American Medical Association Family Medical Guide - American Medical Association [257]
Medical conditions that damage nerves and blood vessels—such as diabetes (see page 889), heart disease (see page 558), brain or spinal cord injuries, multiple sclerosis (see page 696), or Parkinson’s disease (see page 691)—can cause erection problems. In some cases, prescription medications—such as drugs used to treat high blood pressure and heart disease, and drugs that affect the nervous system such as antidepressants, tranquilizers, and sedatives—contribute to erection problems. Cigarette smoking, over-the-counter medications, alcohol, or illicit drugs such as marijuana, heroin, and cocaine also can play a role. Peyronie’s disease (see page 839), a condition in which scarring of the penile tissues produces a curvature of the penis and pain during an erection, is another possible cause. Smoking adversely affects blood flow and can affect a man’s ability to have an erection.
In some men, psychological factors such as anger, stress, anxiety, or depression can contribute to erection problems. Being unable to maintain an erection can make a man feel inadequate, embarrassed, or guilty, and consider himself unattractive to his partner. These feelings may cause him to avoid intimate situations or withdraw from his partner, which can increase tension in the relationship. The psychological effects of erection problems can also affect other areas of his life, such as social interactions and job performance.
Symptoms
Men who have erection problems may be unable to achieve an erection, may be able to achieve an erection only occasionally, or may be unable to maintain an erection. If you have symptoms of erection problems, your doctor may refer you to a urologist (a doctor who specializes in treating disorders of the urinary tract).
Diagnosis
To help diagnose erection problems, a doctor will take a detailed health history and a sexual history. He or she will ask about your ability to achieve and maintain erections and ask you when and how often they occur. The doctor also will want to know about other diseases or conditions you have that could be contributing to the problem. He or she will ask questions about your use of prescription medications and other drugs (including alcohol), which can affect sexual performance. The doctor will perform a physical examination and may recommend blood and urine tests to measure levels of hormones, cholesterol, and glucose, and to evaluate pituitary, liver, kidney, testicle, and thyroid function.
In some cases, the doctor orders specialized tests to evaluate erectile function by examining the blood vessels, nerves, muscles, and other tissues of the penis and surrounding areas. The doctor also may evaluate blood flow in the penis using ultrasound (see page 111) images, which are pictures of blood flow in the penis during an erection induced by injecting a drug that dilates the blood vessels in the penis. The blood pressure in the penis is evaluated with a special cuff. A series of X-rays using a contrast medium (dye) may be performed to evaluate blood flow in the penis.
The doctor will probably evaluate your secondary sexual characteristics, such as breast development, to determine if you have a testosterone deficiency or an excess of the female hormone estrogen, either of which can interfere with the ability to have an erection. Penile nerve function tests can determine if there is sufficient sensation in the penis and surrounding area. Some doctors perform biothesiometry, a diagnostic technique that uses vibration to measure the perception of sensation. A decreased perception of vibration can indicate nerve damage in the pelvic area, which can result in erection problems. Erections during sleep can be measured at home by using either a snap gauge or a strain gauge, devices that are wrapped around the penis to monitor and measure nocturnal erections.
Treatment
If you have erection problems, your doctor will describe the available treatments. For any method to be effective, you must be committed to the option you select and have realistic expectations