|Spanish Multimedia Encyclopedia|
An erection problem is the inability to get or maintain an erection that is firm enough for a man to have satisfactory intercourse. You may be unable to get an erection at all, or you may lose the erection during intercourse before you are ready. If the condition persists, the medical term is erectile dysfunction.
Erectile dysfunction; Impotence; Sexual dysfunction - male
Erection problems are common in adult men. In fact, almost all men experience occasional difficulty getting or maintaining an erection. In many cases, it is a temporary condition that will go away with little or no treatment. In other cases, it can be an ongoing problem that can damage a man's self esteem and harm his relationship with his partner, and thus requires treatment.
If you have difficulty having or keeping an erection more than 25% of the time, it is considered a problem.
In the past, erection problems were thought to be "all in the man's mind." Men often were given unhelpful advice such as "don't worry" or "just relax and it will take care of itself." Today, doctors believe that when the problem is not temporary or does not go away on its own, physical factors are often the cause.
One way to know if the cause is physical or psychologic is to determine if you are having nighttime erections. Normally, men have 3 to 5 erections per night, each lasting up to 30 minutes. Your doctor can explain a test to find out if you are having the normal number of nighttime erections.
In most men, erection difficulties do not affect their sex drive.
Premature ejaculation (when orgasm comes on too quickly) is not the same as impotence. Together with your partner, you should seek counseling for this problem, which is usually due to psychological factors.
Male infertility is also quite different from impotence. A man who is unable to maintain an erection may be very capable of producing sperm that could fertilize an egg. An infertile man is usually able to maintain an erection, but he may be unable to father a child due to problems with sperm count or other factors.
An erection requires the interaction of your brain, nerves, hormones, and blood vessels. Anything that interferes with the normal process can lead to a problem.
Common causes of erection problems include:
Erection problems tend to become more common as you age, but they can affect men at any age and at any time in their lives. Physical causes are more common in older men, while psychological causes are more common in younger men.
Low levels of testosterone rarely lead to erection problems, but may reduce a man's sex drive.
For many men, lifestyle changes can help:
Couples who cannot talk to each other are likely to have problems with sexual intimacy. Men who have trouble communicating their feelings may find it difficult to share with their partner any anxieties about their sexual performance. In these circumstances, counseling can be very helpful for both you and your partner.
Call your doctor if:
If erection problems seem to be caused by a medication you are taking for an unrelated condition, consult your doctor. You may benefit from reducing the dose of the drug or changing to another drug that has the same result but not the same side effects. DO NOT change or stop taking any medications without first talking to your doctor.
Talk to your health care provider if your erection problems are related to fear of recurring heart problems. Sexual intercourse is usually safe in these circumstances.
Call your doctor immediately or go to an emergency room if medication for erection problems give you an unwanted erection that lasts more than 4 hours. Permanent impotence or other lasting damage to your penis may result from this condition.
Your doctor will perform a physical examination, which will likely include:
To help diagnose the cause of the problem, your doctor will ask medical history questions such as:
Tests that may be done include:
The treatment may depend on the cause. For example, if the problem is caused by a hormonal imbalance, medication to treat the underlying endocrine disorder will be prescribed. However, the same treatment may be used for many different causes. Consult your health care provider for appropriate evaluation and management.
There are many treatment options today. These include medicines taken by mouth, injections into the penis, medicines inserted into the urethra (urinary channel), vacuum devices, and surgery. In order to treat erectile dysfunction effectively, you must be aware of and comfortable with the possible side effects and complications that may occur with each therapy.
Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are medicines prescribed for erection difficulties caused by either physical or psychological problems. The drugs work only when the man is sexually aroused. The effect is usually seen within 15 - 45 minutes.
These drugs are called phosphodiesterase-5 (PDE5) inhibitors.
Although these drugs have become extremely popular, they do not enhance erections if you are not impotent. And they DO have side effects, which can be as serious as a heart attack or as minor as muscle pain or facial flushing.
These drugs should not be used with certain other medications, including nitroglycerin. When taken with nitroglycerin, a man's blood pressure can become dangerously low. Some men have died after taking these drugs with nitroglycerin.
PDE5 inhibitors should be used with caution if you have any of the following conditions:
If pills do not work, options such as the following are available.
Many herbs and dietary supplements are marketed to help sexual performance or desire. There are several special concerns for people taking alternative remedies for erectile dysfunction. Also, none of these remedies have been proven effective for treating erectile dysfunction.
Consult your health care provider to see if one of these treatments is right for you.
McVary, K. T.. Clinical practice. Erectile dysfunction. N Engl J Med. 2007 Dec; 357(24): 2472-81.
Melnik T, Soares BG, Nasselo AG. Psychosocial interventions for erectile dysfunction. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004825.