For many men, lifestyle changes can help:

• Cut down on smoking, alcohol, and illegal drugs.
• Get plenty of rest and take time to relax.
• Exercise and eat a healthy diet to maintain good circulation.
• Use safe sex practices, which reduces fear of HIV and STDs.
• Talk openly to your partner about sex and your relationship. If you are unable to do this, counseling can help.

Couples who cannot talk to each other are not likely to be able to make love to each other. Men who have trouble communicating their feelings may find it difficult to share with their partner any anxieties about their sexual performance. If you keep worries to yourself, you are more likely to lose erections. Men who cannot express and resolve feelings of anger or frustration towards their partner may hold back their erection as a weapon in the conflict. In these circumstances, counseling can be very helpful for both you and your partner.

If erection problems seem to be caused by a medication you are taking for an unrelated condition, consult your doctor. You may benefit from reducing the dose of the drug or changing to another drug that has the same result but not the same side effects. DO NOT adjust or discontinue medications without consulting your doctor first.

Talk to your health care provider if your erection problems are related to fear of recurring heart problems -- sexual intercourse is usually safe in these circumstances.

Call your doctor if:

• Self-care measures do not resolve the problem and you continue having difficulty with erections. Effective treatments are available.
• You suspect that a medication is causing the problem.
• The problems begin after an injury or prostate surgery.
• You have other symptoms like low back pain, abdominal pain, or change in urination.

Call your doctor immediately or go to an emergency room if medication for erection problems give you an unwanted erection that lasts more than an hour. Permanent impotence or other lasting damage to your penis may result from this condition.

Your doctor will perform a physical examination, which will likely include checking your circulation, a rectal exam, a neurological exam, and an exam of your penis.

To help diagnose the cause of the problem, your doctor will ask medical history questions, such as:

• Have you been able to achieve and maintain erections in the past?
• Is the difficulty in achieving erections or maintaining the erection?
• Do you have erections during sleep?
• How long have you had difficulty with erections?
• What medications are you taking (including prescription medications, over-the-counter medications, recreational drugs)?
• Do you smoke? How much each day?
• Do you use alcohol? How much?
• Have you recently had surgery?
• Have you ever had vascular surgery or other treatments for your blood vessels?
• Are you depressed?
• Are you afraid or worried about something?
• Are you experiencing a lot of stress?
• Has your energy level decreased?
• Are you sleeping well each night?
• Are you afraid of sexual activity because of physical problems?
• Have there been any recent changes in your life?
• What other symptoms do you have?
• Have you noticed changes in sensations in your penis?
• Do you have any problems with urination?

Tests that may be performed include:

• Urine analysis
• Blood tests, including CBC, metabolic panel, hormone profile, PSA
• Penile ultrasound (to evaluate for blood vessel or blood flow problems)
• Nocturnal penile tuemscence (NPT) to test if you are having nighttime erections and rigidity monitoring (Rigiscan)
• Neurological testing
• Psychometric testing

TREATMENT

The treatment depends on the cause. For example, if the problem is caused by a hormonal imbalance, medication to treat the underlying endocrine disorder will be prescribed. Consult your health care provider for appropriate evaluation and management.

There are many treatment options today. These include medicines taken by mouth, injections into the penis, vacuum devices, and surgery. In order to treat erectile dysfunction effectively, you must be aware of and comfortable with the possible side-effects and complications that may occur with each therapy.

Sildenafil (Viagra), vardenafil (Levitra), and tadalafil are medicines prescribed for mild-to-moderate erection difficulties caused by either physical or psychological problems. Although these medicines have become extremely popular, they are not "cure-alls," and they do not enhance erections if you are not impotent. And, they DO have side effects. These pills should not be used with certain other medications.

Men who take nitroglycerin for a heart condition (as either tablets, spray, or patches) should NOT take these medications. When taken with nitroglycerin, these drugs can significantly lower blood pressure. Some men have died from combining these drugs and nitroglycerin.

If pills do not work, other options are available. Testosterone may be prescribed by either skin patch or injection, especially if the problem is related to age. Alprostadil, injected at the penis or inserted as pellets, improves blood flow to the penis. This technique is usually more effective than medications taken by mouth.

For some patients, a vacuum pump or penile prosthesis (implant) may also be recommended or required.

Consult your health care provider to see if one of these treatments is right for you.

Kaiser DR, Billups K, Mason C, et. al. Impaired Brachial Artery Endothelium-Dependent and Independent Vasodilation in Men With Erectile Dysfunction and No Other Clinical Cardiovascular Disease. JACC. 2004:179–84

Glina S. Testosterone and erectile dysfunction. J Men’s Health Gend. 2004; 1(4): 407-412.

Use of Sildenafil (Viagra) in Patients with Cardiovascular Disease: Expert Consensus Document. J Am Coll Cardiol. 1999; 33: 273-82.