Erectile DysFunction

Erectile dysfunction (ED) is the inability to achieve or maintain an erection firm enough for sexual intercourse. It is a common condition, especially in men over 40 years old, but it can affect men of all ages. Occasional trouble with erections is normal, but frequent or persistent ED may indicate an underlying health issue that requires treatment.

​

ED medications are used to:

• Improve blood flow to the penis

• Help achieve and maintain erections

• Boost sexual performance and confidence

ED can be caused by physical, psychological, or lifestyle factors, including:

​

• Physical causes:

  • Poor blood circulation: Conditions like atherosclerosis, high blood pressure, or heart disease restrict blood flow to the penis.

  • Diabetes: Damages blood vessels and nerves, affecting erections.

  • Hormonal imbalances: Low testosterone or thyroid issues can cause ED.

  • Obesity: Excess weight affects circulation and hormone levels.

  • Medications: Certain drugs (e.g., antidepressants, blood pressure medications) can cause ED as a side effect.

  • Injury or surgery: Pelvic or spinal cord injuries can affect erectile function.

​

• Psychological causes:

  • Stress and anxiety: Performance anxiety or chronic stress can impact sexual performance.

  • Depression: Low libido and ED are common symptoms of depression.

  • Relationship problems: Emotional disconnect or unresolved conflicts can reduce sexual desire.

​

• Lifestyle factors:

  • Smoking and alcohol consumption: Damages blood vessels and reduces blood flow.

  • Lack of exercise: Decreases circulation and leads to obesity, contributing to ED.

  • Poor diet: A diet high in processed foods and sugar can affect vascular health.

ED may be a symptom of underlying health issues, such as:

• Cardiovascular disease: ED can be an early warning sign of heart problems.

• Diabetes: Reduces blood flow and nerve function, increasing ED risk.

• Hypertension: Damages blood vessels, limiting penile blood flow.

• Depression and anxiety disorders: Cause low libido and sexual performance issues.

• Obesity and metabolic syndrome: Impair vascular health, reducing erectile function.

• Prostate problems: Prostate surgery or conditions like prostatitis can contribute to ED.

Common signs and symptoms of ED include:

• Difficulty achieving an erection: Even with sexual arousal.

• Trouble maintaining an erection: Erections may be brief or inconsistent.

• Reduced sexual desire: Low libido or lack of interest in sex.

• Emotional distress: Anxiety, frustration, or embarrassment related to sexual performance.

ED medications improve blood flow or enhance sexual function. The most common types include:

​

1. Phosphodiesterase-5 (PDE5) Inhibitors

PDE5 inhibitors are the most common ED medications. They increase blood flow to the penis by relaxing blood vessels, helping achieve and maintain an erection.

• Common PDE5 Inhibitors:

• Sildenafil (Viagra)

  • Onset: 30-60 minutes

  • Lasts: 4-6 hours

• Tadalafil (Cialis)

  • Onset: 30 minutes

  • Lasts: Up to 36 hours (weekend pill)

• Vardenafil (Levitra, Staxyn)

  • Onset: 30-60 minutes

  • Lasts: 4-5 hours

• Avanafil (Stendra)

  • Onset: 15-30 minutes

  • Lasts: 6-8 hours

• How They Work:

  • Block PDE5 enzyme → increases nitric oxide levels → improves blood flow to the penis

  • Requires sexual stimulation to be effective

• Side Effects:

  • Headache or dizziness

  • Flushing or nasal congestion

  • Indigestion or upset stomach

  • Back pain or muscle aches (with Tadalafil)

  • Vision changes (rare with Sildenafil)

​

2. Alprostadil (Caverject, MUSE)

• Purpose: Used when PDE5 inhibitors are ineffective

• Form: Injectable or urethral suppository

• How It Works:

  • Increases blood flow by relaxing smooth muscle in the penis

  • Causes an immediate erection without sexual stimulation

• Side Effects:

  • Pain at the injection site

  • Prolonged erection (priapism)

  • Mild bleeding or bruising

​

3. Testosterone Replacement Therapy (TRT)

• Purpose: For men with low testosterone levels causing ED

• Forms: Injections, gels, or patches

• How It Works:

  • Restores testosterone levels, improving libido and erectile function

• Side Effects:

  • Acne or oily skin

  • Fluid retention

  • Breast enlargement (gynecomastia)

  • Sleep apnea worsening

​

4. Vacuum Erection Devices (VEDs)

• Purpose: Non-drug option for ED

• How It Works:

  • Uses vacuum pressure to draw blood into the penis

  • Maintains erection with a rubber ring around the base

• Side Effects:

  • Numbness or bruising

  • Weak ejaculation

While generally safe, ED medications can cause side effects, including:

• Headache or facial flushing

• Nasal congestion or runny nose

• Upset stomach or indigestion

• Back pain or muscle aches

• Vision changes (rare with PDE5 inhibitors)

• Prolonged erection (priapism) → medical emergency

• Low blood pressure (especially with nitrate use)

To diagnose ED, a doctor may:

• Conduct a physical exam: Check for signs of heart disease, diabetes, or nerve issues.

• Blood tests: Measure testosterone, cholesterol, and glucose levels.

• Urine tests: Identify diabetes or other underlying conditions.

• Ultrasound: Assess blood flow to the penis.

• Psychological evaluation: Screen for anxiety, depression, or stress.

You can reduce your risk of ED by making healthy lifestyle changes, such as:

• Exercise regularly: Improves blood flow and cardiovascular health.

• Maintain a healthy weight: Reduces the risk of diabetes and heart disease.

• Limit alcohol and avoid smoking: Both impair blood flow and erectile function.

• Manage stress and mental health: Practice relaxation techniques.

• Follow a balanced diet: Prioritize fruits, vegetables, lean proteins, and whole grains.

• Stay hydrated: Dehydration can reduce circulation and affect erections.

1. How quickly do ED medications work?

• PDE5 inhibitors like Viagra and Cialis typically work within 30-60 minutes.

• Avanafil works faster (15-30 minutes).

2. Can I take ED medications with food?

• Sildenafil and vardenafil may be less effective with a high-fat meal.

• Tadalafil and avanafil are not affected by food.

3. Are ED medications safe with heart disease?

• Consult your doctor first, especially if taking nitrates, as they can cause dangerous blood pressure drops.

4. Do ED medications affect fertility?

• No, they do not impact sperm quality or fertility.

5. Can lifestyle changes alone reverse ED?

• In mild cases, weight loss, exercise, and stress reduction can improve ED without medications.