blood might be sent to a lab.

  • Urine tests (urinalysis). To look for signs of diabetes and other underlying health conditions, urine tests are used like blood tests.

  • Ultrasound. A specialist usually performs this in a clinic. Over the blood vessels that supply the penis, a wand-like device (transducer) is held and a video image is created by it to let your doctor see if you have blood problems. In combination with this test, sometimes medications are also injected into the penis for stimulating the blood flow and producing an erection.

  • Psychological exam. You might be asked questions by your urologist to screen for depression and other possible psychological causes of erectile dysfunction.

Treatment

You might have various erectile dysfunction treatment options depending on the cause and severity of erectile dysfunction and any underlying health conditions. You will be given an explanation of the risks and benefits of each treatment by your urologist.

Oral medications

For many men, oral medications prove to be a successful erectile dysfunction treatment. They include:

Sildenafil (Viagra)
Tadalafil (Adcirca, Cialis)
Vardenafil (Levitra, Staxyn)
Avanafil (Stendra)
The effects of nitric oxide are enhanced by these medications. Nitric oxide is a natural chemical produced by your body that relaxes muscles in the penis. Blood flow increases as a result of this and allows you to get an erection in response to sexual stimulation.

Vacuum devices

For men who do not want or cannot use drug treatments or find them to fail, vacuum erection devices are used to produce an erection. A vacuum pump is sealed around the penis that draws blood and in this way, it is made rigid. An accompanying band is used after removing the vacuum pump to maintain the erection of the penis.

Surgical treatments

There are several surgical treatment options:
Penile implants: After not getting success with drug treatments and other non-invasive options, these are the ultimate option for men.
Vascular surgery: For some men there is another surgical option called vascular surgery, attempting to correct some blood vessel causes of erectile dysfunction.
In the most extreme cases, surgery is used which is the last resort. In surgery, recovery time varies but there are high success rates.