What you need to know
Erectile dysfunction is a common condition that affects many men, particularly as they age.
- Erectile dysfunction (also called ED) is the consistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. ED is a common condition affecting millions of men worldwide.
- ED can be caused by physical or psychological issues, or a combination of both.
- There are different treatments for ED, including medication, hormone replacement and implants. Working with a trained men’s health specialist is the best way to find a treatment option that will work for you and your goals.
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What causes erectile dysfunction?
Erectile dysfunction can be caused by different health conditions. Risk factors for erectile dysfunction may include:
- Prostate problems
- Diabetes
- Hypertension (high blood pressure)
- Heart disease
- Depression
- Smoking
- Alcohol use
These and other underlying conditions can cause ED. Sometimes, ED can be the first sign of another health issue, so seeing a doctor early can help you detect and treat any conditions that might be leading to erectile dysfunction.
Screening and diagnosis
Usually, the first sign of erectile dysfunction is the inability to achieve or maintain an erection. If this problem persists (meaning it happens regularly), that can be a sign to talk to a urologist.
Your care provider may perform tests to understand the cause of ED. These tests can include:
- Patient medical and sexual history
- Physical exam
- Lab tests
- Psychosocial exam
Depending on your health and other conditions, your doctor may recommend other tests and diagnostic procedures.
Why choose WashU Medicine for ED treatment?
- Our specialists offer the latest treatment options, including different medications and minimally invasive procedures.
- We take the time to listen and work with you on a plan that fits your preferences and goals.
- Our urologists rank among the top doctors in the region, and we see patients at convenient locations around St. Louis.
Types of treatment
There are several treatment options available for erectile dysfunction.
Which treatment is best for you depends on:
- Your age, health and medical history
- Severity of your ED
- Your preference
- Other factors you and your urologist discuss
Treatments include both surgical and non-surgical options.
Non-surgical options
Most cases of erectile dysfunction can be treated without the need for surgery. Non-surgical treatments include:
- Medical treatments: Oral medications including sildenafil, tadalafil and vardenafil increase blood flow to the penis before sexual activity. These are effective for approximately 70-80% of men with ED.
- Hormone replacement therapy: Testosterone replacement therapy may improve several symptoms in men who have insufficient testosterone levels. This type of therapy is not recommended for people with normal testosterone levels, as it can lead to prostate enlargement and other issues. Testosterone therapy can be offered as a cream, gel, patch, injectable or other form of treatment.
- Vacuum devices: These are external devices consisting of a cylinder, a pump and an elastic ring. A clear tube is placed over the penis, and suction is used to create an erection. The ring serves as a tourniquet at the base of the penis to maintain the erection.
- Urethral suppositories: Medications inserted into the urethra at the tip of the penis can be used to enhance blood flow, stimulating an erection.
- Injection therapy: A syringe and needle – the same size as used by diabetic patients to inject insulin – are used to inject a blood vessel-dilating medicine into the side of the penis. An erection develops about 10-15 minutes after the injection. The goal is to create a rigid erection that lasts from 20 to 60 minutes. The dose is individualized for each patient.
Men’s health specialists at WashU Medicine
Surgical care options
For patients who do not respond to conservative treatments, WashU Medicine offers multiple advanced surgical options:
- Penile implants: A device is surgically placed inside the penis. Options include semi-rigid rods and inflatable implants. Urologists at WashU Medicine most often implant a three-piece inflatable prosthesis with fluid cylinders that can be completely filled, resulting in an erection, or completely emptied, resulting in a natural, non-erect (flaccid) state. A pump in the scrotum is used to inflate the penis.
- Revascularization: Vascular surgery to restore blood flow to the penis. ED that happens in young people after a pelvic fracture can often be corrected with surgical transfer and sewing of an artery into the penis.
- Peyronie’s disease treatment: Severe penile curvature that makes intercourse difficult or impossible is a distressing condition. Surgical correction of penile curvature caused by Peyronie’s disease can help with ED in some cases.
Recovery
Most medical treatments can have rapid results without any recovery time.
After surgery, patients receive instructions to ensure effective healing and return to function.
Regular follow-up visits are scheduled to monitor progress and address any issues.
Recovery varies with each patient, but most can expect gradual improvement over several weeks.
World-class care, close to home
Urologists at WashU Medicine see patients at Barnes-Jewish Hospital, one of the top hospitals in the nation, as well as convenient locations across the region.
Managing chronic conditions and complications
ED can sometimes be a symptom of chronic health conditions and should not be overlooked.
Our urologists are part of a team of multidisciplinary WashU physicians. This means that if your ED has a simple solution, we can provide all the care you need—often in a simple office visit—but we are also capable of providing comprehensive care if your erectile dysfunction has a more severe underlying cause.