Erectile Dysfunction (ED)

 
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WHAT IS ED ?

ED (Erectile Dysfunction) affects as many as 30 million men. Most men have problems with erections from time to time. In some men, these problems are regular and more severe. ED, or erectile dysfunction, is when it is hard to get or keep an erection that’s firm enough for sex.

WHAT CAUSES ED?

While ED becomes more common as men age, growing old is not the cause of the problem. ED can be an early sign of a more serious health problem. Finding and treating the cause(s) of your ED can improve your overall health and well-being. ED can result from health or emotional problems, or from both combined. Reduced blood flow or harm to nerves in the penis can result in erection problems. These can be caused by heart disease, high blood pressure, high blood sugar, surgery, injuries and even smoking. Some medicine, as well as alcohol or other drugs may also cause erection problems. Emotional (depression, stress or worry) or relationship problems can cause or worsen ED.


The Sexual Health Inventory for Men (SHIM) Questionnaire

This questionnaire can help you and your doctor determine if you have symptoms of ED (erectile dysfunction).

For each question, note your answer by circling the number that approximates your belief. Add your numbers together and refer to the table below to see what your score may mean.

This questionnaire can help you and your doctor determine if you have symptoms of ED (erectile dysfunction). For each question, note your answer by circling the number that approximates your belief. Add your numbers together and refer to the table below to see what your score may mean.


Over the past six months . . .

1) How do you rate your confidence that you could get and keep an erection?

1. Very low - 2. Low - 3. Moderate - 4. High-  5. Very high

2) When you had erections with sexual stimulation, how often were your erections hard enough for penetration (entering your partner)?

1. Very low - 2. Low - 3. Moderate - 4. High-  5. Very high

3) During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?

1. Very low - 2. Low - 3. Moderate - 4. High-  5. Very high

4) During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?

1. Very low - 2. Low - 3. Moderate - 4. High-  5. Very high

5) When you attempted sexual intercourse, how often was it satisfactory for you?

1. Very low - 2. Low - 3. Moderate - 4. High-  5. Very high

 

SCORE: 

  • 1-7:  Servere ED
  • 8-11: Moderate
  • 12-16: Mild to Moderate ED
  • 17 - 21: Mild ED
  • 22-25: No signs of ED

HOW IS ED TREATED?

To improve erection problems, Dr. Nimeh may need to treat the root causes. Dr. Nimeh may ask you to change certain habits, such as stopping smoking, drug or alcohol use. Treating emotional problems, such as relationship conflicts, depression or performance anxiety can also help. Cutting back on or changing certain meds can often improve ED. Do not stop taking your medicine or change any meds without talking to Dr. Nimeh first. If a blood test shows low testosterone levels (low T), testosterone replacement therapy (TRT) may help. However, if a blood test shows you have normal testosterone levels, adding TRT will not help your erection problems.

Other treatment choices are:

  • Oral drugs, known as PDE-5 inhibitors. These drugs relax muscle cells in the penis and increase blood flow. (These are the drugs you see often on TV and internet ads.)
  • A vacuum erection device pulls blood into the penis, causing an erection. An elastic ring is then slipped onto the base of the penis. This holds the blood in the penis (and keeps it hard) for up to 30 minutes.
  • Self-injection therapy. By injecting this medication into the penis with a very fine needle, an erection is created.
  • Intraurethral therapy. Patients place a tiny medicated pellet of the drug alprostadil into their urethra. (The urethra is the tube that carries urine out of the body). This causes an erection.
  • A urologist can surgically implant one of two types of penile prostheses.

Ask Dr. Nimeh which treatment is right for you. Dietary supplements (often called “herbal remedies”) for ED are popular but may not be safe or even work. Unlike prescription drugs, they do not have to be proven to work. Check with your health care provider before you take any supplements or medicine to treat your ED. The good news for many men is that ED can be treated safely, and treatments can work well. If you have ED, there is hope. There is help. Talk to your health care provider to see if one of these treatment choices will work for you.


Surgical Treatment of ED

Because of new treatments, today urologists are helping men with ED perform better and longer. When other treatments do not improve ED, Dr. Nimeh may offer you surgery as a treatment choice. Surgery to fix problems with blood vessels in the penis may help in rare cases. Young men who have had injuries to the pelvis or penis are most likely to be helped by this treatment.

Penile Prostheses

Penile prostheses are devices implanted inside the penis that allow men with ED to have an erection. Penile prostheses, which provide firm erections, are good treatment choices for some men. One type of implant uses two bendable rods placed in the penis during a surgery. To have an erection, a man bends his penis upward into an erect position.

With an inflatable implant, a pair of rods is placed lengthwise in the penis. The rods fill with fluid when a pump hidden in the body is pressed. This fluid makes the penis hard. Penile implants are placed during a several-hour surgery. There is a risk of infection and a risk that the device will fail. Most men with penile implants and their partners say they’re satisfied with the results. However, once a prosthesis is placed, other non-surgical treatments will no longer work if the prosthesis is removed. The good news for many men is that ED can be treated safely, and treatments work well. If you have ED, there is hope. There is help. Talk to your health care provider to see which treatment will work best for you.

RESOURCES

  • American Association of Sexuality Educators, Counselors, and Therapists Find a certified sex therapist/counselor near you www.aasect.org, click on “Locate a Professional”
  • Frank Talk Peer support to help men deal with ED www.FrankTalk.org
  • Hormone Health Network In English: www.hormone.org/diseases-and-conditions/ mens-health/erectile-dysfunction 

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