Erectile Dysfunction Health Center

An erection problem is not a life-threatening condition, yet it can seriously affect your emotional health and sense of self-worth. It can also make it difficult to father a child, if that is your desire. So the decision about whether to treat an erection problem is often based on your and your partner's preferences. Consider the following when making your decision:

• If you are able to try phosphodiesterase-5 inhibitors (such as sildenafil [Viagra], tadalafil [Cialis], and vardenafil [Levitra]) but have not, you should try one of these medicines first.
• At this time, it is not known how effective injections are in those who have already tried phosphodiesterase-5 inhibitors.

What is an erection problem?

An erection problem (also called erectile dysfunction and sometimes impotence) refers to a man's consistent inability to get or maintain an erection sufficient to have satisfactory sex. It does not mean a lack of sexual interest or desire or the occasional difficulty achieving or maintaining an erection that affects all men at some time in their lives.

What causes an erection problem?

The cause of erection problems may be physical (such as injury to the nerves or loss of blood flow going to the penis) or psychological (such as anxiety or depression). Medications you take for other conditions, alcohol consumption, smoking, and illegal drug use can cause erection problems.

Certain conditions may affect blood flow or the nervous system, increasing the risk of having erection problems. These include diabetes, high blood pressure, high cholesterol levels, atherosclerosis, multiple sclerosis, and Parkinson's disease.

Erection problems can occur at any age but are more common in older men, who often have additional health problems or who may be taking medicines that can interfere with normal erectile function. Treatment of erection problems in older men can be as effective as in younger men.

Why treat an erection problem?

The decision about whether to treat an erection problem may not be as straightforward as the decision about whether to treat many other medical conditions. An erection problem is not life-threatening, yet it can seriously affect your emotional health and sense of self-worth. It can also make it difficult to father a child, if that is your desire. So the decision about whether to treat an erection problem is often based on personal preference.

Very often, this decision is also based on how intensive or invasive the treatment is and its chance of succeeding. Injecting medication directly into the penis is often effective, but it is usually only considered after oral medicines (such as sildenafil [Viagra], tadalafil [Cialis], and vardenafil [Levitra]) have been tried.

Your choices are:

• Try MUSE (medicated urethral system for erections), which calls for inserting a tiny pellet of alprostadil into the opening at the end of the penis (the urethra). A thin tube contains the pellet of medicine. The tube is inserted into the opening in the end of the penis. By pressing a button on the applicator, the pellet is released into the penis.
• Inject medication into the side of the penis. This often involves using a mixture of medicines that include alprostadil (Caverject), papaverine hydrochloride (Pavabid), and phentolamine mesylate (Regitine).
• Try counseling or sex therapy.
• Seek other ways to express intimacy.

The decision about whether to use injections or pellets takes into account your personal feelings and the medical facts.

Following are some general considerations about using injections or pellets for an erection problem.

These personal stories may be helpful in making your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about using injections or pellets for an erection problem. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use injections or pellets.

Check the box below that represents your overall impression about your decision.

• Erection Problems (Erectile Dysfunction)
• Tests for Erection Problems

Citations

1. Tharyan P, Gopalakrishanan G (2006). Erectile dysfunction, search date August 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

2. Lue TF, Broderick GA (2007). Evaluation and nonsurgical management of erectile dysfunction and premature ejaculation. In AJ Wein, ed., Campbell-Walsh Urology, 9th ed., vol. 1, pp. 750–787. Philadelphia: Saunders Elsevier.