male erectile dysfunction

Erectile Dysfunction

Also know as male impotence can affect men as early as late to mid 30’s and 40’s or later in life.  Regardless of when it starts it can have a dramatic effect on both physical and mental health.  Erectile dysfunction is when the male body is unable to either attain or maintain an erection for sufficient rigidity to have intercourse.  Many people refer to this issue as the body’s check engine light, letting you know that your body is unhealthy and some things need to change. How to identify erectile dysfunction. 

  1.  Inability to maintain an erection.
  2. Inability to get an erection.
  3. Reduced desire for sex.


What causes erectile dysfunction?

Natural erections are highly coordinated neurovascular process that involve the nervous system, vascular system, and endocrine system. The erectile process begins with either tactile or mental stimulation triggering the release of neurotransmitters from the brain. These neurotransmitters causes an increase in the release of Nitric Oxide (NO) within the corpus cavernosum (the penile erectile bodies). Nitric Oxide then propagates the production of cGMP,  which is directly responsible for dilation of arterial smooth muscles resulting in blood vessel dilation and in increase in blood flow into the penis.

Increased penile expansion during an erection, causes increased pressure on the penile corpora cavernosum known as the tunica albuginea. The bridging veins, that are responsible for penile detumescence (loss of an erection) get compressed, thus decreasing outflow of blood from the penis resulting in a rigid erection. When sexual stimulation is decreased, a chemical messenger called as phosphodiesterase 5 (PDE5) breaks down on cGMP into GMP and thereby decreasing blood flow into the penis, resulting in detumescence.  A deficiency in any of the described processes can results in impaired erectile function, however, there are treatment options available to enhance the process and improve erectile function.

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What Causes Erectile Dysfunction?

As a comprehensive men’s health clinic, we focus not on just treating erectile function, but identifying its cause. Given that an erection is a highly coordinated physiological process, it can be impacted by a multitude of reasons:

  • Neurogenic disorders (neuropathy, Multiple Sclerosis, Parkinson’s disease)
  • Prescription drugs (SSRIs, beta blockers, alpha-2 agonists, hormone modulators, 5α reductase inhibitors, thiazide diuretics)
  • Reduced blood flow to the penis
  • Post-prostatectomy/pelvic surgery
  • Vascular disease
  • Psychological conditions
  • Venous leak (vein leakage)
  • Diabetes and other hormonal disorders
  • Pelvic trauma
  • Peyronie’s disease (scarring of erectile tissue)
Given that male potency is an intimate and sensitive topic, erectile dysfunction can lead to worsening self-esteem, depression, anxiety, and cause emotion strain on intimidate relationships. We at the Men’s Health Institute understand the sensitive nature of discussions regarding sexual difficulties, and we ensure to treat all men with the proper discretion and respect that they deserve. 

What treatment options are available for erectile dysfunction?

Lifestyle Changes

Lifestyle changes can not only contribute to improved erectile function, but good overall health and quality of life. Examples of lifestyle changes that could contribute to improved erectile function include:

  • Regular exercise
  • Weight loss
  • Decreasing or limiting the alcohol consumption
  • Dietary changes to reduce the intake of fat and cholesterol
  • Eliminating the use of tobacco and vaping


male and female in bed

Medication Changes

A careful review of your current medications may result in changes to them especially if they are known to cause erectile dysfunction.

Oral Medication Therapy

Oral medications, such as Viagra, Cialis, Levitra, and Stendra, are all ways to improve penile blood flow by directly dilating blood vessels. They allow the arteries to engorge to produce an erection. As widely as they are used today, they do not work for 20-30% of men.

External Appliances

Vacuum pump therapy is a non-invasive means in which to produce an erection. As the pump device is positioned over the penis, a vacuum is created, thus mechanically enhancing the flow of blood into the penis. A rubber ring is then placed at the penile base to help retain blood in the penis, thus maintaining the erection. Of note, vacuum pumps cannot be prescribed for patients with bleeding disorders, patients on anti-coagulants, or those with sickle cell anemia.

Intraurethral Gels

Intraurethral gels require the insertion of a small dose of medication directly into the urethral opening at the end of the penis. Being that it is placed within the urethral, the medication is easily absorbed into the erectile tissue, dilating the blood vessels and leading to increased penile blood flow. Possible side effects include priapism (a sustained erection lasting longer than 4 hours) and a mild burning sensation after application.

Shockwave Treatment for ED

Extracorporeal shock wave therapy (ESWT) for erectile dysfunction is a unique new therapy for the treatment of  erectile dysfunction. Unlike other ED treatments, shock wave therapy has the goal of achieving normal erections without assistance. Shock wave therapy can restore natural erectile function by improving penile health and blood flow. Shock wave therapy utilizes low intensity pulsatile sound waves at the cellular level to increase penile neovascularization and stimulate increased penile blood flow. 

Penile Injection Therapy

Penile injection therapy is the most effective non-surgical method for the treatment of erectile dysfunction. Typically, it consists of a potent three drug combination injection consisting of phentolamine, alprostadil and papaverine (Trimix). The injection is placed towards the base of the penis at the lateral aspect. Once injected, the smooth muscles of the erectile bodies relax, allowing increased blood flow and an erection within 3-5 minutes. One possible complication associated with penile injection therapy is priapism (a sustained erection lasting longer than 4 hours), therefore, careful dose titration must be performed by a urologist. 

Inflatable Penile Prosthesis

A penile prosthesis is a excellent surgical option for men with erectile dysfunction in which a prosthetic device is placed into the erectile capsules of the penis in order to gain rigidity during sexual intercourse. The three forms of penile implants are:

  • Semi-rigid prostheses: silicon-covered flexible metal rod are implanted into the erectile bodies, providing rigidity for intercourse. These implants remain rigid at all times, patients must bend the prosthesis straight when they want to engage in sexual activity. Malleable penile implants are mainly offered to patients without the manual dexterity in their hands to activate an inflatable prosthesis.
  • Inflatable penile prostheses two soft silicone tubes are implanted into the penis, along with a small reservoir in the abdomen, and a small pump in the scrotum. This has a more natural appearance with erections and is easier for patients to conceal when they are not active.
  • Self-contained inflatable implants consist of a pair of inflatable tubes inserted into the penis with a pump attached to the end of the implant and a reservoir located in the shaft of the penis.