Erectile dysfunction quiz: Don't suffer in silence

Men can experience erectile dysfunction (ED) at any age. In fact, most men have this problem at some point in life.

Your chance of developing ED increases as you get older. About 5 percent of otherwise healthy 40-year-old men experience ED, compared with 15 percent to 25 percent of 65-year-old men.

Remember that a range of disorders can interfere with sexual intercourse. Examples are curvature of the penis during erection (Peyronie's disease), prolonged painful erection not associated with sexual desire (priapism) and premature ejaculation. However, ED refers specifically to the inability to achieve and sustain an erection that's adequate for satisfying sexual activity.

Though the percentage of men with ED increases with age, don't accept this as inevitable. Talk about ED with your doctor. You may uncover an underlying disease or a need to adjust your medications. This discussion is worthwhile because many safe and effective treatments are available.

Three important steps are necessary to produce an erection:

• Arousal, which can come from sexual thoughts or from the senses — sight, touch, hearing or smell.
• Communication of that arousal from nerves in the brain to nerves in the penis.
• Relaxing of the arteries that supply the penis, allowing more blood to flow into it. This produces an erection because exit valves of the veins in the penis close, trapping the blood.

If something affects any of these steps, ED can result.

Don't be concerned about an occasional episode of ED. But if the problem recurs frequently enough to prevent you from having satisfying sex, then get medical treatment.

It's especially important to see your doctor if ED begins after an injury, is associated with a new medication, or develops at the same time as a newly diagnosed illness. Also seek treatment if ED occurs with low back pain, abdominal pain or changes in urination. Your doctor or a specialist can determine the causes and help you find appropriate treatment.

Diabetes, multiple sclerosis, chronic alcoholism and atherosclerosis can all be associated with ED. In fact, diseases cause about 70 percent of all cases.

Other physical causes include neurological disease, hormonal disorders, some prescription medications, drug abuse and treatment for prostate disorders. Erectile dysfunction may be one early sign of an underlying medical problem.

In addition, psychological factors can affect sexual performance. Stress, anxiety, guilt, depression, low self-esteem, anger, fear of sexual failure and poor communication with a sexual partner can all lead to problems with erections. Sometimes ED involves both physical and psychological factors.

To help find the cause of ED, your doctor gathers information about your medical and sexual history and performs a physical exam. He or she may also request laboratory tests to determine whether an underlying medical condition contributes to the erectile dysfunction.

If your doctor suspects an underlying disease, he or she may recommend further testing. For example:

• Neurological tests can evaluate problems with nerve signals to and from the brain.
• A Doppler ultrasound test measures blood flow to the penis.
• Angiography involves injecting a dye material into the blood vessels in your penis. This study creates an image that shows up on X-rays, indicating whether a blood vessel in the penis is blocked.

Neither ultrasound nor angiography testing is done frequently to help find the cause of erectile dysfunction. In a few circumstances, though, they can be helpful.

If your doctor suspects a prescription drug is responsible, he or she may prescribe a different medication.

Depending on the cause, your doctor may suggest one or more of these options. Here's a brief look at what's available:

• Medications. Prescription medication, such as sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis), can produce a natural erection by increasing blood flow to the penis. If hormone deficiencies are the cause, your doctor may prescribe synthetic male hormones.
• Penile injections. Self-injection therapy introduces medication directly into the penis to increase blood flow and cause an erection. These medications include papaverine hydrochloride, phentolamine and alprostadil (Caverject). You can perform the injections at home after detailed instructions from your doctor.
• Intraurethral therapy. This treatment involves inserting a small suppository — a pellet half the size of a grain of rice — into the opening of the penis. This helps relax the muscle tissue and increase blood flow to the penis. A system for doing this procedure is marketed as Muse.
• Medical devices. A vacuum device uses a hand pump to draw blood into the penis, creating an erection. An elastic ring placed at the base of the penis keeps it erect. This low-cost device is available at most drugstores with a doctor's prescription. Another device that works on a similar principle is a semirigid rubber sheath. A man places this sheath on his penis after getting an erection and leaves it there during intercourse to trap blood.
• Surgery. Surgery might be an option. Implanting a penile prosthesis is useful for people who are carefully selected for this treatment. Various types of prostheses are also available, ranging from semirigid rods to inflatable devices. Procedures to increase blood circulation to the penis are rarely used.
• Psychotherapy. If the cause of ED isn't physical, your doctor may suggest psychotherapy. You might visit a psychiatrist, psychologist or sex therapist, either alone or with your partner. These specialists can help you address problems such as stress, anxiety or depression. To strengthen your relationship with your sexual partner, talk openly and honestly about your condition. Use counseling time to share concerns and discuss your feelings.

Some men have lost eyesight in one eye after taking one of these drugs for ED. This type of vision loss is called nonarteritic anterior ischemic optic neuropathy (NAION). The problem results when blood flow to the optic nerve is blocked.

Researchers do not know for sure that ED drugs cause NAION. Even so, the Food and Drug Administration (FDA) has approved labels for Viagra, Levitra and Cialis, with information on NAION.

The bottom line: If you experience any vision changes while taking these drugs, see your doctor right away.

ED medications are only facilitators. In other words, they can help you achieve an erection after sexual stimulation. But you shouldn't count on these medications to increase sexual desire.