While most men occasionally experience difficulty achieving and maintaining an erection, about one in 10 men (more than 18 million) in the United States experience erectile dysfunction (i.e., chronic impotence). Despite this high prevalence, less than 10 percent of men affected by this condition seek treatment. Erectile dysfuntion is not a normal part of aging although the prevalence is higher among older men.

About 70 percent of all cases of erectile dysfunction are caused by diseases such as diabetes, kidney disease, alcoholism, atherosclerosis and heart disease. An estimated 35 to 50 percent of men with diabetes experience erectile dysfunction. Other causes of erectile dysfunction include surgery (e.g., prostate surgery) which can injury nerves and arteries near the penis. Erectil dysfuntion may occur as a side effect of many common medications (e.g., high blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and ulcer drugs.

About 10 to 20 percent of the cases of erectile dysfunction are caused by psychological factors that include stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure. If nocturnal erections continue to occur, then psychological causes are more likely

Erectile dysfunction can be devastating. Luckily, 90 percent of erectile dysfunction patients can be treated successfully. Initial treatment of erectile dysfunction is directed towards correcting any medical of problems that may contribute to erection failure. About 30% of men with erectile dysfunction have undiagnosed conditions such as diabetes, hypertension, heart disease or cancer of the prostate (Butler, 1998). Medications (e.g., methyldopa, propranolol for high blood pressure, or alcohol) are a common cause of erectile dysfunction and simply changing to another medicaiton is often effective. Lifestyle changes (e.g., reducing alcohol intake or lowering stress) may also help.

Treatment

Treatment of erectile dysfunction can include drug therapy, vacuum constriction devices; penile prostheses, and vascular surgery. Some of the most common drug therapies are described below:

• Drug Therapies

  Oral Medication (e.g. Viagra) is the newest and most exciting treatment. Viagra is the first oral medication that can cause an erection within 1 hour after taking it. It works by preventing blood from leaving the penis which results in an erection. Viagra is effective in men with erectile dysfunction related to conditions that include diabetes, hypertension, protatectomy, heart disease, and depression. Viagra can be dangerous for those with low blood pressure, myocardial ischemia, kidney or liver disease, or patients on drugs such as erythromycin, tagamet or nitroglycerine. Viagra has become very popular, but it is also very expensive (up to $10 per pill). Only 26 of the Medicaid programs and one-half of health maintenance organizations currently pay for this medication.

  Intracavernosal Injection. Injecting vasodilator drugs (e.g. papaverine, Regitine, Caverject) into the cavernosal body of the penis can increase blood flow and produce an erection within minutes that can last up to 2 hours. These drugs may cause priapism (a persistant erection) and other side effects such as pain, nodules and hypotension (low blood pressure).

  Urethral Suppositories (e.g. Muse) mimic natural prostaglandins and cause relaxation of the smooth muscles. This allows the corpus cavernosum of the penis to vasodilate and an erection to occur. The effect occurs within 5 to 10 minutes and can last up to 1 hour.