Erectile Dysfunction

Overview

Erectile dysfunction (ED), also known as impotence, is the inability to get and keep an erection firm enough for intercourse.

Most men will have ED occasionally, and this is not cause for any worry. However, if ED becomes a consistent problem, it can cause emotional distress, impact your quality of life and may be an indicator of an underlying health issue.

If you are suffering from ED, talk to us. Our experts at City of Hope have many effective treatment options available for you.

Request a Consultation

To make an appointment here at City of Hope, request an appointment online or contact us at 800-826-4673 (HOPE). Please visit Making Your First Appointment for more information.

As a founding member of the National Comprehensive Cancer Network, our doctors also help develop and improve evidence-based prostate cancer treatment guidelines for patients throughout the country.

The physicians in our Division of Urology and Urologic Oncology are leading experts in treating patients with all types of urologic disorders and cancers. Just as no two patients are alike, erectile dysfunction requires a unique treatment plan tailored to each individual to attain the best possible outcomes.

 

 

NEWS & BREAKTHROUGHS

What causes erectile dysfunction?

Male Anatomy (Courtesy: National Cancer Institute)

The penis is comprised of three main chambers: the urethra, where urine and semen pass, and the paired corpora cavernosa. The corpora are composed of a firm elastic layer called the tunica albuginea, and the inner erectile tissue called the corpora cavernosa, that fills with blood during an erection.

For an erection to occur, there are three important factors: stimulation, the nerve function in the penis and the blood flow to fill the corpora to induce an erection. When any of these factors are impacted, erectile dysfunction (ED) can occur.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, a variety of physical and psychological or emotional issues can cause ED. Physical causes include damage to the nerves, arteries, smooth muscles, and fibrous tissues in the penis.

Diseases and disorders that cause damage and can lead to ED include:

  • High blood pressure
  • Diabetes, a complex group of diseases characterized by high blood glucose, also called high blood sugar or hyperglycemia
  • Atherosclerosis, the buildup of a substance called plaque on the inside of arteries
  • Heart and blood vessel disease
  • Chronic kidney disease
  • Multiple sclerosis, an autoimmune disease that attacks the nerves
  • Injury from treatments for prostate cancer, including radiation and prostate surgery
  • Injury to the penis, spinal cord, prostate, bladder, or pelvis
  • Surgery for bladder cancer
  • Peyronie’s disease, a disorder in which scar tissue, called a plaque, forms in the penis
  • Lifestyle choices, such as smoking, drinking too much alcohol, using illegal drugs, being overweight, and not exercising

Psychological or emotional issues, such as the following, can also contribute to ED:

  • Anxiety
  • Depression
  • Dear of sexual failure
  • Guilt
  • Low self-esteem
  • Stress

Signs and symptoms of erectile dysfunction

Contributing factors to ED include:

  •  Low testosterone: When the desire to achieve an erection is low, the stimulation factor is limited.
  •  Prostate removal: When the prostate is removed, the nerves that induce an erection can be injured and result in ED.
  •  Diabetes: Diabetes can damage the nerves that induce an erection.
  •  Vascular disease: Vascular disease can impact the ability of blood to flow into the penis. Common causes of vascular ED include tobacco use, diabetes, peripheral vascular disease and advanced age.

 
Who is likely to develop ED?

Men with an underlying disease that can cause ED are more likely to develop ED. ED affects men of all races and in all regions. Researchers estimate that ED affects as many as 30 million men in the United States.1 While the likelihood of ED increases with age, the aging process does not cause ED. ED occurs in:

  • About 12 percent of men younger than 60
  • 22 percent of men age 60 to 69
  • 30 percent of men age 70 or older

How we diagnose erectile dysfunction

At City of Hope, we diagnose ED by identifying reversible causes, discussing what treatments have been attempted previously and completing a thorough medical history and physical exam.  

In some cases, blood work may also be necessary to identify hormonal problems and any treatable conditions like hyperlipidemia, hypertension and diabetes. We will also review each patient’s medication list to make sure no prescriptions are impacting erectile function.

In rare cases, doctors may perform ultrasound testing of the penis to ensure that there is appropriate blood flow, occlusion of blood flow and retention of blood to maintain an erection.

We may also perform injection testing to see if there is normal response to medications that induce erections. This not only helps in diagnosis, but it also introduces treatment options for ED.

 

At City of Hope, we employ several methods for treating ED, such as:

Lifestyle modifications

  • Maintaining behaviors that positively impact heart health may help combat ED. Eating a heart healthy diet, exercising, reducing stress, stopping smoking and avoiding excess alcohol are all helpful in treating ED.
  • Hypertension, high cholesterol and diabetes are the three most common conditions that affect erectile function. Controlling these illnesses is vital to maintaining penile health.

