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.

“Sex often feels different for your partner when you experience ED,” warns Dr. Schwarts. “Men may not notice gradual changes to the girth or angle of his erection. But his partner does.” If you or your partner notice a persistent change in your erections that affects your sexual intimacy, you may have erectile dysfunction—even if you’re still able to get an erection.


With coronary artery disease, a buildup of plaque inside the arteries can limit the amount of blood that’s able to flow through them. If the flow of oxygen-rich blood to your heart muscle is reduced or blocked by this hardening of the arteries, the result can be angina (chest pain) or a heart attack.17 Because the arteries that supply blood to the penis are much smaller than the ones that feed the heart, the problem may show up earlier as having difficulty getting an erection.18

Injury to the penis may cause the scar tissue to develop. Sex, sports, or an accident might cause the injury. However, most patients don’t remember any painful injury. There are risk factors that increase the chances that an injury may cause scar tissue. They are genetics, connective tissue disorders, and age. The risk of Peyronie’s increases with age.


 Other treatment options such as penile self-injection therapy, external vacuum pumps and the medicated urethral system for erection are on rare occasions an effective long-term treatment. A very small percentage of men will continue with these treatments as evidenced by a very high drop out rate and a very low refill rate for these treatments. These procedures require extensive planning which interfere with sexual spontaneity and are really not a realistic long-term treatment for young patients with permanent ED. 
Pharmacological treatment of T deficiency in the young essentially relies on the site of origin of the dysfunction: the testis (primary hypogonadism) or the hypothalamic-pituitary region (secondary hypogonadism). In the case of primary hypogonadism, the only available treatment is T replacement therapy (TRT). In secondary hypogonadism, patient needs dictate the therapy. If fertility is requested, gonadotropin is the only option, with the caveat of anti-estrogens in selected cases. If fertility is not an issue, TRT is again the primary choice (63).
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.
Given the different questions and response options used here, I’d be cautious about concluding that the NSSHB is necessarily registering a rise in ED among young men compared to the aforementioned US study from the 90s. Given that the NSSHB response options allowed for different degrees of severity, it’s likely that this study is detecting more guys who occasionally have mild erectile issues (issues that may not even be significant enough to prompt distress or clinical attention). Also, the NSSHB was bound to produce different figures given that participants only had to think about the most recent time they had sex, as opposed to recalling all sexual experiences over the last year (indeed, thinking only about a single, recent event could make it easier to remember a mild problem that would otherwise be forgotten). For these reasons, the NSSHB data just aren’t directly comparable to the 90s data.
While erectile dysfunction can occur at any age, the risk of developing erectile dysfunction increases with age. According to the Massachusetts Male Aging Study, the prevalence of erectile dysfunction was 52% in men 40-70 years of age. The prevalence of complete erectile dysfunction increases from 5% at 40 years of age to 15% among men 70 years of age and older.
Andrew McCullough, MD, associate professor of clinical urology and director, male sexual health program, New York University Langone Medical Center. Lecturer: Auxillium. Research grant: Pfizer. Data safety monitoring board: Pfizer. Consultant: Slate Pharmaceuticals. Clinical trials: Warner Chilcott, Vivus, Lilly, Bayer-GSK, ICOS, Timm, Schering Plough, Aeterna.
What are the symptoms of diabetes in men? Diabetes is a common lifelong condition that affects the ability of the hormones to manage blood sugar levels. It affects men and women differently. Learn about the signs and symptoms of diabetes in men. This article includes information on how diabetes can affect sex and cause erectile dysfunction. Read now
Although few studies specifically evaluated the clinical characteristics of ED in younger men, this problem is increasingly frequent. Healthcare professionals both inside and outside of Sexual Medicine are likely to deal with young men complaining for ED and it is important that basic knowledge on this topic is available. In fact, young men reporting ED risk being dismissed without any specific medical assessment, including medical history or physical exam, owing to the assumption that ED in younger is a self-limiting condition, without any clinical consequence. However, evidence shows that, similar to middle-aged or older men, ED can be the consequence of the combination of organic, psychological and relational factors and all these components must be assessed for a correct clinical management. In particular, ED in younger, even more than in older men, can be considered a harbinger of CVD and it offers the unique opportunity to unearth the presence of CV risk factors, thus allowing effective and high quality preventive interventions.
We can partially speak to this issue by looking at data from the first wave of the National Survey of Sexual Health and Behavior (NSSHB), a nationally representative US sex survey conducted in 2009 with thousands of Americans aged 14-94 [3]. As part of this study, male participants were asked whether they’d experienced any erectile difficulties the last time they had sex via a single item with five response options, ranging from “not difficult” to “very difficult.” Obviously, this is a quite different question compared to the other studies because it only focused on a single event (the most recent one in memory) and it was more complex than a simple yes/no answer. The researchers also divided men into slightly different age groups.
