Emotions and feelings play a big role in ED. If your ED is caused by emotional or mental stress, talking to a counselor may help.
To diagnose erectile dysfunction, your doctor will do a physical exam and ask questions about your symptoms. You might need blood tests or imaging tests like ultrasound.
Oral Medication
For many men, prescription oral medications are the first treatment option for erectile dysfunction. These drugs, called PDE5 inhibitors, work by increasing the effects of nitric oxide, which helps increase blood flow to the penis during arousal. These medications — which include sildenafil oral jelly — can be taken 30 to 60 minutes before sexual activity. Some men taking these medications experience uncomfortable side effects, such as flushing of the face, vision changes, and upset stomach. Taking the pills at a different time or with food may relieve these.
Some doctors also prescribe a pill that can be inserted into the tip of the penis (alprostadil, or MUSE). This FDA-approved medication triggers an erection in about 10 minutes and can last up to an hour. This medication is often prescribed when a patient cannot take oral medications or if the medication does not produce an erection.
Your doctor will do a physical exam and ask you questions about your health and lifestyle. They may order blood tests or a urine test to check for underlying health conditions, such as diabetes or low testosterone levels. Your doctor might also do a psychological exam to screen for depression or anxiety, which can cause erectile problems in some men. If needed, your doctor will refer you to a specialist.
Intraurethral Medication
For some men who don’t respond to oral medication, a urologist can inject medications directly into the penis to help achieve an erection during sexual activity. Your NYU Langone doctor will give you a trial injection in the office to find out the right dosage for you, then supply you with vials and syringes so you can self-inject at home. Injections increase blood flow to the spongy tissue of the penis (called the corpora cavernosa), causing an erection. Side effects can include an aching sensation in the penis, a dry mouth or throat, and a feeling of pressure in the pelvis or abdomen.
These pills — known by brand names like Viagra, Cialis, Stendra, and Levitra — work by enhancing the effects of nitric oxide, a natural chemical your body produces to increase blood flow during arousal. These medicines should not be taken with nitrates, which also widen or open up the arteries to the heart, because they can cause a dangerous drop in blood pressure.
Some erectile dysfunction is caused by emotional problems, including relationship conflicts, depression, or anxiety about performance (performance anxiety). Therapy that focuses on removing these obstacles can improve a man’s ability to get and keep an erection during sexual activity.
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Penile Self-Injections
A doctor can prescribe a medication that you inject into your penis to treat your erectile dysfunction. These medications work by widening blood vessels to increase blood flow to the head (glans) of the penis and help achieve an erection. Your doctor may recommend a specific site on your penis to inject the medication. You must change injection sites from left to right and up and down the penis, to avoid developing scar tissue at a particular site.
Wipe the area where you will inject the medication with an alcohol swab. Pull the head of the penis straight out in front of you and choose an injection spot. It is best to inject on the sides of the shaft, away from the top where there are blood vessels, and the bottom of the penis where the urethra is located.
Position the syringe in your hand like you are about to throw a dart. Remove the cap from the syringe and check to make sure that you have the correct dose of medication and no air bubbles in the syringe.
Push down on the plunger and draw up the correct dose of medication into the syringe. With your other hand, grasp the head of the penis with the index and middle fingers and move it up and down to stretch the skin until it is taut. Position the needle at a 90-degree angle against the penis and insert it, gently but firmly. Once the needle has entered your body, you should feel a little resistance or a “give” and a distinct penetration into the tunica albuginea.
Surgery
For many people, a physical exam and answering questions about medical history is all that’s needed for your doctor to diagnose erectile dysfunction (ED) and recommend treatment. If you have chronic health conditions, your doctor may also order blood tests to check for heart disease, diabetes, and low testosterone levels that might be causing ED.
If a medication isn’t helping you, your doctor might recommend penile surgery. There are two main types of surgery for ED: repairing the blood vessels in the penis or inserting a pair of penile implants. The implants can be inflatable or malleable rods that bend, but neither type of implant affects penile length or width. Penile implants are most commonly used after other ED treatments fail, and they have the highest rate of patient satisfaction among ED treatment options.
Before you have a medical exam, prepare by writing down all your symptoms, and any other symptoms or signs that might be related to your erectile problems. Write down your personal and family health history, and make a list of all medications, vitamins, herbal remedies, and supplements you take. It’s important to include information about any recent stressors or lifestyle changes. Your doctor may ask yaou to fill out a questionnaire that rates your ability to get and keep an erection and your satisfaction with sex. Read More…
