The treatment of erectile dysfunction (ED) has evolved rapidly over the last 30 years. To put it in perspective, the mainstay of treatment for ED for most of the 20th century was seeing a therapist and taking some Chinese herbs you heard about from your buddy. Progress was made in the 1970s with the invention of penile prosthetic surgery but treatment was very limited and highly invasive. In the 1980s the field of erectile dysfunction was revolutionized when Viagra was discovered, bringing effective treatment to a large scale population.
What causes erectile dysfunction? A myriad of problems both physical and emotional contribute to achieving and maintaining an erection but the overarching themes we use to guide treatment are identifying if we are dealing with organic erectile dysfunction or psychogenic erectile dysfunction. Organic implies that a physiologic problem has developed that prevents the penis from achieving full erection. Psychogenic implies that there is an emotional or stress related barrier present that is limiting erectile function. If you have erectile dysfunction it is prudent to see your doctor as many patients discover underlying medical causes such as diabetes or high blood pressure. In psychogenic ED, a therapist is a great place to start to uncover your emotional barriers.
This flowchart is a general overview to help you assess the root of your ED and hopefully guide you in finding some solutions (click on it to see it full-size).
One of the first things a urologist would probably ask you is whether you get “morning wood,” as in the involuntary erection many men get in the mornings. This will help determine whether the underlying issues are psychogenic (in the mind) or organic (in the body). If you are getting morning wood but find you have ED during sexual experiences, you should initially investigate psychological causes.
If you seldom get morning erections, you should initially look at organic causes. The most common physical cause of ED is atherosclerosis, which is caused by peripheral arterial disease, where the arteries that supply blood to the pelvic area become less efficient due to a buildup of fat and cholesterol deposits.
If you’ve seen your doctor and been given the go-ahead to treat the erectile dysfunction, the mainstay of first line treatment is oral medications. Yes, it’s time for the “little blue pill,” which now is either a little blue pill, a little yellow pill, or a little orange pill. These medications (PDE-5 inhibitors for those who wanna get technical) function by protecting the pro-erectile proteins working to relax the blood vessels in the penis. Normally these proteins are degraded by enzymes and the penis returns to its flaccid state, but with Viagra, Levitra, and Cialis these enzymes are tied up allowing the pro-erectile proteins to continue to do their work to produce a full erection. Viagra and Levitra are short acting versions of the medication that work within an hour of taking while Cialis lasts all day.
Are there side effects? As with any good medication, yes, there are side effects. The most common is light headedness and no it’s not from the blood all rushing to your penis, the medication affects many of the blood vessels in your body and this relaxation effect causes a drop in blood pressure, thus dizziness. Palpitations and vision changes are also common side effects and you should stop the medication and talk to your urologist if this occurs.
“So I take a pill and BAM! boner-town?”…no…not exactly. The medication facilitates blood flow and relaxation of the blood vessels but the stimulation and excitement still needs to take place in order for an erection to form. The other common misunderstanding is that a full stomach affects the drug’s absorption so my advice is to make your move after you’ve digested, don’t go straight home for “dessert.”
– Dr. Amy
Dr. Amy Schlaifer is a urologic surgeon practicing in Phoenix, AZ.