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A significant number of men develop impotence from psychological causes that can be overcome. When a physiological cause is treated, subsequent self-esteem problems may continue to impair normal function and performance. Qualified therapists (e.g., sex counselors, psychotherapists) work with couples to reduce tension, improve sexual communication, and create realistic expectations for sex, all of which can improve erectile function.
Qaseem and colleagues analyzed the findings of 130 studies that evaluated PDE-5 inhibitors alone or combined. They found that treatment with the drugs led to statistically significant and clinically relevant improvements in sexual intercourse and erectile function in men with ED, regardless of the cause (e.g., diabetes, depression, prostate cancer) or ED severity at the start of the study.
In some cases frequent use of a vacuum pump can eventually improve the degree of erection attainable without use of the pump. Claims of cheap "penis pumps" to permanently increase maximum penis size should be viewed with caution, however.
How Does the Penile Prosthesis Work?
Arterial Disorders (peripheral vascular disease, hypertension; reduced blood flow to the penis).
Antidepressants: Many different drugs, including Prozac, Zoloft, Elavil, and Wellbutrin, are used to treat depression. Some antidepressants can worsen ED, so be honest with your doctor about your condition so that he or she can prescribe an appropriate treatment.
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Concurrent administration with ketoconazole (200 mg PO qd), itraconazole (200 mg PO qd), or erythromycin: Not to exceed 5 mg PO q24h
Correspondence to Carmine Gazzaruso, MD, IRCCS Maugeri Foundation Hospital, Internal Medicine Unit, Via Ferrata 8, 27100 Pavia, Italy. E-mail c.gazzaruso@tele2.it
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Hormonal (testosterone) therapy No surgery required
In most cases, ED is a result of physical causes (although it can easily be made worse by psychological factors), and can often be treated. However, silence, embarrassment, and feelings of inadequacy and humiliation only lead to further withdrawal on the part of both partners, increasing the distance and tension within the relationship. The anxiety which results can easily make a case of ED worse, leading to a vicious circle of failure and anxiety about failure.
The findings are published in this weeks issue of the Proceedings of the National Academy of Sciences.
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is a staff family physician at the Branch Medical Clinic, Naval Weapons Station, China Lake, Calif. Dr. Clenney is a graduate of the University of South Florida College of Medicine, Tampa.
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(Abbreviated DICC) technique in which fluid is pumped into the penis at a known rate and pressure. It gives a measurement of the vascular pressure in the corpus cavernosum during an erection. To do this test, a vasodilator like prostaglandin E-1 is injected to measure the rate of infusion required to get a rigid erection and to help find how severe the venous leak is.
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The VCD consists of an acrylic cylinder with a pump that may be attached directly to the end of the penis. A constriction ring or band is placed on the cylinder at the other end, which is applied to the body. The cylinder and pump are used to create a vacuum to help the penis become erect; the band or constriction ring is used to help maintain the erection.
Epidemiology of erectile dysfunction
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The American Academy of Family Physicians says the condition doesn't have to be a natural part of getting older. ED often is attributed to physical or psychological causes. Physical reasons may include:
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