Erectile dysfunction is common among men, especially those who are facing “performance anxiety” when having to perform on demand the exact moment ovulation occurs. In this article, Dr. Sun discusses ED and treatment options.

 

By Dr. Andrew Sun

What is Erectile Dysfunction (ED)

Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection.  Many people assume that ED only affects older men, but this is not true! ED is far more common than most people realize, affecting as many as 30% of men under age 40. Many things can affect a man’s erections, including psychological stress, hormonal abnormalities, medical conditions such as diabetes or high blood pressure, nerve damage, and more. ED is often a source of significant psychological distress for men—they can struggle with feelings of frustration, inadequacy, low self esteem, and depression. Partners of these men often also feel the emotional strain of this condition.

How ED relates to fertility

It’s not hard (no pun intended) to imagine how erectile dysfunction can be a barrier to fertility for many couples. After all, sperm must be delivered to the egg in order to make a baby! Oftentimes, erectile dysfunction will arise due to the “performance anxiety” associated with timed intercourse during ovulation. Fortunately a variety of treatment options exist.

Lifestyle modification

Many of us who specialize in the field of sexual medicine look at the penis as a window into a man’s health. Because an erection requires a perfect interplay between hormones, blood vessels, and nerves, things which affect these vital body systems often will manifest themselves in the form of erectile dysfunction. Accordingly, improvements in diet, exercise, sleep, and weight loss can all play a crucial role in restoring a man’s erections. The first step in addressing ED is to examine these lifestyle factors and find areas which can be targeted for improvement. Thirty minutes of aerobic (cardio) exercise a day can significantly improve erectile function. Many of the same things can also negatively impact sperm counts, so you’re getting a 2-for-1 deal with lifestyle improvement!

Phosphodiesterase 5 Inhibitors (PD5is) (Viagra/Cialis/Levitra/Stendra)

 Viagra, the “little blue pill,” revolutionized the field of erectile dysfunction when it was released in 1998, and remains one of the most popular medications prescribed for erectile dysfunction today.  Viagra is one of 4 medications in the class known as Phosphodiesterase 5 inhibitors—all of which act on the same biochemical pathway to promote blood flow to the penis by generating a molecule called Nitric Oxide. Cialis is probably the second most commonly prescribed drug and can be taken as a low-dose daily pill, which allows for more spontaniety with sex. Levitra and Stendra also have advantages and disadvantages when it comes to side effect profile, and some patients may prefer one over another. There have been a few small studies which have shown that PDE5is may actually increase sperm motility! The intricacies between the different options are worth discussing with a urologist to find the best option for each individual patient.

L-Citrulline / L-Arginine

These are two naturally occurring amino acids, widely available as an over-the-counter supplement. These amino acids can help promote nitric oxide formation, the key molecule used to generate an erection. Patients looking for a natural, non-prescription supplement may benefit from these. Many men also find L-citrulline in particular to be an effective workout supplement, and some studies have found improved workout tolerance and reduced muscle.

Vacuum Erection Device (VED)

Of Austin Powers fame, VEDs come in all shapes and sizes, from simple manual pumps to fancy electronic versions. By generating negative pressure in a chamber, it pulls blood into the penis, creating an erection. Often these are paired with a penile constriction ring to keep the blood in after using the pump. Men looking for a non-medication based solution may prefer to give this a try. Many sexual medicine experts will also utilize VEDs to prevent scarring of the penis (called corporal fibrosis) in patients with longstanding erectile dysfunction.

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Intracavernosal Injections (ICI)

A longstanding treatment for ED that dates back to the 1980s, these are injections of medications using a tiny needle directly into the side of the penis to generate an erection. Men looking for the most definitive form of medical therapy for erections will often look to ICI. Proper dosing is essential, as taking too much can cause a serious problem called a priapism, when an erection lasts too long and is a medical emergency.  ICI should only be prescribed by a physician with experience in treating men with sexual dysfunction. Of course, there's one big downside - you have to inject the penis with a needle!

Intraurethral Alprostadil

Another direct-to-penis therapy, similar to ICI, this category includes a variety of suppositories, pellets, and gels which are inserted into the urethra and deliver medication directly into the penis to create an erection. We generally find this treatment to be ideal for the man who wants a stronger and more direct medication than Viagra, but does not want to do penile injections.

Low Intensity Shockwave Therapy (LISWT)

A relatively new technology, Low intensity shock wave therapy delivers energy pulses to the penis in an effort to treat erectile dysfunction. This is non-invasive, painless, and quick, which makes it attractive to many men. However, it should be noted that the scientific data on the effectiveness of LISWT is mixed, and therefore still evolving. In Europe, LISWT is recommended for the treatment of mild-to-moderate erectile dysfunction, however here in the United States, it is still considered an experimental therapy for now, until more conclusive research is done.

Penile Prosthesis

The ultimate “cure” for erectile dysfunction, the penile prosthesis implant is the only therapy which can be said to offer 100% effectiveness in generating an erection. This is a mechanical pump placed inside the penis through a minimally invasive surgery which usually takes under an hour. Though it does require surgery, for the right man who is looking for a definitive therapy, or who cannot tolerate or has failed the other therapies listed above, this can be a great option to restore a normal sex life.

Erectile dysfunction is surprisingly more common in young men than most people think. ED can be a significant source of emotional frustration for men and their partners, and present a clear barrier to natural conception. Fortunately, there are a variety of treatments available, including pills, devices, procedures, and even surgery. As with all medical issues, it is best to consult with a urologist or sexual medicine expert to find the optimal treatment for you. The sooner we can restore normal erectile function, the sooner couples can get back to the business of making a baby!

To read more, check out our other articles on Male Fertility.