Are you having a problem getting or keeping an erection? This is called erectile dysfunction (ED). Many men have ED sometime during their lives. It can be discouraging, but it can also be treated. Read on to learn more about ED. Share the information on this page with your partner if you can. And work with your doctor to find the best treatment for you. In most cases, ED is a problem that men don't have to live with.

Any man can experience ED at any time during his adult life. An erection problem may happen once in a while, or all the time. Either way, your doctors can help. You might visit your regular doctor. Or you may be referred to an urologist (a doctor who specializes in the urinary tract and the male sexual organs).

To find the cause of your ED, your doctor will evaluate you. Knowing the cause will help your doctor choose a treatment. Causes of ED may include:

• Using certain medications, such as sedatives, tranquilizers, blood pressure medications, or diuretics
  
• Smoking tobacco or marijuana
  
• Drinking too much alcohol
  
• Injury to nerves or blood vessels
  
• Having an illness, such as diabetes, alcoholism, depression, or a prostate problem
  
• Feeling stress over a recent hardship or lifestyle change

Ed Can Be Treated
Based on your evaluation, you and your doctor will discuss your treatment options. Your partner can meet with your doctor, too. Together, you'll decide on treatment. Your treatment options may include:

• Medications
  
• Erectile aids
  
• Surgery
  
• Counseling

Upcoming Treatments
New treatments for ED are being studied. These include new medications, gels, and patches. So stay in contact with your doctor. If your symptoms persist, he or she may be able to adjust your current treatment or prescribe something new.

STAGES OF AN ERECTION
Knowing how an erection occurs can help you understand how ED happens. How does the penis change from soft to swollen to erect? This change requires a healthy mind-body "team effort" led by the brain. Upon receiving signals from the brain, the blood vessels, nerves, and hormones work together to cause and maintain an erection.

The Soft
(Flaccid) Penis
If nothing is causing a man to become aroused, then his body's erection "team" of brain, nerves, blood vessels, and hormones won't begin working to cause an erection. The amount of blood flowing into his penis equals the amount flowing out. His penis remains soft.

The Swollen (Tumescent) Penis

A man becomes aroused through his senses (such as sight or touch) or his thoughts (such as memories or fantasies). His brain, blood vessels, nerves, and hormones begin working together to cause an erection. More blood flows into his penis than flows out. His penis starts to swell.

The Erect
(Rigid) Penis
As arousal continues, blood keeps moving into the man's penis. Blood-swollen tissues press against the veins. Some of the blood is kept from flowing back out. Engorged (filled) with blood, his penis becomes rigid. The man is able to have intercourse.

YOUR PATIENT HISTORY

Evaluating ED begins with your patient history. Your doctor will ask about your physical health, sexual health, relationship, and emotional health. Your answers will be kept confidential. So answer as completely as you can. Complete answers will help you get the most from your treatment.

Be honest and open when you talk with your doctor. Don't leave anything out. Talk about health problems or diseases you've had. List the drugs you take. Tell your doctor how and when your ED problems began. Also, discuss how you and your partner are getting along. Mention recent changes in your life. To prepare for talking with your doctor, answer the following questions.

Has a doctor every diagnosed you with:

• High blood pressure?
  
• Heart disease?
  
• Stroke or vascular disease?
  
• Diabetes?
  
• Alcoholism?
  
• Kidney disease?
  
• A disease of the nervous system?
  
• Do you have a family history of any of the diseases listed above?
  
• Have you been injured in your pelvis, genitals, or rectal area?
  
• Have you had surgery of the prostate, bladder, rectum, or spine?

In the last three months, have you used any drugs, such as:

• Prescription (peptic ulcer drugs, antidepressants, blood pressure medications, sedatives, or hormones)?
  
• Over-the-counter (cold or allergy medications, aspirin, antacids, vitamins, or herbal preparations)?
  
• Recreational (marijuana, cocaine, or amphetamine)?
  
• Tobacco (cigarettes, cigars, or chewing tobacco)?
  
• Alcohol?

• Do you have erection problems?
  
• Did your erection problem begin suddenly?
  
• Do you get erections but have problems keeping them?
  
• Do you ever wake up in the morning with an erection?
  
• Is your erection rigid enough for intercourse?
  
• Can you get an erection by fantasizing or masturbating?
  
• Do you have any problems climaxing or ejaculating?

• Are you and your partner sexually attracted to each other?
  
• Are you emotionally attracted to each other?
  
• Are there any ways you feel rejected by each other?
  
• Are you and your partner having problems with your relationship?
  
• Are you arguing with your partner a lot these days?
  
• Do you talk things over with your partner?
  
• Will your partner take part in treatment with you?

When you first began to have ED, were you:

• Under a lot of stress (job, relationship, money)?
  
• Using drugs or alcohol?
  
• Frequently feeling tired?
  
• Becoming involved with a new partner?
  
