Frequently Asked Questions
These terms are used interchangeably, but there are big differences in their connotations. Erectile dysfunction describes a range of conditions, from an occasional inability to have an erection to a complete and permanent inability to have an erection.
Contrastingly, “impotence” connotes a permanent, unchanging condition. It makes erectile dysfunction sound like a man has lost his power as a man. It suggests the condition never gets better and never gets worse. For these reasons, “erectile dysfunction” has become the preferred term.
. The most common presentation of ED is “moderate” or “complete” interference with sexual satisfaction. Men who have ED don’t just have occasional problems with their erections. They are more likely to have erectile dysfunction more than 50 percent of the tie they attempt to have sex or not to be able to have erections at all than they are to have ED as only an occasional problem.
The sooner a man brings his concerns about erectile dysfunction to his doctor’s attention, the sooner he can get effective treatment. Erectile dysfunction can be a symptom of an undiagnosed condition requiring medical treatment, such as heart disease or diabetes. Seeing the doctor about ED may lead to lifesaving treatment for some other condition.
It may be OK to defer talking with the doctor about ED when a man believes it is caused by fatigue, passing depression, or a psychological issue he can resolve on his own. But it is usually better to seek treatment sooner rather than later.
It’s important for men who have a “little” problem with ED to realize that if they don’t do something about it, it has a way of becoming a big problem. And it may help men to know that their situation is hardly unique.
ED can be treated with injections of drugs like alprostadil and phentolamine. These drugs open the blood vessels in the cavernus cavernosum, the spongy vascular tissue in the penis that fills up with blood to make the penis erect. These injections can be highly effective, but men have to be shown injection technique and advised on injection timing by their doctors.
ED can be treated with vacuum pumps that enlarge the penis by lowering air pressure around it. And, as a last resort, it is possible to replace the blood vessels in a man’s penis with an inflatable device that makes the penis erect at the touch of a button. But this device can never be removed or replaced.
Not every man will respond to medications in the same class as Viagra, but 80 percent will. However, testosterone therapy is also effective for men who have hypogonadism (low-T), and it has benefits in addition to helping men get stronger erections.
Men who don’t get relief from any other treatment for ED who want to continue their sex lives can investigate implant surgery. However, if the procedure doesn’t work, the man can never have sexual intercourse again.
Urologists used to think that men who have or who have had successful treatment for prostate cancer, or who have PSA levels that suggest a high risk of prostate cancer, should not be given testosterone replacement therapy. Recent research has found that some men who have prostate cancer actually do better with testosterone therapy.
It’s important to be open and honest with your doctor about prostate health. Doctors can work with you even when you have prostate issues, but you should not make them repeat diagnostic procedures to help you.
Can men who have lots of problems with erections improve so that ED is only an occasional problem? Yes, usually. Can men who can’t have erections at all have erections again? Sometimes, although surgical intervention may be necessary. Testosterone therapy often brings men back to a state where they are happy about their sex lives.
Among men of all ages, psychological issues are the most common cause of ED. That doesn’t mean, however, that every man who has psychological issues that interfere with sexual performance has to resolve them in therapy. In many men, the emotional and cognitive boost from appropriate testosterone therapy is enough to restore normal erectile function with the right partner.