Home Care:

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 likely to have problems with sexual intimacy. Men who have trouble communicating their feelings may find it difficult to share with their partner any anxieties about their sexual performance. In these circumstances, counseling can be very helpful for both you and your partner.

Call your health care provider if:

Call your doctor if:

• The problem does not go away with self-care measures -- effective treatments are available
• The problem begins after an injury or prostate surgery
• You have other symptoms like low back pain, abdominal pain, or change in urination

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 change or stop taking any medications without first talking to your doctor.

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 immediately or go to an emergency room if medication for erection problems give you an unwanted erection that lasts more than 4 hours. Permanent impotence or other lasting damage to your penis may result from this condition.

What to expect at your health care provider's office:

Your doctor will perform a physical examination, which will likely include:

• Checking your blood flow (circulation)
• Exam of your penis
• Neurological exam
• Rectal exam

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, and 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 done include:

• Blood tests, including complete blood count, metabolic panel, hormone profile, and PSA
• Neurological (nerve) testing
• Nocturnal penile tumescence (NPT) to check for normal nighttime erections
• Penile ultrasound to check for blood vessel or blood flow problems
• Psychometric testing
• Rigidity monitoring
• Urine analysis

The treatment may depend on the cause. For example, if the problem is caused by a hormonal imbalance, medication to treat the underlying endocrine disorder will be prescribed. However, the same treatment may be used for many different causes. 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, medicines inserted into the urethra (urinary channel), 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 (Cialis) are medicines prescribed for erection difficulties caused by either physical or psychological problems. The drugs work only when the man is sexually aroused. The effect is usually seen within 15 - 45 minutes.

These drugs are called phosphodiesterase-5 (PDE5) inhibitors.

Although these drugs have become extremely popular, they do not enhance erections if you are not impotent. And they DO have side effects, which can be as serious as a heart attack or as minor as muscle pain or facial flushing.

These drugs should not be used with certain other medications, including nitroglycerin. When taken with nitroglycerin, a man's blood pressure can become dangerously low. Some men have died after taking these drugs with nitroglycerin.

PDE5 inhibitors should be used with caution if you have any of the following conditions:

• Recent stroke
• Severe heart disease, such as unstable angina, a recent heart attack, or arrhythmia
• Severe heart failure
• Uncontrolled hypertension (high blood pressure)
• Uncontrolled diabetes
• Very low blood pressure (hypotension)

If pills do not work, options such as the following are available.

• Testosterone replacement using skin patches, topical gel, or injections into the muscle may be prescribed if your blood testosterone level is low.
• A medicine called alprostadil, injected into the penis or inserted into the urethra, improves blood flow to the penis. This usually works better than medications taken by mouth.
• An external vacuum device can be used to pull blood into the penis. A special rubber band is then used to maintain the erection during intercourse.
• For some patients, a surgically-placed penile implant (prosthesis) may also be recommended or needed.

Many herbs and dietary supplements are marketed to help sexual performance or desire. There are several special concerns for people taking alternative remedies for erectile dysfunction. Also, none of these remedies have been proven effective for treating erectile dysfunction.

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