Erection problems: causes and treatment options

It's treatable

Erection problems? It's not just in your head, and it's treatable.

I'm Dr. Chirag Dave with Advanced Urology.

Erection problems are one of the most common reasons men come to see me, and one of the hardest to bring up. It's not a weakness, and it's not something you have to accept. My fellowship training at Johns Hopkins included sexual and male reproductive medicine. Let's talk about why it happens and the treatment options.

How an erection works

An erection is mostly about blood flow. Nerves signal the arteries in the penis to open, blood flows in, and it's held there. Anything that affects the blood vessels, the nerves or your hormones can get in the way.

Common causes

The most common causes are diabetes, high blood pressure, high cholesterol, smoking and extra weight, because they all damage blood vessels. Some medicines, including certain blood pressure pills and antidepressants, can play a part. So can low testosterone, poor sleep, heavy drinking, prostate cancer treatment, and stress or anxiety. Often it's more than one thing.

An early warning sign

Here's what many men don't know. The arteries in the penis are smaller than the ones in the heart, so erection problems can show up before heart disease does. That's why I look at your heart risk factors, not just the symptom.

Start with the basics

Treatment starts with the basics. Better control of blood sugar and blood pressure, quitting smoking, losing weight, more exercise and better sleep can all help, and they protect your heart too. If testing confirms low testosterone, we'll discuss whether treatment fits you.

Pills

Pills like sildenafil and tadalafil help many men. Side effects can include headache, flushing and a stuffy nose. Never take them with nitrate heart medicines. And skip the gas station "male enhancement" pills. Some have been found to contain hidden drugs.

When pills aren't enough

If pills don't work or you can't take them, there are other options. A vacuum device draws blood in, and a band holds it there. Penile injections work directly in the penis and help many men when pills don't. I'll teach you how, and the needle is very small. A serious risk is an erection that won't go away. If one lasts more than four hours, go to the ER.

Penile implants

For men considering a surgical option, there's a penile implant. It's placed completely inside the body, so the device is not visible from outside. After healing and training, you operate it to create an erection. It can be done in our own outpatient surgery centers; the setting depends on your health and procedure. Risks include infection and the device needing repair, and once it's placed, natural erections usually aren't possible.

Our approach

Men's sexual health is part of my fellowship training and my clinical focus. At Advanced Urology, I treat the whole picture: blood flow, hormones, prostate health and heart risk. We offer options from pills to injections to implants, so the plan fits you. Our urologists can usually get patients in fast, and our conversations stay private.

Every treatment, and any anesthesia, has risks, benefits and alternatives, and we'll go over yours together. Call Advanced Urology at 678-344-8900. This article is educational, not medical advice.