Penile prostheses are very effective, and most patients who have a prosthesis placed are satisfied with the prosthesis. However, placement of a prosthesis causes scarring of the tissue within the corpora cavernosa, and if the prosthesis requires removal, other forms of therapy, except for the vacuum device, are often not effective. Thus, most physicians reserve placement of a prosthesis for men who have tried and failed or have contraindications to other therapies.
Few simple laboratory tests can help identify obvious causes of organic ED. Initial labs should include HbA1c, free testosterone, thyroid function tests, and prolactin levels. However, patients who do not respond to pharmacological therapy or who may be candidates for surgical treatment may require more in-depth testing, including nocturnal penile tumescence testing, duplex Doppler imaging, somatosensory evoked potentials, or pudendal artery angiography.
Mechanical therapy is also effective and is especially well-accepted in men with stable partners. Vacuum-assisted erection devices are effective in creating erections in as much as 67% of cases. Vacuum pressure encourages increased arterial inflow, and occlusive tension rings discourage venous outflow from the penile corpus cavernosae. The penis placed inside the cylinder, a pump is used to produce a vacuum that pulls the blood into the penis. After the tension ring is slipped onto the base of the penis, the cylinder is removed. Erection lasts until the rings are removed. The one-time expense of this therapy is $120–300.
Patient can inject medications directly into the corpora cavernosa to help attain and maintain erections. Medications such as papaverine hydrochloride, phentolamine, and prostaglandin E1 (alprostadil) can be used alone or in combinations to attain erections. All of these medications are vasodilators and work by increasing blood flow into the penis. Prostaglandin E1 (Caverject, Edex) is easier to obtain; however, it is associated with penile pain in some individuals. The use of combinations of two or three of these medications can decrease the risk of having penile pain.
Erectile dysfunction is often an early warning sign of more serious problems like hypertension, diabetes, obesity, and cholesterol. That’s why we call ED your body’s “check engine light”. The blood vessels in the penis are smaller than the rest of the body, especially the blood vessels that lead to the heart and brain. So ED is usually the first sign of high cholesterol or high blood pressure before a blockage causes more serious problems, like a heart attack or stroke.
Medications used to treat high blood pressure (hypertension), including diuretics and beta-blockers, may cause ED. Not all blood pressure medications are associated with ED; alpha-blockers, ACE inhibitors, calcium channel blockers, and angiotensin II receptor blockers don't appear to cause ED. If you are on a blood pressure medication, have an ED talk with your doctor about whether or not your medication may be contributing to your ED and if there is an alternative blood pressure medication that is safe for you to try.
These are among the most challenging patients seen in urology practice today: a young, healthy man with neither systemic disease nor a history of trauma, who has complaints of ED (Table 2). These men often have co-morbid diagnoses, such as anxiety, depression, or mood disorders, which make the issue of ED more complex for both the patient and the urologist (12). The psychological burden of ED in these young men is more pronounced than it might be in older men as this is the phase of life during which many men expect to be highly sexually active (4). These young men are usually technologically savvy and may have scrutinized much of the readily available information on the internet regarding ED. Often they arrive to clinic armed with an understanding of the diagnostic evaluation that may be offered to further investigate the etiology of their concerns. This makes the evaluation and treatment of these men more challenging since additional diagnostic testing is often not indicated after a thorough history and physical examination. In many cases, they may have self-diagnosed and self-treated based on the information that they obtained prior to seeing a physician. Many of these men will see multiple urologists on their quest to find a pathophysiology that they can accept, and many have unrealistic expectations of a rapid cure or a surgical cure.
In rare cases, the drug Viagra ® can cause blue-green shading to vision that lasts for a short time. In rare cases, the drug Cialis® can cause or increase back pain or aching muscles in the back. In most cases, the side effects are linked to PDE5 inhibitor effects on other tissues in the body, meaning they are working to increase blood flow to your penis and at the same time impacting other vascular tissues in your body. These are not ‘allergic reactions'.
 5. Medline Plus. US National Library of Medicine. NIH National Institutes of Health. Drugs that may cause impotence (updated 21 Jan 2015). http://www.nlm.nih.gov/medlineplus/ency/article/004024.htm (accessed Nov 2016). myDr myDr provides comprehensive Australian health and medical information, images and tools covering symptoms, diseases, tests, medicines and treatments, and nutrition and fitness.Related ArticlesImpotence treatmentsIf you have impotence (erectile dysfunction), the treatment your doctor recommends will depend on thErectile dysfunction: visiting your doctorFind out what questions a doctor may ask when discussing erectile dysfunction (ED, or impotenceGum disease linked to erectile dysfunctionAdvanced gum disease (periodontitis) has been linked to an increased risk of erectile dysfunction, wPeyronie's diseasePeyronie’s disease is condition where a band of scar tissue forms in the penis, causing aAdvertisement

