Cognitive behavioral therapy (CBT) is a common and highly effective treatment for psychological issues in general, but also for ED. Facilitated by a therapist, this type of treatment helps you to identify and change unhealthy patterns of thought and action which may be contributing to your erectile issues. This kind of treatment is based on the idea that the situation itself (your inability to achieve or maintain an erection) is not the core problem, but rather your reaction to it. If you can learn to better understand yourself and your thought patterns, you can change them in a positive way to resolve your issues.
As you can imagine, these symptoms can make it difficult to take pleasure in much of anything, let alone sex. A study published in a 1998 edition of Psychosomatic Medicine shows a clear link between depression and erectile dysfunction in men. Using data obtained from the Massachusetts Male Aging Study, researchers were able to conclude that a relationship between depressive symptoms and erectile dysfunction existed and was independent of aging and demographics.
When a man becomes sexually excited, muscles in their penis relax. This relaxation allows for increased blood flow through the penile arteries. This blood fills two chambers inside the penis called the corpora cavernosa. As the chambers fill with blood, the penis grows rigid. Erection ends when the muscles contract and the accumulated blood can flow out through the penile veins.
With that said, the only data we’re going to focus on here are the results of large, nationally representative sex surveys because they offer the best source of information when it comes to trying to establish realistic prevalence rates and how they might have changed over time. Data from convenience samples of college students just aren’t reliable enough for these purposes.
The symptoms of erectile dysfunction include difficulty achieving an erection, trouble maintaining an erection, and a reduced interest in sex. Because male sexual arousal is a fairly complex process, it can sometimes be difficult to identify a specific cause. Arousal starts in the brain but it also involves the nerves, muscles, and blood vessels and can be impacted by hormones and emotions. If a problem develops with any of these things, erectile dysfunction could be the consequence.

In many cases, diagnosing erectile dysfunction requires little more than a physical exam and a review of your symptoms. If your doctor suspects that an underlying health problem may be at play, however, he may request additional testing. Once you’ve determined the cause for your ED, you and your doctor can decide on a form of treatment – here are some of the options:
Though psychological causes of erectile dysfunction may be more complex than medical causes, they are still treatable. You should know, however, that resolving psychological impotence may not be quite as simple as taking Viagra (sildenafil citrate). ED drugs are designed to sidestep the physiological causes for ED such as low blood pressure or vascular damage – they won’t help you with issues of anxiety, stress, or low self-esteem. The best treatment for psychological ED will address the problem at its root.
Yes, the vacuum device is effective. In fact, with use of the vacuum device, 88% of men will have an erection that is satisfactory for completion of sexual activity. The vacuum device may be the only therapy that is effective after the removal of a penile prosthesis. Patients also use vacuum devices as part of penile rehabilitation after radical prostatectomy to help preserve the tissue of the penis and prevent scarring within the penis and loss of penile length. Its use, however, is limited by the mechanical nature of it and the time taken to pump the device and apply the band. Sex partners may complain of the penis being cool to touch.
Getting (and maintaining) an erection requires a surprising amount of things to go right. You have to get aroused, then pass that signal from your brain, through your nerves and hormones, to your blood vessels and muscles before an erection can even happen. If one thing goes wrong in that complicated exchange between your cardiovascular, and nerve system, and your hormone levels, blood vessels, and even your mood the result is usually erectile dysfunction. In other words, getting an erection is hard.

Prostaglandins (alprostadil): Alprostadil can be injected into the penis or inserted as a pellet through the urethra. It causes an erection without sexual stimulation that usually lasts about 60 minutes. The danger with this method is that too high a dose can cause priapism, an erection that won't go away. This condition requires immediate medical attention as it can cause serious bruising, bleeding, pain and permanent penile damage. Once the doctor is sure of the right dose, the man can self-inject at home.
Cardiovascular diseases account for nearly half of all cases of erectile dysfunction in men older than 50 years. Cardiovascular causes include those that affect arteries and veins. Damage to arteries that bring blood flow into the penis may occur from hardening of the arteries (atherosclerosis) or trauma to the pelvis/perineum (for example, pelvic fracture, long-distance bicycle riding).

The number of symptoms reported appeared to be a function of the amount of alcoholic beverage consumed. The chance of developing sexual dysfunctions appears to increase with increasing quantity of alcohol consumed. Higher levels of alcohol intake may result in greater neurotoxic effects. It has been reported that heavy alcohol use may contribute to a reversible vagal neuropathy, which is perhaps reversible on abstinence.[17] However, chronic heavy use of alcohol is also known to significantly alter gonadal hormones.[9]


There have been rare reports of priapism (prolonged and painful erections lasting more than six hours) with the use of PDE5 inhibitors such as sildenafil, vardenafil, and tadalafil. Patients with blood cell diseases such as sickle cell anemia, leukemia, and multiple myeloma have higher than normal risks of developing priapism. Untreated priapism can cause injury to the penis and lead to permanent impotence. Therefore, if your erection lasts four hours, you should seek emergency medical care.
When blood sugar levels are out of control, nerve and blood vessel damage occurs throughout your body. Nerve damage breaks down the ability to turn sexual stimulation into an erection.6 Poor blood circulation reduces blood flow to the penis. Together they impact your ability to get an erection that is rigid and lasts long enough for sexual satisfaction.
Alcohol abuse is the leading cause of impotence and other disturbances in sexual dysfunction.[3] Episodic erectile failure in alcoholic men is fairly routine, found to be significantly higher in men consuming more than three standard units of alcohol (12 g ethanol) daily and in subjects smoking more than 10 cigarettes/day.[4] Van Thiel and Lester[5] reported that 61% of patients dependent on alcohol reported sexual dysfunction, the most common being erectile dysfunction followed by reduced sexual desire. Erectile dysfunction and reduced sexual desire were frequently seen to be coexisting.[6–9] Vijayasenan,[10] found that of 97 male inpatients admitted for the treatment of alcoholism, 71% suffered from sexual dysfunction for a period of more than 12 months prior to admission to a hospital. The disturbances noted were diminished sexual desire (58%), ejaculatory incompetence (22%), erectile impotence (16%) and premature ejaculation (4%). Virtually all aspects of the human sexual response are affected by alcohol especially sexual desire and erection.[11]