A medical history focused on risk factors, such as cigarette smoking, hypertension, alcoholism, drug abuse, trauma, and endocrine problems including hypothyroidism, low testosterone levels, and hyperprolactinemia, is very important. Commonly used drugs that disrupt male sexual function are spironolactone (Aldactone), sympathetic blockers such as clonidine (Catapres), guanethidine (Islemin), methyldopa (Aldomet), thiazide diuretics, most antidepressants, ketoconazole (Nizoral), cimetidine (Tagamet), alcohol, methadone, heroin, and cocaine. Finally, assessment of psychiatric history will help identify emotional issues such as interpersonal conflict, performance anxiety, depression, or anxiety.
The reasons young men develop erectile dysfunction differ from those of their older peers. The typical aging male with erectile dysfunction develops the condition because some underlying disease (such as heart disease or diabetes) is preventing blood from flowing into his penis. For a younger man, the problem is more likely to be some form of trauma, such as an accident that damaged nerves needed to produce an erection. Regardless of the cause, a young man with erectile dysfunction should talk about the problem with a physician.
At the same time, people with diabetes are susceptible to a type of blood vessel damage known as endothelial dysfunction. A recent study found that men with ED are at a greater risk of heart disease, which is also associated with endothelial dysfunction. If blood vessels aren't in good working order, the penis may not get enough blood for an erection.
Nonsustained erection with detumescence after penetration is most commonly caused by anxiety or the vascular steel syndrome. In the vascular steel syndrome, blood is diverted from the engorged corpora cavernosae to accommodate the oxygen requirements of the thrusting pelvis. Questions should be asked regarding the presence or absence of nocturnal or morning erections and the ability to masturbate. Complete loss of nocturnal erections and the ability to masturbate are signs of neurological or vascular disease. It is important to remember that sexual desire is not lost with ED—only the ability to act on those emotions.
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Then you have to be able to make the right diagnosis. What is the basis for their erectile dysfunction? Is it psychogenic? Is it some sort of neurological or blood vessel or hormonal issue? So you have to make a diagnosis. You have to be able to make an assessment. And then only after those things are done, then you start to think about medications.
There are risks to prosthetic surgery and patients are counselled before the procedure. If there is a post-operative infection, the implant will likely be removed. The devices are reliable, but in the case of mechanical malfunction, the device or a part of the device will need to be replaced surgically. If a penile prosthesis is removed, other non-surgical treatments may no longer work.
Long-term erectile dysfunction. The risk for long-term erectile dysfunction has been linked to chronic heavy use of alcohol. In fact, studies show that men who are dependent on alcohol have a 60 to 70 percent chance of suffering from sexual problems. The most common of these are erectile dysfunction, premature ejaculation, and loss of sexual desire.
Given the different questions and response options used here, I’d be cautious about concluding that the NSSHB is necessarily registering a rise in ED among young men compared to the aforementioned US study from the 90s. Given that the NSSHB response options allowed for different degrees of severity, it’s likely that this study is detecting more guys who occasionally have mild erectile issues (issues that may not even be significant enough to prompt distress or clinical attention). Also, the NSSHB was bound to produce different figures given that participants only had to think about the most recent time they had sex, as opposed to recalling all sexual experiences over the last year (indeed, thinking only about a single, recent event could make it easier to remember a mild problem that would otherwise be forgotten). For these reasons, the NSSHB data just aren’t directly comparable to the 90s data.
Psychological Causes of ED – Between 10% and 20% of ED cases have a psychological cause. Because arousal starts in the brain, psychological issues can be a significant contributing factor to erectile dysfunction. Mental health conditions like depression or anxiety can negatively impact your libido, making it more difficult for you to become aroused.
This man’s history is adequate to rule out arterial or venous insufficiency as he can masturbate to produce a rigid, sustainable erection and he responds well to tadalafil. Due to his report of gradual onset, his lack of response to ongoing sexual therapy, and his tremendous anxiety associated with the issue, the decision was made to offer a PCDU to assess for a vascular etiology for his disorder. PCDU revealed normal peak flow bilaterally of 40 cm/sec with no end diastolic flow and 100% rigidity obtained. His erection lasted more than 2 hours and required phenylephrine to resolve the erection.
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.
Another common reason for failures of oral therapy is the absence of sexual or genital stimulation prior to attempting sexual intercourse. These medicines facilitate an erection by increasing blood flow to the penis, but they do not act as an aphrodisiac or as an initiator of the erection. A man who is not “in the mood” or does not have adequate physical stimulation will not respond with an erection.
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