Erectile Dysfunction (ED)

Erectile dysfunction (ED) is a common men's health problem characterized by the consistent inability to obtain or sustain an erection sufficient for sexual intercourse. It is estimated that 50% of the men between the ages of 40 and 70 have ED. It can involve a total inability to achieve an erection or ejaculation, an inconsistent ability to do so, or a tendency to sustain only very brief erections. Erectile dysfunction is also commonly referred to as impotence.

Risk Factors

The risk of erectile dysfunction increases markedly with age. Medical conditions that increase the risk for ED include:

  • hypertension
  • diabetes
  • heart disease
  • elevated cholesterol or lipids
  • atherosclerosis (hardening of the arteries)
  • obesity, and other conditions that impair the blood flow or nerve supply to the penis.

Physical exercise tends to lessen the risk.

Smoking has been found to be detrimental to a man’s ability to obtain and sustain an erection.

Erectile dysfunction can have emotional causes but most often it is due to the physical problems listed above.

Certain medications can cause ED as well. It is important that you do not stop a medication without your doctor’s knowledge and consent. Remember, dead men do not have sex.


Treatment for ED begins with a complete evaluation by your doctor and by recognizing and treating the risks factors listed above. It is important to address lifestyle issues contributing to your erection problems. It is unrealistic to remain an obese, hypertensive, smoking diabetic male and expect a healthy sexual experience. Diet and exercise are the first steps.

Treatment for ED was revolutionized after the introduction of sildenafil (Viagra). This was the first effective pill for the treatment of ED and is now joined by vardenafil (Levitra) and tadalafil (Cialis).

Other treatment options include:

  • Vacuum erectile device (yes, this is a penis pump): This remains the most cost effective and non-invasive method of treating ED. Many men, however, find the devices cumbersome and nearly half of couples stop using the device by one year’s time.
  • Penile injection therapy: Medication is injected into the penis prior to intercourse. The obvious limitation here is placing a needle into their penis. Cost is significantly higher than pills or the vacuum device. The most significant concern regarding injection is Priapism. This is a prolonged and painful erection. Men with erections lasting more than three hours should seek medical attention immediately.
  • Penile prosthesis: This is an implant placed into the penis. There are two types. One that stays rigid at all times or the more common variety that inflates for intercourse and then deflates. This is a surgically implanted device with obvious concerns for surgical complications, infection, or device failure.

Erectile dysfunction is a common and treatable condition in the vast majority of men. Many couples find means of remaining intimate without an erection. It is important for men to address this issue with their partner and include their partner with the evaluation and treatment. Treatment for ED begins with a discussion with your doctor. It is important that all men with Erectile Dysfunction undergo a thorough evaluation by their primary care physician for risk factors that lead to ED.

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