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Erectile Dysfunction

Guys may be hesitant to discuss this in public, but erectile dysfunction is an important topic that affects
nearly 30 million men. A satisfying sex life is part of an overall healthy lifestyle. So let’s dive into the
subject and see if we can penetrate it enough to attain an understanding with more girth and depth.

What is erectile dysfunction?  What causes it? What can you do to prevent it?  Is testosterone involved? What are the treatment options?  If you no longer have to figure out how to take a piss with morning wood, keep reading, you may have a different issue.

Erectile dysfunction is the inability to maintain an erection that is adequate for satisfying intercourse.   As such, it can affect more guys than care to admit it.  One common misconception is that problems are “normal” as men age.  Don’t conflate common with normal; erectile dysfunction is never considered normal.  You should expect to be able to enjoy a satisfying sex life no matter your age.



There are many different types of erectile dysfunction or ED (formerly called impotence, but I hate this term and never use it.).  It is common for men of all ages to have an issue from time to time, especially after a few too many drinks, during times of stress or relationship issues, or when extremely tired.  Some guys frequently have difficulty achieving an erection, and some have trouble maintaining it once they do.  For some people, there is even pain or curvature with an erection.  So, if it’s occurring with a regularity that is troubling to you or your partner, it may be time to do something about it.  

Causes of ED and Related Issues

ED is often a symptom of another underlying disorder, and this is why it is important not to just ignore it.  Most men will overlook problems with their heart or blood vessels, but once it affects their boner, they see a doctor immediately.  Which is good, because, for many men, problems with ED are the first sign of underlying atherosclerotic disease or hardening of the arteries.  Unlike down below, this hardening is a severe health issue. This may merely be a bothersome problem for the arteries leading to the penis, but it can be a life-threatening problem for the arteries leading to the heart and brain.  This is why many men with ED end up seeing a cardiologist. Diabetes is another common underlying factor that needs to be considered.   Poorly controlled diabetes can damage the nerves that stimulate erections. Our practice takes a personalized approach to treating erection issues and will discuss your symptoms, your medical history, and your goals before deciding on a treatment course.  


There are other common causes of ED that need to be considered.  Different types of surgeries, such as prostate, back, or pelvic surgery, can lead to ED.  Many common medications can contribute to difficulties as well. Blood pressure medications, sleep aids, and antidepressants are some of the most frequently implicated, but there are many others.  You should NOT adjust your medications without speaking with a physician. Smoking, obesity, heavy use of alcohol, use of marijuana, or other illicit drugs are also common causes. Try not to overindulge too much in these things…


What’s the best way to try to prevent ED?  

Maintain a healthy lifestyle.  Eat a good diet. Stay active. Don’t smoke.  Drink in moderation. Be proactive about treatment for high blood pressure, diabetes, and heart/vascular disease.  See your physician regularly.

Is testosterone involved in ED?

There is a complex interplay between low testosterone and erection problems.  While supplementing your T levels (discussed further in a different blog post) probably won’t cure your ED problems, we are probably fighting a losing battle if we don’t address that issue too.  As a part of an ED evaluation, we commonly evaluate patients for symptoms of low T, such as loss of sex drive and fatigue.

What are the treatment options?

The first-line treatment for almost every one involves making sure that we’ve considered and optimized the above parameters.  Some patients are actually candidates for sex therapy, and sometimes the problem can be solved without further treatment. Once that’s done, we usually start with a trial of medications such as Viagra or Cialis.  There are different doses and regimens we consider for each patient. For some patients, like those who take nitrates for cardiac issues, these medications are not an option. ED meds are usually well-tolerated and effective, but some common side effects include headache, nasal congestion, and possible vision changes.  If you have difficulty affording these meds, we have some ways to work with you too.

There are other treatment options if pills are not as successful as you might want.  There is a type of injection given directly into the penis (gulp) that is actually very effective and well-tolerated once you get used to it.  There is a small pill that is actually placed in the urethra that delivers similar medication to the injection but avoids a needle stick (is putting a pill in the end of your pecker better?  That’s your call.) There is a new treatment option that delivers shock-waves to the tissue of the penis. This sounds like a strange option, but as the tissue heals, the blood supply can improve and consequently the erections may improve.  “Shock waves” to the penis sound scary but are actually easy and well-tolerated. In spite of the humor in Austin Powers, penis pumps are a real and effective treatment option (though they don’t actually enlarge your penis, sorry.)



If the problem is very severe, and none of the above work, there is also a surgery to implant a penile prosthesis device that can be used for erections.  This surgery is typically a last resort but is a well-established and proven approach that many men are grateful they underwent.

Pain with an erection, or curvature of the penis, may indicate a problem called Peyronie’s disease that needs to be addressed.  Premature ejaculation is a different topic that can be as distressing as ED and is something we can help with too.

So, if any of these are issues you’ve been struggling with, I urge you to get help.  For most men, there are options, and for some men, seeking help can lead to a diagnosis that could save your life.  I intended this article to be light-hearted and humorous, but ED is often neither of these things. It can cause tremendous stress and anxiety in a man’s life.  I’ve had patients sobbing in my office because this issue threatened his marriage and family. Please don’t be too embarrassed to seek help. While it’s easy to joke, at Midtown Urology this is a topic we take very seriously and will work diligently with you to improve your erections, your health, and your life.  Let’s try to change your ED problem, to a Ron Burgundy-esk problem.



Midtown Urology is centrally located at 38th and Lamar.  If we can help with any urologic-related issues for you or your family, please let us know.

This Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

Midtown Urology

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