Erectile Dysfunction

Male sexual dysfunction includes erectile dysfunction, premature ejaculation, retrograde ejaculation and inability to reach orgasm. Erectile dysfunction (ED) is defined as the inability to obtain or maintain an erection suitable for satisfactory sexual performance. Approximately 50% of men between the ages of 40 and 70 years report experiencing some degree of ED.

Sexual function naturally declines in the healthy, aging male. Erections can become progressively less firm and require more stimulation to achieve, semen volume and ejaculatory force diminish and the latency period between ejaculation and repeat erection increases.

Once thought to be primarily a psychological condition, it is now recognized that the vast majority of ED stems from a combination of physical and emotional causes.

A number of acute and chronic medical conditions, and the treatment of those conditions, can contribute to ED. Most commonly, ED can result from longstanding diabetes mellitus and cardiovascular disease. High blood pressure and high cholesterol levels may affect normal erectile function, and certain medications to control high blood pressure can cause ED. Neurologic disorders such as Parkinsons, multiple sclerosis and spinal cord injuries are frequently associated with a significant degree of ED. The surgical management of prostate and rectal cancer, as well as pelvic irradiation, can leave men suffering with ED.

Depression and anxiety affect not only sexual desire, but also sexual performance. It is imperative that any patient seeking medical advice regarding ED provides his doctor the details of any past or ongoing psychological troubles.

The evaluation of the male suffering with ED includes taking a lifetime sexual history, a medical and past surgical history, a physical exam, blood tests and in certain cases, additional, more invasive testing. Medical problems known to contribute to ED must be effectively managed, the medications used to treat those conditions might require adjusting, and hormonal deficiencies should be corrected.

Treating Erectile Dysfunction in Bucks County PA

The first step in treating ED often involves a few recommended lifestyle changes. Cigarette smoking and excessive consumption of alcoholic beverages are frequent contributing causes of ED. Smoking cessation and moderation of alcoholic beverage intake can dramatically improve sexual function. Weight loss and regular exercise can help improve erectile function in the overweight and unconditioned patient. Men engaged in long-distance bicycle riding often must consider changes in seat design or riding practices to prevent injury to nerves and blood vessels critical for normal erectile function.

Currently there exist a large number of medications to help treat ED. There are oral medications designed to improve blood flow to the penis at the time of sexual stimulation (Viagra, Levitra, Cialis), urethral suppositories which accomplish similar results (Muse), and penile injections which are also capable of improving blood flow and the penile response to stimulation (Caverject, trimix). A number of medications are available to help restore normal testosterone levels to men deficient in this important hormone (testosterone injections, Androgel, Testaderm, Testim, Testopel). Whether the commonly prescribed herbal supplement Yohimbine enhances erectile function remains unclear.

Despite making proper lifestyle changes and using the medications listed above, some men will continue to experience ED. If sufficiently motivated, these men might be candidates for vacuum erection devices, penile vascular surgery or the surgical placement of a penile prosthesis.

Men, and their partners, interested in speaking to a urologist about their sexual dysfunction are encouraged to call the office to schedule an initial consultation.


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