If the patient complains of loss of sensation on his penile shaft or glans, it is useful to perform hot and cold perception testing and/or additional vibratory sensory testing with biothesiometer. These are tests that can be performed quickly during the office visit and provide useful information about the function of the dorsal nerve of the penis (Table 3).
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.
The vascular processes that produce an erection are controlled by the nervous system and certain prescription medications may have the side effect of interfering with necessary nerve signals. Among the possible culprits are a variety of stimulants, sedatives, diuretics, antihistamines, and drugs to treat high blood pressure, cancer, or depression. But never stop a medication unless your doctor tells you to. In addition, alcohol, tobacco, and illegal drugs, such as marijuana, may contribute to the dysfunction.
Phosphodiesterase inhibitors: This class of medications includes sildenafil, tadalafil, and vardenafil. They work by inhibiting an enzyme called phosphodiesterase type 5 (PDE-5), allowing more blood to enter the penis and helping to produce an erection. These medications are often taken before sex and will cause an erection only when the man is sexually stimulated.
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).
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Injury to the nerves and arteries near the penis can lead to erectile dysfunction. According to the National Institutes of Diabetes and Digestive and Kidney Diseases, surgeries for prostate and bladder cancer can injure penile nerves and arteries, although it doesn’t always happen. Spinal cord injuries can affect the ability to achieve and maintain an erection, as can injuries to the penis, prostate, bladder and pelvis.
Erectile dysfunction, often referred to as ED, is characterized by a persistent and recurring inability to achieve or maintain an erection sufficient for sexual intercourse. Psychological, physical and lifestyle issues can all cause ED, as can trauma to nerves and arteries. The incidence of erectile dysfunction increases with age, but young men can also experience it.
Patients taking PDE5 inhibitors should avoid consuming large amounts of alcohol, which may cause a sudden decrease in blood pressure when getting up from a standing or reclining position. Although effects can be variable, symptoms may include a fast heart rate, dizziness, headache and fainting. Studies with some PDE5 inhibitors have shown a decrease in blood pressure and symptomatic effects when combined with alcohol.
The condition is often an early warning sign of heart disease and other circulatory problems. To achieve and maintain an erection, extra blood must be able to flow unimpeded. Anything that interferes with healthy flow – for example atherosclerosis, the artery-clogging process at the root of most heart attacks, strokes, and other cardiovascular conditions – has the potential to cause erectile dysfunction, too.

Erectile dysfunction is your body’s “check engine light” because ED can be an early sign of serious health problems like high blood pressure, diabetes, high cholesterol or low testosterone. The blood vessels in the penis are smaller than other parts of the body. So ED symptoms often occur long before more serious problems like a heart attack or stroke. When an otherwise healthy man in his 20’s experiences ED, it’s cause for concern.
• Blood Vessels: Diabetes damages blood vessels, especially the smallest blood vessels such as those in the penis. Diabetes can also cause heart disease and other circulatory problems. Proper blood flow is absolutely crucial to achieving erection. “Erection is a hydraulic phenomenon that occurs involuntarily,” says Arturo Rolla, MD, of Harvard University School of Medicine. “Nobody can will an erection!” Anything that limits or impairs blood flow can interfere with the ability to achieve an erection, no matter how strong one’s sexual desire.
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