Erectile Dysfunction

Problems with sexual interactions can impact you as an individual as well as strain a relationship or marriage. Erectile dysfunction (ED), also known as impotence, can occur at any age and can be persistent, recurrent or situational. In addition to affecting intimacy, erectile dysfunction can also contribute to male factor infertility by making it difficult to engage in successful intercourse required for conception.

Erectile dysfunction is a common problem affecting more than 50% of men between the ages of 40 and 70. With newer treatments available, public awareness of the problem has greatly increased.

If you suffer from erectile dysfunction, the team at The University of Kansas Health System can help.

Erectile dysfunction, or impotence, is the persistent inability to maintain an erection that is firm enough or lasts long enough to have sexual intercourse. In the past, physicians often attributed ED to psychological causes. However, we now know that psychological causes are responsible for less than 10% of cases of serious ED. ED is a common problem that’s often caused by physical conditions, including prostate cancer, diabetes and cardiovascular disease.

ED can limit your intimacy, affect your self-esteem and impact your most important relationships. However, the good news is that today nearly every case is treatable.

Erectile dysfunction (ED) presents in different forms depending on its underlying causes.

• Organic ED: This type is rooted in physical causes such as vascular conditions (like atherosclerosis), hormonal imbalances (e.g., low testosterone) or neurological issues (such as multiple sclerosis). Organic ED is frequently linked to reduced blood flow or nerve damage affecting erectile function.
• Psychogenic ED: Many men also suffer from ED caused by psychological factors. Stress, anxiety, depression or relationship issues can disrupt the brain’s ability to initiate or maintain an erection, even in the absence of physical problems.
• Mixed ED: Many individuals with ED experience a combination of both organic and psychogenic factors contributing to their condition. This mixed ED can be challenging to diagnose and treat since it involves a complex interplay of physical and psychological elements.
• Lifestyle-related ED: Unhealthy lifestyle choices, including smoking, excessive alcohol consumption, a sedentary lifestyle and poor dietary habits, can lead to ED. These factors can affect blood circulation and overall health, making it difficult to achieve and sustain an erection.
• Medication-induced ED: Certain medications, such as some antidepressants, antihypertensives or drugs that affect the central nervous system, can have ED as a side effect. Managing this type of ED may involve adjusting or discontinuing the offending medication under a doctor’s supervision.
• Hormonal ED: Hormonal imbalances, especially low testosterone, are another cause of ED. In some patients, thyroid disorders may also play a role.

Erectile dysfunction, as with many health conditions, has a spectrum of severity. The most frequent symptom is the inability to achieve any penile erection at all. Commonly, however, men may experience partial erection with either incomplete rigidity or loss of rigidity before ejaculation. ED can be associated with a decreased interest in sex or a reduced libido.

ED can result from a variety of underlying factors – both physical and psychological. Understanding what’s contributing to your ED is the first step toward effective treatment.

• Vascular issues: Problems with blood flow to the penis are a common cause of ED. Conditions such as arterial blockage due to atherosclerosis (hardening of the arteries), high blood pressure or diabetes can restrict blood flow, making it difficult to achieve and maintain an erection.
• Neurological conditions: Conditions that affect the nervous system, like multiple sclerosis or Parkinson’s disease, can disrupt the signals between the brain and the penis necessary for an erection.
• Hormonal imbalances: Low testosterone levels, a condition called hypogonadism, can contribute to ED. Hormonal fluctuations can affect sexual function.
• Psychological factors: Stress, anxiety, depression and relationship problems can lead to psychogenic ED by interfering with the brain’s ability to initiate or maintain an erection.
• Medications: Some drugs, including certain antidepressants, antihypertensives and sedatives, can have ED as a side effect.
• Lifestyle factors: Unhealthy lifestyle choices, such as smoking, excessive alcohol consumption, lack of physical activity and a poor diet, can contribute to ED by impairing overall health and blood circulation.
• Injury or surgery: Trauma to the pelvic area, spinal cord injury or surgery involving the prostate, bladder or colon can damage nerves and blood vessels responsible for erections.
• Underlying medical conditions: Conditions like obesity, metabolic syndrome and chronic kidney disease can increase the risk of ED.
• Age: While not a cause in itself, aging can lead to changes in blood vessels and hormonal levels, making older men more susceptible to ED.