Erectile dysfunction, also known as impotence, is defined as not being able to get or keep an erection firm enough for sex. Remember, occasional erectile dysfunction is not uncommon, but if it’s persistent, erectile dysfunction can be the sign of a more serious health issue, and so you should visit your doctor.Here are 8 surprising causes of erectile dysfunction:High cholesterol. Having a raised cholesterol increases the risk of atherosclerosis where the arteries become narrowed and clogged, resulting in impaired blood flow. When this happens to the arteries in the penis, it can prevent enough blood to create an erection from reaching the penis.Depression. This can cause a lack of interest in sex. See your doctor if this happens to you.Smoking. Smoking causes damage to blood vessels, including those that supply the penis which can result in difficulty in achieving an erection.Cycling. Long hours in the saddle without changing position can cause compression of the perineal nerves and blood vessels, resulting in nerve damage which causes erectile dysfunction. Some saddles are worse than others. If cycling is causing you symptoms of tingling or numbness in your penis, adjust your riding position and take a break.  You might want to look at a different saddle, too. Rodeo riding can have the same effect.Medicines. Erectile dysfunction can be a side-effect of many medicines, including some antipsychotics and antidepressants, cholesterol-lowering medicines, high blood pressure medicines, and epilepsy medicines.Stress. Feelings of stress and anxiety can overflow onto your sex life, and you may find you can’t perform as well as you normally could. 'Performance anxiety' is a common cause of erectile problems.Diabetes. Diabetes raises the risk of erectile dysfunction threefold by its effects on nerves and blood vessels.Peyronie’s disease. This disease causes curvature of the penis due to a hardened area of scar tissue, which results in pain when the man has an erection.If you suffer from erectile dysfunction, don’t be embarrassed – it affects one in 5 men over 40. Remember your doctor can help identify the cause of your erectile dysfunction,  and put you on the path to successful treatment. Read erectile dysfunction – visiting your doctor to find out what to expect when you visit your doctor. Last Reviewed: 18 February 2016
While there are many ways to treat ED today, men with diabetes may require maximum doses of medications such as Viagra™, Cialis™, Levitra™ and Stendra™, yet still find drugs ineffective.7 In a study of nearly 20,000 men with ED, men with diabetes were 1.5 to 2 times more likely to move on to other treatments, such as pumps and penile implants than men without diabetes.9
It's not easy to get in the mood when you're overwhelmed by responsibilities at work and home. Stress can take its toll on many different parts of your body, including your penis. Deal with stress by making lifestyle changes that promote well-being and relaxation, such as exercising regularly, getting enough sleep, and seeking professional help when appropriate.

ED is easily and successfully treated! If your sex drive is unaffected, but you experience problems achieving or sustaining erection for a period of four to five weeks, you may have ED. Talk to your doctor immediately. Don’t delay—erectile dysfunction doesn’t “just go away!” Additionally, ED could be a sign of a serious, even life-threatening complication, such as congestive heart failure or kidney disease. Ignoring your ED because it’s embarrassing could jeopardize your health.

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