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Erectile dysfunction…a term that often sparks a pang of worry in the hearts of men worldwide. While poor self-esteem, embarrassment, and shame are often by-products of this condition, periodic trouble in this department is normal and can be linked to depression, work and home stress, and performance anxiety.

Erectile dysfunction can happen to any man. In fact, it is estimated that the condition affects over 30 million men in the United States. Sometimes it is just a part of aging, and other times it may be related to other health-related concerns. If you've noticed that you have fewer erections or are unable to sustain an erection—this is the right time to seek medical help. At Physician Promise, our physicians are experts in diagnosing and treating ED.

This article discusses erectile dysfunction symptoms: how to determine whether you have erectile dysfunction and what you can do to alleviate symptoms.


Should I Be Worried About Erectile Dysfunction?


Erectile Dysfunction (ED) can indicate an underlying health issue, so it's always best to get checked out by a physician. ED can be one of the first signs of diabetes because of high blood sugar. However, it is often heart-related, indicating cardiovascular disease, hypertension, and hardening of the arteries. Men with ED are often at risk of a heart attack, circulatory problems in the lower extremities, or stroke.


What Are the Physical Causes of ED?


Although there is a correlation between ED and aging (since many older men may need more stimulation to induce an erection), other physical causes can come into play.


These include:


      Limited blood flow: This is when the penis cannot trap blood during an erection (called a venous leak) and may be due to diabetes, Peyronie's disease, nerve conditions, and severe anxiety.

      Sleep loss: Studies have shown that men with sleeping disorders are more likely to have ED. One study published in 2016 found that 63% of men living with obstructive sleep apnea also had erectile dysfunction.

      Nerve damage: Nerves in the pelvic area might be affected by disease, surgery, or injury, or nerve signals may not reach the penis from the brain or spinal cord. Nerve damage can also be caused by diabetes.

      Radiation therapy: Anyone who has been through bladder, prostate, or colon-rectal cancer may be affected as cancer treatments in the lower abdomen or pelvis, such as radiation, can cause ED.

      Drug use: Recreational drugs and certain pharmaceuticals can have side effects that affect sexual performance.

      Frequency of sex: Studies show that men who have sex less than once a week are more likely to develop ED.

      Hypogonadism: This condition leads to low levels of the male hormone testosterone

      Multiple sclerosis and Parkinson's disease





How Can I Test for ED?


To confirm that a patient experiences normal physiological erectile function during sleep, overnight self-testing or nocturnal penile tumescence (NPT) might be conducted to ascertain whether the cause is physical.


A portable battery-powered home device, the Rigiscan, is strapped around the thigh. The machine measures the blood in the penis and its rigidity over several nights, and a doctor can download and analyze it.


A penile plethysmograph measures the erection as the patient is exposed to sexually-stimulating material. Penile cuffs attach to a pulse volume recorder which displays and records waves of blood to the penis to establish if the condition is physical or psychological.


Sexual Health Inventory for Men (SHIM)


The Sexual Health Inventory for Men questionnaire offers an accurate indication of ED. An example of the questionnaire can be found here.


What Can I Expect When I Visit My Physician?


Diagnosing the condition usually begins with a physician posing several lifestyle questions, conducting a physical exam, and concentrating on ED symptoms. Blood, urine, and other tests might be done to rule out certain conditions.

It is critical to be upfront about lifestyle, smoking, drinking habits, drugs the patient may be taking, pressures they may be under, and relationships.

Questions About Your ED Symptoms

Erectile dysfunction history allows the health care provider to glean information. Rest assured, the doctor has heard it all before, and the aim is merely to understand the causes and recommend a course of action.

Physical Examinations

A general health check will be conducted, and based on age and risk factors; an exam may look at the heart and vascular system. A rectal exam may be done to check the prostate if age and family history dictate. An examination of the penis and testicles will check for erectile dysfunction.

