Erectile Dysfunction (ED) What is erectile dysfunction? How common is erectile dysfunction? What causes erectile dysfunction? What are the symptoms of erectile dysfunction? How is erectile dysfunction diagnosed? How can I prevent the onset of erectile dysfunction? How is erectile dysfunction treated? HIV/AIDS and erectile dysfunction Links and References

There are several options available to the man suffering from ED. Speak with your physician as to the medication/approach best suited to you.

Drugs called PDE5 inhibitors (available in Canada under the trade names Viagra-sildenafil, Cialis-tadalafil and Levitra-vardenafil hydrochloride) help a man achieve and maintain an erection. With sexual stimulation, these drugs increase blood flow to the penis, allowing an erection to occur naturally. These drugs will not work if the nerves that control erection are removed or damaged due to injury or subsequent to surgery (radical prostate surgery). If nerves are damaged, penile implants can be used. They can be used safely in most men with diabetes, including select elderly men. However, they are not safe for men with certain heart conditions or men who take nitrates (which are often used to treat angina). Use of PDE5 inhibitors should be discussed with your physician.

It is important for sexual partners to be involved in any discussion about treatment choices.

For men who can't take PDE5 inhibitors or find that they don't work, other options include other drugs, injections, hormone replacements, mechanical devices such as vacuum constriction devices, implants and surgery.

It also makes sense (for many health reasons other than ED) to keep your blood glucose, blood pressure and cholesterol in the target range, to quit smoking and start exercising. These will all lead to better overall health and, in turn, better sexual health.

Did we mention quit smoking?!

How do PDE5 inhibitors work? 

The use of PDE5 inhibitors prior to sexual activity permits the vascular caverns of the penis to relax – the vessels widen and dilate with blood. This hardening compresses the veins at the base of the penis and thereby prevents efflux of blood from the penis – an erection! (Nerves and vessels must be intact). Successful erection with PDE5 inhibitors requires sexual stimulation, it is not magic! The effect of the medication varies from one man to the next but typically lasts for up to 4 hours. The effects of the medication may be slowed if taken with a large meal and/or alcohol. Side effects may occur but are rarely troubling – discuss these with your doc. The evaluation by your physician prior to starting a PDE5 inhibitor is important to ensure that your heart is able to handle the extra stress imposed by sexual relations.

It is important to avoid the combination of PDE5 inhibitors and medications that contain nitrates. Amyl nitrate also known as "poppers" should not be used in combination with PDE5 inhibitors, as pronounced and even dangerously low blood pressure levels have been reported.

Other erectogenic medications (erection provoking) – other oral medications include:

• Yohimbine (better than placebo)
• Trazodone (not much better than placebo and lots of side effects)
• Phentolamine (better than placebo)

Direct agents:

Alprostadil as an injection into the penis or as a suppository (intra-urethral). This latter approach is called "medicated urethral system for erection" or MUSE. These direct approaches cause direct relaxation of the vessels and may provoke erection in the absence of sexual stimulation.