Oral medications

Oral medications used to treat ED include, sildenofil (Viagra), tadalafil (Cialis), vardenafil (Levitra or Staxyn), and avanafil (Stendra). These medications should never be taken with nitrate drugs for chest pain, and they should be taken under close supervision by a medical professional in any patient taking alpha blockers for hypertension or enlarged prostate.

Surgery

  • Penile prosthesis (penile implant): 40 million men suffer from ED. When Viagra, Cialis and other pills fail, penile implants are a popular and effective option.
    • Reports indicate that the penile implant has the highest degree of satisfaction because of its spontaneous and reliable results.
    • There are two types of implants, those that inflate and deflate, and those that are always firm (semirigid).
    • The implant is placed through a small three centimeter incision within the tunica albuginea, which allows the penis to become rigid for intercourse.
    • This 30-40 minute outpatient operation has a 98 percent patient and partner satisfaction rate, making penile implant the most successful operation for ED. The operation is covered by nearly all insurance, and is the only ED treatment covered by Medicare.
    • Penile implant devices are recommended after other therapies have failed. Once an implant is placed, no other form of treatment will work.
    • The risks of penile prosthesis include infection, bleeding and pain. In addition, the device is a mechanical device, and over time it can break down. But with new models, the rate of mechanical failure and infection is incredibly low.

Other treatments

  • Vacuum erection device: This is a chamber placed over the penis to create a vacuum, which pulls blood into the penis. After the penis is erect, a restrictive band is placed at the base of the penis to trap the blood in the penis.
    • The device works very well, though some patients report dissatisfaction with the cumbersome nature of the vacuum. In addition, the penis may be hinged and rigid beyond the restrictive band, and flaccid closer to the body.
    • Additionally, the penis tends to be cool to the touch, as there is no active blood flow while the restrictive band is in place.
  • Penile injection therapy: There are medications that can safely be injected directly into the penis. These medications include alprostadil (Edex), papavarine and phentolamine. The first dose of the injection therapy is usually administered under the supervision of a health care provider.
    • While many men are apprehensive about giving themselves an injection, it can be an effective option when oral therapy does not work.
  • Muse: Muse is a form of the drug alprostadil. This small pellet is placed into the urethra to dissolve and be absorbed into the erectile tissue.
  • Elator: The elator is an external penile support device that places the penis on stretch to allow for penetration despite the lack of a firm erection.

City of Hope brings expert urologic care to treating any urologic condition.

Urologic Surgeons - Duarte

Clayton S. Lau, M.D.

Clinical Specialties

  • Urologic Oncology
  • Urology
Kevin G. Chan, M.D.

Clinical Specialties

  • Urologic Oncology
  • Urology
Laura Crocitto, M.D., M.H.A.

Clinical Specialties

  • Urologic Oncology
  • Urology
Jonathan Lim Yamzon, M.D.

Clinical Specialties

  • Urologic Oncology
  • Urology
Bertram Yuh, M.D., M.S.H.C.P.M., M.I.S.M.

Clinical Specialties

  • Urologic Oncology
  • Urology

Urologic Surgeons - Community

Clayton S. Lau, M.D.

Clinical Specialties

  • Urologic Oncology
  • Urology
Seth A. Cohen, M.D.

Clinical Specialties

  • Female Pelvic Medicine and Reconstructive Surgery
Donald Hannoun, M.D.

Clinical Specialties

  • Urology and Urologic Oncology
Roger W. Satterthwaite, M.D., M.P.H.

Clinical Specialties

  • Urologic Oncology
  • Urology
Jonathan N. Warner, M.D.

Clinical Specialties

  • Urology and Urologic Oncology
  • Reconstructive Urology
Kristina Wittig, M.D.

Clinical Specialties

  • Urology and Urologic Oncology
Jonathan Lim Yamzon, M.D.

Clinical Specialties

  • Urologic Oncology
  • Urology
Benjamin J. Yuh, M.D.

Clinical Specialties

  • Urologic Oncology
  • Urology
Bertram Yuh, M.D., M.S.H.C.P.M., M.I.S.M.

Clinical Specialties

  • Urologic Oncology
  • Urology
Ali Zhumkhawala, M.D.

Clinical Specialties

  • Urologic Oncology
  • Urology

Urologists - Community

Edward L. Davis, M.D.

Clinical Specialties

  • Urology and Urologic Oncology
Rendel Houston, M.D.

Clinical Specialties

  • Urology and Urologic Oncology
Philip G. Pearson, M.D.

Clinical Specialties

  • Urology and Urologic Oncology
David W. Rhodes, M.D.

Clinical Specialties

  • Urology and Urologic Oncology

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