Often, your doctor can diagnose erectile dysfunction based on your description of symptoms and medical history along with a physical exam. In some cases, your doctor may recommend additional tests to rule out or identify an underlying condition that could be the cause of your ED symptoms.

Our doctors follow a thorough, multistep evaluation process that typically includes:

• Medical history: The first step is a thorough medical history discussion, during which the healthcare provider will inquire about the patient’s sexual history, overall health, lifestyle habits and any medications or supplements being taken. It’s essential for the patient to be open and honest about their symptoms and concerns.
• Physical examination: A physical examination may be conducted to check for any physical abnormalities that could contribute to ED, such as signs of vascular or neurological issues. The doctor may also examine the genital area for any physical abnormalities or structural problems.
• Blood tests: Blood tests can help identify underlying medical conditions that may be causing ED, such as diabetes, hormonal imbalances or high cholesterol levels. A testosterone level test may also be conducted to assess hormonal status.
• Psychological evaluation: In cases where psychological factors are suspected, a psychological evaluation may be recommended. This can involve assessing mental health, stress levels and any underlying psychological conditions that could contribute to ED.
• Imaging studies: In some cases, specialized imaging studies like Doppler ultrasound may be used to evaluate blood flow to the penis. This test can help identify vascular issues that may be causing ED.
• Nocturnal penile tumescence (NPT) test: This test measures spontaneous nighttime erections, which can help determine if the cause of ED is primarily physical or psychological. Men typically have several erections during sleep, and the absence of these can indicate underlying physical factors.
• Screening for underlying conditions: Since ED can be associated with other health issues, such as cardiovascular disease, it may be necessary to screen for these conditions if they are suspected based on the patient’s medical history and risk factors.
• Questionnaires: Healthcare providers may use standardized questionnaires, such as the International Index of Erectile Function (IIEF), to assess the severity of ED and monitor treatment progress.

ED usually can be treated easily with prescription oral medications called PDE5 inhibitors, commonly known as brands such as Viagra®, Levitra® or Cialis®. Physicians at The University of Kansas Health System will evaluate your erectile dysfunction and select the best medication for you.

If ED medication is not effective for you, our physicians are experienced in a wide range of options to treat erectile dysfunction:

• Lifestyle modifications: Improving diet and exercise can enhance overall vascular health, reducing ED risk. Reducing stress and quitting smoking may also improve ED symptoms.
• Vacuum erection devices (VEDs): These devices create a vacuum around the penis, drawing blood into the organ to induce an erection.
• Penile injections: Intracavernosal injections deliver medications (e.g., alprostadil) directly into the penis, stimulating an erection.
• Psychotherapy: Counseling or sex therapy can be beneficial, particularly for ED with psychological roots.
• Hormone therapy: In cases of hormonal imbalance, hormone replacement therapy may be recommended.
• Natural supplements: Some individuals explore herbal remedies like ginseng or L-arginine, but their effectiveness varies.
• Shockwave therapy: This noninvasive treatment uses low-intensity shock waves to stimulate blood flow and improve erectile function.
• Penile implants: Surgical implants (e.g., inflatable or semi-rigid) provide a long-term solution for ED when other treatments are ineffective.

If surgery is needed for your erectile dysfunction, our urologists are among the few physicians in the Kansas City area who implant penile protheses and perform complex prothesis surgery to treat erectile dysfunction. This procedure uses an artificial device to provide erections and is reported to result in satisfaction rates greater than 90%. With extensive experience in these techniques, our physicians offer the latest approaches for surgical correction of impotence.

A penile implant is entirely concealed within the body and is designed to be simple and discreet to operate. ED implant surgery can offer a long-term solution to ED and help you return to an active, satisfying sex life.

As with any medical procedure, there are risks involved and not all men are candidates for a penile implant. Discuss the risks and benefits of this procedure in more detail with your doctor. There are benefits and risks to penile implants: