Erectile Dysfunction

Sexual health is an important topic for discussion in the urologist’s office. Men and women are enjoying longer lives, and want to maintain good sexual connection into their 70s and beyond.

Some men may have sexual troubles as they age including weaker erections, a decrease in their libido/interest in sex, and penile curvature. Erectile dysfunction occurs when men cannot obtain or maintain an adequate erection. The diagnosis and treatment of erectile dysfunction will be dependent on the reason it occurs.

Some causes include:
Decreased blood flow to the penis
• The same conditions that lead to heart attack and stroke can lead to erectile dysfunction. These include medical issues such as diabetes, high blood pressure, or smoking. Men who have erectile dysfunction should be assessed by their family doctor to determine if they have cardiovascular risk factors.

Neurologic causes
• Conditions including diabetes, spinal cord injury, prostate cancer surgery, or stroke may damage the nerves to the penis.

Medications
• Many medications can result in worsening erections. These include blood pressure medications or even opioid pain medications.

Hormones
• Low testosterone may result in decrease of your libido, or interest in sex, as well as weaker erections.

Psychologic causes
• Depression, stress, anxiety, and relationship issues can also contribute to erectile dysfunction.

Treatment for erectile dysfunction will depend on the cause. We often recommend patients see their family doctor for a cardiac assessment. Weight reduction, exercise, and in particular weight training, can increase the body’s testosterone naturally. Medications, such as Viagra or Cialis, may be prescribed. Further medical or surgical therapy is available for patients who do not respond adequately to these medications.

Testosterone replacement therapy may be recommended to men with signs and symptoms of low testosterone. Surgical therapy may include insertion of a penile prosthesis, a device which inflates to allow the penis to become erect.

Peyronie’s Disease is a condition caused by scarring in the penis, which results in a penile curvature. This is commonly caused by microtrauma to the penis during intercourse. Some men may have a genetic cause for scar formation. There may be some pain associated with the initial trauma, however eventually the pain will resolve. When this occurs, a man may be left with a bend in the penis. Penile curvature, especially when it is greater than 40-50 degrees, can result in difficulties with penetrative intercourse. Some men may also have weak erections associated with Peyronie’s disease.

Treatment options for Peyronie’s disease include medication for erectile dysfunction and surgery to straighten the penis. We reserve surgery for men with severe curvature, usually greater than 60 degrees.

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