Erectile Dysfunction

Also called: impotence

Erectile dysfunction (ED) is the inability of a man to get and keep an erection firm enough to have sex.

Causes

Many men have erection problems from time to time. The brain, male hormones, sexual interest and healthy nerves and blood vessels that supply the penis are all needed for an erection to occur. Anything that interferes with these normal processes can cause erection problems.

Cancer treatments

Some cancer treatments can cause damage to the pelvic nerves, pelvic blood vessels or changes in hormone levels and cause erectile dysfunction.

• Some pelvic surgeries can damage the nerves needed for an erection.
  • prostatectomy for prostate cancer
  • abdominoperineal resection for rectal cancer
  • radical cystectomy for bladder cancer
• Men will not be able to have an erection and sexual intercourse when the entire penis is surgically removed (called a total penectomy) to treat penile cancer. A man may still be able to have an erection if only a portion of their penis is removed (called partial penectomy).
• Radiation therapy to the pelvic area may damage blood vessels that supply the penis and also cause nerve damage. This is often related to the dose of radiation used. The pelvic area may be radiated for:
  • prostate cancer
  • rectal cancer
  • bladder cancer
• Some hormonal therapies for prostate cancer will decrease normal levels of hormones, such as testosterone.
• A stem cell transplant may cause a loss of sexual desire and ED to occur because of graft-versus-host disease (GVHD) or nerve damage from chemotherapy.

Other factors

There are many other factors that can also cause erection problems. Some of these include:

• older age - tends to become more common as a man ages
• circulation or heart problems
• high blood pressure
• neurologic problems
• diabetes
• injury to the spinal cord
• smoking
• alcohol use
• medications such as blood pressure drugs, heart medications, sleeping pills or antidepressants
• emotional distress
  • anxiety – if a man is able to get an erection when they wake up or by masturbating, they may be "trying too hard" when they are with a partner
  • depression

Sometimes ED can be temporary and in other cases, it may be permanent. If the ED is an effect caused by cancer treatment, often the younger a man is, the more likely he is to regain erectile function. Men under 60, and especially those under 50, have much higher recovery rates than older men.

Men can still have pleasure with an orgasm and be fertile with ED.

Symptoms

The man may be not be able to get an erection at all or may lose the erection during sex.

Diagnosis

ED may be diagnosed by doing:

• a physical examination, which may include:
  • a neurological examination
  • checking circulation
  • a rectal and genital examination
• a personal health history, including questions about:
  • sexual function before cancer treatment
  • other medical conditions
  • medications

Prevention

It may be possible to spare the nerves during surgery (nerve-sparing surgery) in some men, depending on their cancer and the type or extent of surgery needed to treat it.

Treatment

Treatment depends on the cause of ED and certain treatments may be better for some men.

Many men find they can have pleasure without erections or sex. They may explore other ways of sexually satisfying their partner and themselves. Some men and their partners find it helpful to talk to a  professional who is comfortable discussing sex issues and can give them information or counselling. There are several types of treatment available for ED. Most of the available treatments need a prescription from a doctor. Each treatment has side effects and should be used as directed. Some of the most common treatments include:

Pills

Pills may be used for mild to moderate erection problems. These drugs enhance an erection and cause more blood flow into the penis. They are taken about an hour before sex and an erection may last up to one hour or longer. Some of these pills should not be used at the same time as certain other medications, such as nitrates, commonly used to treat a heart condition called angina.

• sildenafil (Viagra)
• tadalafil (Cialis)
• vardenafil (Levitra)

Injections and suppositories

Drugs such as alprostadil improve the blood flow to the penis by causing blood vessels to widen (dilate). They keep blood in the penis for awhile and produce an erection. The erection occurs fairly soon after the injection of the drug and may last for 30 to 90 minutes. Sometimes there are limits to the number of times the medication can be used in a week. Alprostadil may be given as:

• Medicated Urethral System for Erection (MUSE)
  • a small gel pellet (suppository) is put into the urethra with a special plunger
• Caverject
  • a small needle is used to inject the drug into the side of the penis

Vacuum devices

Men who are not able to use medications may think about using a vacuum erection device. These devices can increase blood flow by drawing blood into the penis. Erections may be maintained for up to 30 minutes.

• A hollow tube is placed around the penis and the vacuum is applied.
• Once the man gets the erection, he puts an elastic band or ring around the base of the penis to keep the blood in the penis and maintain the erection.

Penile implant

Also called: penile prostheses

A penile implant is a device that is put into the penis to help it become erect by doing surgery. There are a few different types:

• semi-rigid
  • Two bendable rods are put in the penis.
  • They are firm enough to allow sex, but leave the man with a permanent erection.
• inflatable
  • Can be semi-inflatable or fully inflatable.
  • Two hollow rods (cylinders) are put in the shaft of the penis.
  • A small balloon-like container (reservoir), which is filled with fluid, is put in the lower abdomen and a small pump is implanted either at the head of the penis or in the scrotum.
  • Squeezing the pump moves the fluid from the container to the rods in the penis and causes the penis to become hard.
  • The rods are deflated after sex and the penis becomes soft again.

Dildos or vibrators

Some men may choose to use a dildo or vibrator to satisfy their partners. A strap-on dildo has a harness usually worn around the waist that connects the dildo (which resembles a penis) to the wearer's body. This allows the wearer to go through the hip movements of having sex.