Erectile Dysfunction
By Hitesh R. Patel, M.D.
Erectile dysfunction affects millions of men in this country. Erectile dysfunction is when men
can't get a penile erection or can't keep an erection long enough to finish having sex. Erectile
dysfunction is sometimes called "impotence," although that's an older term that doctors aren't
using as much these days. Erectile dysfunction is a highly common problem. Ten to 20 million
men in the United States have erectile dysfunction to some degree. The chance of having
problems with erection increases as men age, but many older men have no problems at all.
Many medical conditions, including the use of certain medicines and psychologic problems, may
cause erectile dysfunction.The most common cause of erectile dysfunction is problems with the
blood vessels that carry blood to the penis. In some men, the blood vessels narrow and don't
allow the increased blood flow needed for a full erection. Conditions that cause the blood
vessels to narrow include atherosclerosis (hardening of the arteries), high blood pressure, high
cholesterol levels and long-term smoking.
During a normal erection, signals from the brain and spinal cord are sent through nerves to the
blood vessels in the pelvis and the genitals. These signals cause the blood vessels to widen and
allow the penis to fill with blood and become erect.
Many conditions can interfere with these signals, causing erectile dysfunction. Damage to the
nerves may be caused by stroke or spinal cord injury, or may occur during prostate surgery or
other types of surgery. Diabetes and long-term heavy alcohol use can also damage the nerves'
ability to send signals.
Men who don't make enough testosterone (male hormone) may have problems achieving an
erection. However, low hormone levels more commonly affect a man's interest in sex (libido)
rather than the ability to have an erection. Other hormone abnormalities may also cause erection
problems.
Many medicines can affect the ability to have sex. Medicines can decrease the ability to have an
erection. Medicines can also affect the level of interest in sex and the ability to have an orgasm.
Medicines used to treat high blood pressure, heart disease, depression and heartburn are among
the most common medicines that interfere with the ability to have an erection.
Viagra is the brand name for Sildenafil. It's a medicine that doctors prescribe to help men with
erectile dysfunction have sex. If your doctor prescribes this medication for you, follow your
doctor's instructions. Usually, a man takes 1 tablet 1 hour before he plans to have sex. You
should not take more than 1 tablet in 24 hours. The medicine comes in tablets of 25 mg, 50 mg
and 100 mg. Most patients start with 50 mg.
Even if you take Viagra, you still need physical and mental stimulation and desire to have an
erection. If your first dose of Viagra doesn't help, call your doctor. Your doctor may want to
change your tablet strength.
Viagra has some common side effects:
 Headache
 Flushing (face and upper body turning red and warm)
 Stomach upset
 Runny nose (sniffles)
 Vision changes (things look blue)
Headache is the most common side effect. Vision changes are the least common. Talk to your
doctor if you have any side effect that bothers you.
Not everyone can take Viagra. You shouldn't use Viagra if you take any of these forms of
nitroglycerin or any other nitrates:
 Isosorbide mononitrate (brand names: Ismo, Monoket, Imdur)
 Isosorbide dinitrate (brand names: Isordil, Sorbitrate)
 Sublingual nitroglycerin tablets or spray (brand names: Nitrostat, Nitrolingual Spray)
 Transdermal nitroglycerin patches or paste (brand names: Minitran, Nitro-Dur,
Transderm-Nitro TTS)
If you use Viagra and get chest pains, be sure to tell the paramedics, nurses or doctors at the
hospital that you use Viagra and how long ago it was that you last took a Viagra tablet. In overall
effectiveness, based on clinical trials, men with erectile dysfunction were 3.6 times more likely
to improve with sildenafil than with placebo.
Depression, anxiety or stress may also cause problems with erectile function. In some men, not
feeling satisfied with their sexual function may lead to depression or other psychologic
symptoms.
The most effective treatment depends on the cause of the erectile dysfunction. Lifestyle changes,
such as quitting smoking, drinking less alcohol, reducing stress and strengthening relationships
may improve erectile function. Adjusting regularly used medications and identifying and treating
certain medical conditions may also improve erectile function. Pills to aid erectile ability,
vacuum devices, and medication placed in the penis are additional treatment options available.
If you have erectile dysfunction, you and your family physician should work together to decide
what treatment is best for you.
If you have any further questions on anything we have discussed in this article, please feel
free to contact us at the Physicians Wellness Center at (732) 744-0634. You will find a
comfortable and confidential environment in which you can discuss any medical issue that you
wish. While appointments are preferred, walk-ins are welcome. Weekday, weeknight, and
Saturday hours available and we take same-day appointments for your convenience. We are
located right on Oak Tree Road at #1804, Suite #4. You can also find us on the Internet at
www.physicianswellnesscenter.com