We might think of erection problems (erectile dysfunction) as something only older men experience. While it is true that it is more likely to happen with increasing age, not being able to get or keep an erection can affect men at any age. The condition can be simple to treat.
Being able to get an erection is often taken for granted and can be closely linked with how a man perceives himself, being part of their identity. When erection issues then arise, it can result in reduced confidence and self-esteem affecting how a man thinks about himself as a father, husband and in some cases, even at work. Issues with sexual performance can cause relationship problems too as men pull away emotionally from a partner, fearing that they cannot live up to expectations.
Causes of Erection Problems
Most men can experience trouble getting an erection when they are stressed, anxious, tired, or if they have drunk too much alcohol. These situations tend to remedy themselves without treatment and are not necessarily causes for concern.
Other causes can be subtle, while some are more serious and will need further medical investigation. Physical causes of erectile issues can include:
- High blood pressure
- Heart disease
- High cholesterol
- Neurological conditions such as epilepsy, stroke, multiple sclerosis, or Parkinson’s disease
- Prostate problems, the most common being: enlarged prostate, prostate cancer, prostatitis
- Hormone problems, such as low testosterone
The actual medical treatments for these conditions can in some cases affect erectile function too. A conversation about this with a specialist or your doctor might prove very helpful.
There are, of course, certain emotional and lifestyle factors that can affect sexual performance too, some of which include:
Psychological or emotional factors:
- Depression or feeling low
- Relationship issues
- Stress at home or at work
- Stress from social, cultural or religious conflicts
- Worry about sexual performance
- Drinking too much
- Some recreational drugs
- Being overweight
In this article, we will be looking at the medical treatment of erectile dysfunction.
Treatment of Erection Problems
Apart from living a healthy lifestyle and practicing self-care (which will be addressed in another article), there are a number of other treatments available:
Testosterone¹: Some medications can cause a drop in testosterone, the hormone that is thought to regulate a man’s sex drive. Occasionally this drop can have more natural causes; either way, a doctor or specialist can prescribe the hormone in pill format.
Tablets¹,²: You might have heard of Viagra but there are other similar types of drugs available too. These all belong to a group of drugs called PDE5 inhibitors (phosphodiesterase type 5 inhibitors) and include:
- Sildenafil (Viagra)
- Tadalafil (Adcirca, Cialis)
- Vardenafil (Levitra, Staxyn)
- Avanafil (Stendra)
PDE5 inhibitors will enhance the effect of nitric oxide (Mayo Clinic³). Nitric oxide is a chemical the body produces naturally which relaxes the muscles in the penis making it easier for the blood to flow into this area. Please note that PDE5 inhibitors will not help you get psychologically or emotionally sexually aroused, which is a major factor in physical arousal and sexual satisfaction. In other words, you need to want and enjoy sexual stimulation for this medication to work.
Sildenafil, avanafil, and vardenafil can be taken when needed and will be effective for up to six hours. Tadalafil can work for up to 36 hours, providing the opportunity for intimacy to become more spontaneous. Note that these will only produce an erection with physical stimulation or psychological arousal.
Before taking any medication for erection problems, do talk with your doctor. There are some dangers if these are taken with certain other medications or if some medical conditions are present. Specifically, but not exclusively:
- Combined with nitrate drugs — commonly prescribed for chest pain (angina)
- Heart disease or heart failure
- Very low blood pressure (hypotension)
Injections¹,³: Injections in the side of the penis might seem extreme, perhaps off-putting and even painful, but many men find this method helpful and report that it doesn’t hurt. There are two drugs that can be used in this way:
- Alprostadil (Caverject®, Caverject® Dual Chamber, Viridal Duo®)
- Aviptadil with phentolamine mesilate (Invicorp®)
These drugs work similarly to the PDE5 inhibitors, by relaxing the muscles and blood vessels, allowing the blood to flow and an erection to occur. If this method is prescribed, the nurse or doctor will demonstrate how to inject the side of the penis using a very thin needle.
Once the penis is filled with blood, which usually happens within 10 minutes, the erection is likely to last up to an hour.
Pellets or cream¹,³: Alprostadil can be acquired in the form of a small pellet, called MUSE®, or as a cream called Vitaros®. Though they are said to not work as well as the injection, it may be an option if for any reason injections are out of the question.
The pellet or cream is inserted with an applicator into the opening of the penis. Inserting the pellets becomes easier when the opening is already moist, so is it worth urinating before attempting insertion. These usually work within 10 minutes and can last for up to an hour.
The cream, itself moisturising, may be a little easier to insert and some can also be used to massage into the penis to help absorb the drug better. Bear in mind that it does take a little longer for this method to work.
Vacuum pump¹,³: The instrument of a vacuum pump could seem a little medieval, but for some men, this works really quite well.
A vacuum pump consists of a manual or battery-operated pump and a plastic cylinder. This is used to create a vacuum around the penis, enabling the blood to be pulled into the penis, resulting in an erection.
Once you have an erection, the constriction ring which sits at the end of the cylinder is slipped around the base of the penis to stop the blood from flowing back into the body. This ring should not be worn for longer than 30 minutes at a time.
Implants¹: This could be the solution if no other treatment has worked. It involves having an operation to insert implants into the penis. The two possible options are:
- Semi-rigid rods that keep your penis consistently fairly firm but allow it to be bent down when you don’t want an erection.
- An inflatable implant in the penis and a pump in your scrotum (the skin around testicles). When you squeeze the pump the implant fills with fluid (saline) to make the penis hard. Your erection will last for as long as the implant is inflated, and you can deflate it when you want to.
If you are experiencing any other health issues, one or more of these issues may be the cause of erectile dysfunction. Some men are reluctant to seek their doctor’s help when something physical isn’t feeling right. The importance, however, of getting the appropriate medical advice cannot be emphasised enough. The earlier that some conditions are detected, the sooner treatment can start and the associated risks minimised.
For example, the symptoms of prostate cancer are⁴:
- Needing to pee more frequently, often during the night
- Needing to rush to the toilet
- Difficulty in starting to pee (hesitancy)
- Straining or taking a long time while peeing
- Weak flow
- Feeling that your bladder has not emptied fully
- Blood in urine or blood in semen
These symptoms need investigating as soon as possible. Prostate cancer kills 12,000 men each year in the UK alone¹; in the US this figure is 34,130⁵. Some of these deaths could be avoided with earlier detection. Don’t become part of this statistic!
If taking medication for erectile dysfunction while also taking medication for another condition, do make sure you seek advice from your doctor first. Some combinations of medication can be dangerous.
Of course, using methods such as those above will only work on a physical level. Emotional and psychological issues can have distressing effects on your sex life too and can influence your ability to have an erection or your enjoyment of physical intimacy. For these issues, it is always best to seek the help of a qualified and licensed (US) or registered (UK) therapist with experience of working with these specific issues.