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Erectile Dysfunction (ED): Causes and Treatment

Erectile dysfunction (ED) is increasingly becoming common. At Advanced Urology Institute, we are seeing more and more young men presenting with the problem. 

Having an occasional erectile dysfunction shouldn’t be a problem. In fact, almost all men have ED at one point or another in their lifetime. But frequently having ED is a serious problem that may point to a bigger underlying condition and may result in relationship and self-esteem problems.

What are the cases of erectile dysfunction?

In most cases, multiple co-existing factors combine to cause erectile dysfunction. The underlying cause of erectile dysfunction may be one or a combination of vascular, neurological, psychological, drug, hormonal, or medical conditions.

The causes of erectile dysfunction include:

  1. Psychological problems like:
  2. Anxiety
  3. Stress
  4. Depression
  5. Post-traumatic stress disorder (PTSD)
  6. Relationship challenges
  7. Sleep disorders

If you’re having erectile dysfunction due to psychological problems, your urologist may recommend talk therapy. Your therapist will schedule various sessions to discuss with you:

  1. Your feelings around sex
  2. Major anxiety of stress factors
  3. Any subconscious conflicts that could be hurting your sexual well-being

And if the ED is affecting your relationship, you may be referred to a relationship counselor. Relationship counseling can help you and your partner reconnect emotionally, which in turn helps the ED

  1. Hormonal problems 
  2. Low testosterone
  3. Hormonal imbalance
  4. Medications that treat certain medical conditions
  5. Antihistamines
  6. Antidepressants
  7. Anti-hypertensives (high blood pressure drugs)
  8. Diuretics (pills given to boost urine flow)
  9. Anti-arrhythmics (drugs for irregular heart action)
  10. Anti-seizure medications
  11. Prostate cancer drugs
  12. Chemotherapy drugs
  13. Non-steroidal anti-inflammatory drugs
  14. Muscle relaxants
  15. Histamine H2-receptor antagonists
  16. Tranquilizers
  17. Parkinson’s disease drugs
  18. Recreational and frequently abused substances
  19. Opiates
  20. Nicotine
  21. Too much alcohol
  22. Methadone
  23. Marijuana
  24. Cocaine
  25. Barbiturates
  26. Amphetamines
  27. Medical conditions
  28. Cardiovascular disease
  29. Hypertension
  30. Diabetes
  31. High cholesterol
  32. Obesity
  33. Peyronie’s disease, which leads to scar tissue development in the penis
  34. Multiple sclerosis
  35. Injury or surgery that damages the pelvic area
  36. Parkinson’s disease

How is erectile dysfunction treated?

Because ED can be caused by one or by several factors, it is important to have an open conversation with your urologist so that any underlying conditions are ruled out or treated. Your doctor will perform a physical examination, take your medical and sexual history, and order a number of tests to establish whether your symptoms are caused by an underlying condition.

At Advanced Urology Institute, we have a clinic that is dedicated to men with erectile dysfunction. So we are able to spend enough time with patients, go through their medical history, consider different medical conditions, and finally figure out the underlying causes of their ED.

Once we are sure about the factors behind an erectile dysfunction, we begin treatment, but usually start from non-invasive options and go up the ladder to more invasive treatments. Typically, we start with physical therapy, recommending various exercises to build the tone and strength of muscles involved in maintaining an erection. 

From our experience, well-tailored Kegel exercises performed two times a day can rebuild the pelvic floor and help make erections more rigid. Alongside the exercises, we may recommend therapy with a trained counselor to help address feelings of anxiety, guilt, or fear that may have an impact on sexual function.

The next step is to try non-invasive treatment, usually medication.  We start by giving phosphodiesterase type-5 inhibitors, such as sildenafil (Viagra), tadalafil (Cialis), avanafil (Stendra), or vardenafil (Levitra, Staxyn). These oral pills increase blood flow to the penis and ensure an erection.

Alprostadil (Caverject, Edex, MUSE) is another medication that we may recommend. It can be used as a penile suppository or as a self-injection at the side or base of the penis. And in most cases, the drug isn’t used alone as an injection, but in combination with papaverine and phentolamine.

When your erectile dysfunction is associated with low testosterone, we may recommend testosterone replacement therapy (TRT). Testosterone replacement is done in the form of topical gels, patches, creams, pellets, or injections.

Another option is the vacuum pump, which relies on the creation of a vacuum to stimulate an erection. When such a pump is used, it draws blood to the penis, resulting in an erection. An elastic ring is applied to maintain the erection by holding the blood in the penis and stopping it from returning to circulation.

In cases where the above options are ineffective or inappropriate, the urologist may recommend surgery to place an implant or to correct a vascular problem. With the use of an implant, also called prosthesis, there are two options: inflatable and malleable. 

An inflatable implant comes with a pump that is used to make the penis larger, while a malleable implant allows for manual adjustment of the position of the penis.

Vascular surgery is rare, but helps to repair blocked arteries. It is reserved for erectile dysfunction caused by trauma that results in vascular injury. Younger people are typically good candidates for the procedure.

Safe, effective ED treatment

Are you struggling with erectile dysfunction? At Advanced Urology Institute, we have a team of skilled urologists with a rich experience and a track record of successfully diagnosing and treating ED. 

We resolve your ED by ensuring you have an open, candid conversation with an experienced urologist. This helps us to identify the underlying problem, and then to develop a tailored treatment that addresses all the specific factors involved in your ED.

For more information on the causes, diagnosis and treatment of erectile dysfunction, visit the site “Advanced Urology Institute.”

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Advanced Urology Institute

Advanced Urology Institute is the largest urology practice in Florida. We are dedicated to improving the lives of our patients by providing excellent Patient-Centered Care. Set an appointment or visit our closest office near you.

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