Acupuncture may help treat psychological ED, though studies are limited and inconclusive. You’ll likely need several appointments before you begin to notice any improvements. When choosing an acupuncturist, look for a certified practitioner who uses disposable needles and follows U.S. Food and Drug Administration guidelines for needle disposal and sterilization.
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Infection is a concern after placement of a prosthesis and is a reported complication in 8%-20% of men undergoing placement of a penile prosthesis. If a prosthesis becomes infected (redness, pain, and swelling of the penis and sometimes purulent drainage are signs of infection), the prosthesis must be removed. Depending on the timing and severity of the infection and your surgeon's preference, the area can be irrigated extensively with antibiotic solutions and a new prosthesis placed at the same time or removal of the infected prosthesis and an attempt to place a new prosthesis made at a later time when the infection is totally cleared.
This is a 22-year-old man who presents with no medical or surgical history who reports that he has never had a rigid erection in his life. He reports normal libido, penile sensation, orgasm, and ejaculation. The remainder of his history is negative. His physical examination is normal with normal genital exam and secondary sexual characteristics. He reported no significant change in erection with PDE5 inhibitors.
Currently, there are no therapies that cure erectile dysfunction. However, a number of effective therapies are available that allow an individual to have an erection when desired. Depending on the cause of the erectile dysfunction, certain therapies may be more effective than others. Although there is limited data on lifestyle modification, intuitively, decreasing risk factors for erectile dysfunction may help prevent progression of disease.

Sexual dysfunction and ED become more common as men age. The percentage of complete ED increases from 5% to 15% as age increases from 40 to 70 years. But this does not mean growing older is the end of your sex life. ED can be treated at any age. Also, ED may be more common in Hispanic men and in those with a history of diabetes, obesity, smoking, and hypertension. Research shows that African-American men sought medical care for ED twice the rate of other racial groups.
3. Are there physical causes of erectile dysfunction? Erectile dysfunction may be a symptom of underlying medical conditions, which if not detected may cause further medical problems. A prior history of cigarette smoking, heart attacks, strokes, and poor circulation in the extremities (for example, intermittent claudication or cramping in your leg[s] when you walk) suggest atherosclerosis as the cause of the erectile dysfunction. Loss of sexual desire and drive, lack of sexual fantasies, gynecomastia (enlargement of breasts), and diminished facial hair suggest low testosterone levels. A prior history of pelvic surgery or radiation and trauma to the penis/pelvis/perineum can cause problems with the nerves and blood vessels. Symptoms of intermittent claudication of the lower extremities with exercise may suggest a vascular problem as a cause of the erectile dysfunction.

"Erectile dysfunction can be a very serious issue because it's a marker of underlying cardiovascular disease, and it often occurs before heart conditions become apparent. Therefore, men should consider improving their weight and overall nutrition, exercise more, drink less alcohol and have a better night's sleep, as well as address risk factors such as diabetes, high blood pressure and cholesterol.


medicines called alpha-blockers such as Hytrin (terazosin
HCl), Flomax (tamsulosin HCl), Cardura (doxazosin
mesylate), Minipress (prazosin HCl), Uroxatral (alfuzosin HCl),
 Jalyn (dutasteride and tamsulosin HCl), or Rapaflo (silodosin).
Alpha-blockers are sometimes prescribed for prostate
problems or high blood pressure. In some patients, the use
of Sildenafil with alpha-blockers can lead to a drop in blood pressure or to fainting
Alcohol consumption is a common behavior in social circumstances worldwide. Epidemiological studies have suggested that moderate alcohol consumption reduces cardiovascular morbidity and mortality. The cardiovascular protective effects of alcohol may be attributed to its antioxidant, vasorelaxant, and antithrombotic properties, elevation of high-density lipoprotein or increase of nitric oxide production. Erectile dysfunction (ED) is a harbinger of cardiovascular diseases. Most epidemiological studies have also found that alcohol consumption, like its relationship with coronary artery disease, is related to ED in a J-shaped manner, with moderate consumption conferring the highest protection and higher consumption less benefits. In epidemio-logical studies, it is difficult to distinguish the ethanol effects from those of associated confounding factors. Meanwhile, long-term alcohol users, especially in those with alcohol liver disease, are highly associated with ED. More research is needed to investigate the true effects of alcohol consumption on cardiovascular diseases or ED.
This category of treatments includes external vacuum therapies: devices that go around the penis and produce erections by increasing the flow of blood in, while constricting the flow out. Such devices imitate a natural erection, and do not interfere with orgasm. External vacuum therapy mechanisms are approximately 95 percent successful in causing and sustaining an erection. All are portable, and costs range between $200-$500, covered under most insurance plans and Medicare Part B.
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