• Feeling a lot of anger?
  
• Having other emotional problems?

Have you and your partner:

• Felt nervous about having sex?
  
• Fought over sex recently?
  
• Decided not to have sex?

Do you feel depressed for reasons other than ED?

YOUR PHYSICAL EVALUATION

Ed may be due to a disease, injury, or other physical cause. To find out if your ED has a physical cause, your doctor will examine you. Your exam may include lab tests, sleep monitoring, blood flow tests, and other procedures. Your doctor will decide which tests can help find the cause of your ED.

During Your Physical Exam

Your doctor may first check your overall health. Also, your penis, scrotum, and testicles may be examined. Some or all of these tests may also be done:

Lab tests may be done to check your blood and urine. Some tests measure your levels of hormones (chemicals produced by the body to manage its functions). Other tests check levels of lipids (fatty substances in the body). Others help show the health of your liver, kidneys, and prostate. Another test may be done to check for diabetes.

A rectal exam may be done to check for an enlarged prostate gland. Some prostate problems can cause discomfort during sex.

Nerves in the penis may be checked to see if you have enough feeling in and around your penis. Your doctor may also check your bulbocavernosus (BC) reflex by squeezing the glans of your penis.

Conditions such as Peyronie's disease (hardened tissue in the penis that causes a curved or bent erection) can also limit your ability to have intercourse. Your doctor may check for this and other genital abnormalities.

Sleep Monitoring

Your doctor may have you put a device on your penis before you go to sleep. This can show if you have nocturnal erections (erections while you sleep). You may not know you have them. But they can happen when you dream. Or, your penis may stay soft all through your sleep. This may mean that damaged nerves or low blood supply inside the penis prevent it from becoming erect.

Testing Blood Flow
To further check blood flow, your doctor may order one or more of these tests:

Vasodilation: A drug is used to increase blood flow to the penis. This drug should cause an erection if the blood vessels of the penis are healthy.

Ultrasound: This imaging test uses painless sound waves to measure blood flow through the penis. It may be done before or after vasodilation.

Other tests: Your doctor may refer you for other tests. These measure how blood flows or how strong the blood pressure is within your penis.

Your Treatment Plan
We offer ALL available treatments for impotence including: oral medications, vacuum erection devices, transurethral medications, injection therapy and surgical implants. We will help you choose the most appropriate care and have the experience and expertise to offer the entire complement of services.

Counseling
Your doctor may refer you for counseling or other support. If there is no physical cause for the ED, counseling may be all the treatment you need. Or it may help you to visit a counselor while you're having other treatment. If you are referred to a counselor, ask your partner to take part in the sessions. And don't be afraid to try different counselors until you find someone who is easy for you to talk to.

MEDICATIONS

To treat your ED, your doctor may prescribe a medication. This may be a pill to swallow, or a medication that goes directly into the penis. In some cases, medications used for treating other conditions may be used to treat ED. Be aware that men with certain health problems should not use some medications. And all medications may cause side effects. So, follow your doctor's advice about these and other treatment.

Oral Medications
Drugs like sildenafil citrate (sold as Viagra) may help treat ED in some cases. But they're not for everyone. Don't take any medication for ED unless your doctor prescribes it. Take it only as directed. Tell your doctor if you are being treated for a heart condition.
Visit:
www.viagra.com

www.levitraflame.com

www.cialis.com

Drugs Can Interact
Other drugs may affect how sildenafil citrate works. Tell your doctor if you take other medications, vitamins, or herbal products. Don't take sildenafil citrate if you use pills, patches, or other forms of drugs that contain nitrates. These include nitroglycerin, isosorbide mononitrate, isosorbide dinitrate, and amyl nitrate ("Poppers").

Call your doctor if you have an erection lasting more than 2 hours.

Medications for Related Conditions

Medications used to treat other health problems may also help treat ED. These include medications to treat depression or to increase levels of testosterone. Such medications can be contained in pills, gels, or transdermal (skin) patches. If your doctor prescribes any of these medications, you will be shown how to use it properly.

Transurenthral Medication
With this treatment, a small applicator is used to place a soft, tiny pellet into the urethra. Medication in the pellet causes blood vessels in the penis to relax. The penis then fills with blood. In about 5 to 10 minutes, an erection begins. To hold the blood in the penis and maintain the erection, a tension ring may be used. This aid is placed around the base of the penis (see Constriction Therapy)

Call your doctor if you have an erection lasting more than 2 hours.

Self-Injected Medications
The drugs used with self-injection relax the blood vessels. This lets blood flow into the penis. Within 10 to 15 minutes, the penis can become rigid enough for sexual intercourse. Men with bleeding or clotting problems should talk with their doctor before using this treatment.

Call your doctor if you have an erection lasting more than 2 hours.