Advanced Erectile Function Tests

Specialized testing is necessary in some cases to guide treatment and re-assess if treatment fails. This might include bloodwork to check male hormones, including testosterone, and measure blood sugar in case of diabetes. Ultrasonography (penile Doppler) might be necessary to check blood flow, or a shot with a vascular stimulant might be administered to the penis to cause an erection.


How Can ED Be Treated?


Non-invasive treatments are the first course of action. Prescription drugs should only be changed or halted under the supervision of a qualified doctor. Risk factors would be highlighted to the patient, and lifestyle changes might be recommended. It may also be suggested that the patient start treating emotional problems.


Your physician may recommend the following solutions to help alleviate ED symptoms:


      Vacuum erection device: The penis is inserted into the plastic tube of a vacuum erection device, a low-pressure vacuum around the erectile tissue brings about an erection, and a plastic ring is placed at the base of the penis holding blood in the penis, to keep it firm for up to half an hour.


      Testosterone: This hormone is administered where poor sex drive and low testosterone levels are detected. This therapy may be combined with oral drugs known as phosphodiesterase type-5 inhibitors.


      Phosphodiesterase type-5 (PDE5) inhibitors. These drugs are prescribed for ED if there is normal nerve function in the penis. The pills are ingested an hour or two before sex to increase blood flow for improved erectile responses.


      Examples of PDE5 inhibitors are Sildenafil (brand name: Viagra), tadalafil (brand name Cialis), and vardenafil (brand name Levitra). PDE5 inhibitors are NOT compatible with nitroglycerin or any other nitrates a patient might be taking for chest pain. Ordinarily, the side effects of these drugs are mild, lasting only a short while. They include headaches, indigestion, flushing (face and upper body turning red and warm), stuffy nose, and muscle aches.  Rarely, Viagra might briefly cause blueish shading of the vision and Cialis can cause muscle aches in the back. These effects are due to the effects of the drugs on other vascular tissues in the body.


      Self-injection therapy: Men who don't respond to oral PDE5 inhibitors can try intracavernosal injection (ICI therapy). A professional should give the first shot of ICI Alprostadil to demonstrate how the fine needle is injected into the side of the penis during ICI therapy.


      Intra-Urethral (IU therapy): This treatment involves a tiny suppository of Alprostadil, a synthetic version of prostaglandin E. being inserted into the urethra. This may not work as effectively as ICI, but patients do not have to inject themselves. In the instance of the Alprostadil treatments described above, men with priapism (erections lasting more than two to four hours) should seek Emergency Room care. Failure to undo this painful condition could lead to permanent penile damage.


      Surgical intervention: The chief means of surgical treatment for ED involves having a penile prosthesis or implant inserted.


There are two types of implants:


    The flexible implant consists of two malleable rods inside the penis shaft. The penis can be manipulated upwards to enable penetration.


    The inflatable implant consists of fluid-filled cylinders. Tubing joins these to a pump placed between the testicles inside the scrotum. When engaged, pressure in the cylinders inflates the penis.


Since penile vascular surgery is not an option for older men who have not enjoyed successful treatment with PDE5 inhibitors, ICI, or IU therapies, an implant like this is the logical next step.



Erectile Dysfunction Treatment Available In Easton, Pennsylvania


ED may be uncharted territory, but it needn't be scary. A group of specialized physicians started physician Promise to make healthcare seamless for our patients. The Physician Promise Community is a virtual destination where physicians, pharmacists, nutritionists, and fitness coaches share their expert knowledge and experiences. Regardless of your health issue or concern, we welcome you to Physician Promise. We offer free virtual visits and free delivery when your prescription medication is mailed to your home. If you'd like more information on our services, schedule a virtual visit or contact us today!

Learn about the basics of low testosterone and erectile dysfunction (ED), including causes and treatments!

ED may be an early indicator of cardiovascular disease. Evaluating your cardiovascular health regularly is important to ensure your heart stays healthy and happy.