What are the treatments for erectile dysfunction?

Treatments for erectile dysfunction include:

Working with doctors to select medications that do not impair erectile function,

Making life style improvements (for example; quitting smoking, and exercising more),

Drugs such as sildenafil (Viagra), vardenafil (Levitra) or tadalafi (Cialis),

Inserting medications into the urethra (intraurethral suppositories),

Injecting medications into the corpora cavernosae (intracavernosal injections),

Vacuum constrictive devices for the penis,

Adjusting medications

Many common medications for treating hypertension, depression, and high blood lipids can contribute to erectile dysfunction (see above). Treatment of hypertension is an example. There are many different types (classes) of anti-hypertensive medications (medications that lower blood pressure); these include beta-blockers, calcium channel blockers, diuretics (medications that increase urine volume), angiotensin converting enzyme inhibitors (ACE inhibitors), and angiotensin receptor blockers (ARBs). Anti-hypertensives may be used alone or in combination(s) to control blood pressure. Different classes of anti-hypertensives have different effects on erectile function. Inderal (a beta blocker) and hydrochlorothiazide (a diuretic) are known to cause erectile dysfunction, while calcium channel blockers and ACE inhibitors do not seem to affect erectile function. On the other hand, angiotensin receptor blockers (ARBs) such as losartan (Cozaar) and valsartan (Diovan), may actually increase sexual appetite, improve sexual performance, and decrease erectile dysfunction. Therefore, choosing an optimal anti-hypertensive combination is an important part of treating erectile dysfunction
Penile prostheses, and Psychotherapy.

Lifestyle improvements

Quitting smoking, exercising regularly, losing excess weight, curtailing excessive alcohol consumption, controlling hypertension, and optimizing blood glucose levels in patients with diabetes are not only important for maintaining good health but also may improve erectile function. Some studies suggest that men who have made lifestyle improvements experience increased rates of success with oral medications.

How is erectile dysfunction diagnosed?

Patient history

A diagnosis of erectile dysfunction is made in men who have repeated inability to achieve and/or maintain an erection for satisfactory sexual performance for at least 3 months. Candid communication between the patient and the doctor is important in establishing the diagnosis of erectile dysfunction, assessing its severity, and determining the cause. During patient interviews, doctors try to answer the following questions:

Is the patient suffering from erectile dysfunction or from loss of libido or a disorder of ejaculation?

Is erectile dysfunction due to psychological or physical factors? Healthy men have involuntary erections in the early morning and during REM sleep(a stage in the sleep cycle with rapid eye movements). Men with psychogenic erectile dysfunction (erectile dysfunction due to psychological factors such as stress and anxiety rather than physical factors) usually maintain these involuntary erections. Men with physical causes of erectile dysfunction (for example; atherosclerosis, smoking, and diabetes) usually do not have these involuntary erections.
Are there physical causes of erectile dysfunction? A prior history of cigarette smoking, heart attacks, strokes, and poor circulation in the extremities suggest atherosclerosis as the cause of the erectile dysfunction. Diminished sensation of the penis and the testicles, bladder dysfunction, and decreased sweating in the lower extremities suggest diabetic nerve damage. Loss of sexual desire and drive, lack of sexual fantasies, gynecomastia (enlargement of breasts), and diminished facial hair suggest low testosterone levels.

Is the patient taking medications that can contribute to erectile dysfunction?

Physical examination

The physical examination can reveal clues for physical causes of erectile dysfunction. For example, if the penis does not respond as expected to touching, a problem in the nervous system may be the cause. Small testicles, lack of facial hair and enlarged breasts can point to hormonal problems such as hypogonadism with low testosterone levels. A reduced flow of blood as a result of atherosclerosis can sometimes be diagnosed by finding diminished arterial pulses in the legs or listening with a stethoscope for bruits (the sound of blood flowing through narrowed arteries). Unusual characteristics of the penis itself could suggest the root of the erectile dysfunction, for example, bending of the penis during erection could be the result of Peyronie's disease.

Laboratory tests

Common laboratory tests to evaluate erectile dysfunction include:

Complete blood counts

Urinalysis: An abnormal urinalysis may be a sign of diabetes mellitus and kidney damage

Lipid profile: High levels of LDL cholesterol (bad cholesterol) in the blood promotes atherosclerosis.

Blood glucose levels: Abnormally high blood glucose levels may be a sign of diabetes mellitus.

Blood Hemoglobin A 1c: Abnormally high levels of blood hemoglobin A 1c in patients with diabetes mellitus establish that there is poor control of blood glucose levels.

Serum creatinine: An abnormal serum creatinine may be the result of kidney damage due to diabetes.

Total testosterone levels: Blood samples for total testosterone levels should be obtained in the early morning (before 8 am) because of wide fluctuations in the testosterone levels throughout the day. A low total testosterone level suggests hypogonadism. Measurement of bio-available testosterone may be a better measurement than total testosterone, especially in obese men and men with liver disease, but measurement of bio-available testosterone is not widely available.

PSA levels: PSA (prostate specific antigen) blood levels and prostate examination to exclude prostate cancer is important before starting testosterone treatment since testosterone can aggravate prostate cancer.