ERECTILE AIDS

Special erectile aids are sometimes used to treat ED. These are prescribed by a doctor. If your ED is treated by using an erectile aid, your doctor or nurse will explain how to use it. You and your partner may want to include the use of this aid as part of your sexual foreplay.

Vacuum Erection Therapy

Sometimes an erection can be gained using a vacuum system. To do this, a tube is placed over the penis. Then a pump creates a vacuum to draw blood into the penis, causing an erection. A tension ring placed around the base of the penis holds in the blood.

Venous Flow Constriction Therapy

This treatment is used for men with venous leak syndrome. This condition prevents blood from staying in the penis during an erection. The device is a band or tension ring placed around the base of the penis. The band keeps blood from flowing out of the erect penis.

WHEN SURGERY IS THE ANSWER

Surgery for ED is not common, but it may be the best treatment in some cases. During surgery, an implant (also called prostheses) is placed inside the spongy chambers of the penis. Then, the implant can be used to provide an erection. One of three types of implants may be used. If you receive an implant, your doctor will explain its use. Ask your doctor how soon you can be sexually active again after surgery.

Types of Implants

Malleable
(Semi-Rigid)
This type of implant is easy to use. Bendable rods can make the penis appear erect. When not in use, the rods can be bent downward.

Self-Contained Inflatable
With this implant, the penis can look and feel either erect or flaccid. It doesn't become as rigid as with other implants. Training and dexterity are needed to use the pump properly.

Three-Piece Prosthesis
This is the most complex type of implant. It allows the penis to look and feel either erect or flaccid, but training and dexterity are needed to use it properly.

Call your doctor if you have:

• Severe pain
  
• Fever
  
• Swelling
  
• Excessive bleeding

INTIMACY AS YOU AGE

Many men can enjoy sexual activity throughout their lives. But sexual responses change as people age. To get and keep an erection, an older man is likely to need more fantasy or touching than a man in his 20s. Older men may take longer to climax. Also, women's sexual responses may change as they age. Knowing about these changes can help you and your partner maintain an intimate relationship that grows with time.

The Aging Process
As people age, they often become less active. This can reduce muscle strength and cause weight gain. Sleep patterns may change. As a result, both men and women may have less energy. In men, testosterone levels begin falling in the late 30s or early 40s. In women, hormone levels decline after menopause (when menstruation stops). These and other changes in both men and women can affect sexual response.

Taking care of your body and mind can help make sex easier and more pleasurable - for men and women. If you haven't already, try the self-care tips below.

• Quit smoking.
  
• Drink less alcohol.
  
• Exercise often. (Talk with your doctor before starting an exercise program.)
  
• Reduce the stress in your life
  
• Keep your appointments with your doctors, counselors, and other health care providers.

BUILDING INTIMACY

Being intimate means being close as a couple, with sex as just one part of intimacy. A hug, a kind remark, or a gift can be very romantic, even if sex doesn't always follow. So renew your intimacy, along with your sex life. Spend time doing things you both like. Learn to talk with, and listen to, your partner. And remember that your value as a man goes beyond what you do in bed.

Tips for Talking
It's okay to be shy when you talk about sex with your partner. But talking gets easier with practice. Use these tips when you talk with each other.

Choose a time and place when you're both relaxed and comfortable.

Listen to your partner. Try repeating back what you think the other has said. This will help show if you've understood each other.

Don't judge what your partner says. Talking feels safer if you don't criticize each other.

Don't be defensive. You may not like something your partner says. But you can still thank your partner for being honest.

Think about meeting with a counselor. They're trained to help couples who are being treated for ED.

Tips for Intimacy
As you and your partner become closer to each other, you might find that you can enjoy sex more.

Show and tell your partner what you like. If you don't, your partner might not know what you want.

Ask your partner to show you how he or she wants to be touched.

Be patient. Take your time. Relax. Give your selves a chance to become aroused.

Try being intimate without intercourse. Instead, exchange back rubs. Or try kissing, or just a soft touch.

Focus on what you and your partner like about each other. This could be a certain laugh or smile, or other joys you share together.

FOR MORE INFORMATION

Sexuality changes over time. This is true for everyone. To renew your sex life, keep talking with your partner. Make sure to follow up with your doctor. And remember that your health care team can answer many of your questions. To learn more, or to find support while you're treating ED, contact any of the groups listed below.

Retired Persons Services, Inc.
AARP Pharmacy Service Provided
800-289-6031
www.rpspharmacy.com

American Diabetes Association, Inc.
800-232-3472, or check your
phone book for the local chapter
www.diabetes.org

Sexuality Information and Education
Council of the U.S. (SIECUS)
212-819-9770
www.siecus.org

American Association for Sex Educators,
Counselors, and Therapists (AASECT)
Fax: 319-895-6203
www.impotenceworld.org

Man to Man
(resources for prostate disease patients)
American Cancer Society
800-227-2345
www.cancer.org/m2m/m2m.html

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