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Erectile dysfunction (ED) occurs when a man can’t get an erection to have sex or can’t keep an erection long enough to finish having sex. This condition used to be called impotence. ED can occur at any age, but it is more common in men older than 75 years of age.
Is erectile dysfunction just a part of old age?
ED doesn’t have to be a part of getting older. It’s true that as you get older, you may need more stimulation (such as stroking and touching) to get an erection. You might also need more time between erections. But older men should still be able to get an erection and enjoy sex.
Symptoms of erectile dysfunction
The primary symptom of ED is not being able to get or keep an erection in order to have sex.
What causes erectile dysfunction?
Erectile dysfunction can be caused by:
- diabetes (high blood sugar)
- hypertension (high blood pressure)
- atherosclerosis (hardening of the arteries)
- stress, anxiety, or depression
- alcohol and tobacco use
- some prescription medications, such as antidepressants, pain medicine and medicine for high blood pressure
- brain or spinal-cord injuries
- hypogonadism (which leads to lower testosterone levels)
- multiple sclerosis
- Parkinson’s disease
- radiation therapy to the testicles
- some types of prostate or bladder surgery.
If you can’t keep your blood sugar or your blood pressure under control, you can get erectile dysfunction. It’s important that you take your medicines for these problems just the way your doctor tells you.
Sometimes your hormones get out of balance, and this causes erectile dysfunction. Your doctor will decide if you need blood tests to check your hormones. Some medicines can cause erectile dysfunction. If this is true for you, your doctor may take you off that medicine or give you a different one. Drinking too much alcohol, smoking too much, and abusing drugs can also cause erectile dysfunction.
Problems in your relationship with your sexual partner can also cause erectile dysfunction. Improving your relationship may help your sex life. If you decide to seek therapy, it will probably be most effective if your sex partner is included.
Couples can learn new ways to please one another and to show affection. This can reduce anxiety about having erections.
Feelings that can lead to erectile dysfunction include:
- Feeling nervous about sex, perhaps because of a bad experience or because of a previous episode of impotence.
- Feeling stressed, including stress from work or family situations.
- Being troubled by problems in your relationship with your sex partner.
- Feeling depressed.
- Feeling so self-conscious that you can’t enjoy sex.
- Thinking that your partner is reacting negatively to you.
How is erectile dysfunction diagnosed?
ED is usually easy to diagnose. Even if you are tempted to self-diagnose, you should still talk to your doctor. Your doctor will want to make sure that your ED is not a sign of other health problems.
Your doctor will probably start by asking you some questions and doing a physical exam. He or she may test samples of your blood and urine for diseases and disorders. Other tests may also be needed. Your doctor will determine which tests are right for you.
Can erectile dysfunction be prevented or avoided?
Whether you’ll be able to prevent ED depends on what is causing it. Here are some things you can do that may help prevent ED.
- Avoid drinking too much alcohol, smoking, or abusing drugs.
- Before starting a new medicine, ask your doctor if erectile dysfunction is a possible side effect. If it is, you could discuss possible alterative medicines.
- Keep your blood sugar and blood pressure under control.
- Try to avoid feeling stressed.
Erectile dysfunction treatment
The treatment for erectile dysfunction depends on what is causing it. After your doctor checks you for medical problems and medicines that might cause ED, he or she may recommend a medicine to help with it. Sildenafil (brand name: Viagra), tadalfil (brand name: Cialis), and vardenafil (brand name: Levitra) are medicines that are taken by mouth that help maintain an erection.
Not everyone can use these medicines. Your doctor may talk to you about alprostadil if oral medicines aren’t an option for you. Alprostadil is a synthetic version of prostaglandin E. It can be injected into the penis or inserted as a tiny suppository into the urethra (the hole at the end of the penis). Your doctor will help you decide which treatment is best for you.
How should I take ED medications?
Follow your doctor’s instructions. Usually, a man takes 1 tablet 30 minutes to 1 hour before he plans to have sex. Sildenafil works for 4-8 hours; vardenafil works for up to 8 hours; and tadalafil works for up to 36 hours.
You should not take more than 1 dose in 24 hours. Tadalfil and vardenafil come in tablets of 2.5 mg, 5 mg, 10 mg and 20 mg. Sildenafil comes in tablets of 25 mg, 50 mg and 100 mg.
Even if you take the medications, you still need physical and mental stimulation and desire to have an erection. If your first dose doesn’t help, call your doctor. Your doctor may want to change your tablet strength.
What are the side effects?
The side effects of ED medications are mostly the same. Sildenafil and vardenafil can cause these side effects:
- flushing (face and upper body turning red and warm)
- stomach upset
- runny nose (sniffles)
- vision changes (things look blue).
Tadalfil has the same side effects, except for the flushing and possible changes in vision. Instead, it can also cause back pain and muscle aches. For each of the medications, headache is the most common side effect. Vision changes are the least common. Talk to your doctor if you have any side effect that bothers you.
Call your doctor right away if you take one of these medications and have a prolonged erection that lasts 4 hours or longer. This condition may cause permanent impotence if not treated.
Can everyone use ED medications?
No. You shouldn’t use these medicines if you take nitroglycerin or any other nitrates for chest pain. If you have heart problems, tell your doctor before taking any ED medicines. These medicines can have serious side effects in people who have heart problems.
If you use sildenafil, tadalfil, or vardenafil and get chest pains, be sure to tell the paramedics, nurses or doctors at the hospital that you use it and when you used it last.
Living with erectile dysfunction
If the medicines aren’t right for you, you could also try using a penile implant, vacuum pump devices, or you could have surgery. Your doctor may send you to an urologist to talk about these options.
Questions to ask your doctor
- What treatment is best for me?
- How long will I have to take medicine for erectile dysfunction?
- What is the difference between tadalafil (Cialis), vardenafil (Levitra), and sildenafil (Viagra)?
- Which medicine is right for me?
- Are there any lifestyle changes I should make?
- How can I talk with my partner about my problem?
- Is there something I can do other than take medicine to help?
- Are any of my other medicines causing this problem?
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.