Impotence (Erectile Dysfunction)

Prevention

Little is known about how to prevent impotence. However, it can help to avoid cigarette smoking and maintain normal blood pressure and cholesterol levels because smoking and high cholesterol can affect blood vessels. Men with diabetes should work to keep blood sugar levels under control. Because certain medications have been associated with impotence, ask your doctor about possible side effects before you start using any new prescription.

Treatment

There are many effective treatments for impotence. The most popular is a class of drugs called phosphodiesterase type 5 (PDE5) inhibitors, which includes sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis). These drugs, taken in pill form up to 60 minutes before sexual activity, work in approximately 70% of men. They are less effective in men with neurological causes of impotence such as nerve damage from prostate surgery, diabetes or spinal cord injury. PDE5 drugs can cause minor side effects such as flushing and headache, but they have been shown to be safe in most men, including those with heart disease. However, PDE5 drugs can interact with other medications and cause dangerously low blood pressure. They should never be taken with nitroglycerin or other nitrate medications commonly used to treat heart disease. Men with enlarged prostates who take alpha-blocker drugs such tamsulosin (Flomax) or doxazosin (Cardura) should probably avoid certain PDE5 drugs.

If these drugs don't work or cannot be used because of potential side effects, your doctor can recommend other therapies. The drug alprostadil (Caverject, Edex, Muse) causes blood vessels to widen. This can allow blood to flow more freely in the penis, leading to an erection. The drug can be injected with a tiny needle into your penis, or a small pellet (suppository) can be inserted into the opening of the penis. Suppositories like this are effective in approximately two-thirds of men. Injections are effective about 80% of the time.

Taking extra testosterone will not improve erectile dysfunction. For men who have abnormally low levels of the hormone, testosterone replacement may be helpful because it can enhance sexual desire.