Erectile Dysfunction

The penis is made up of spongy tissue that holds blood. When the penis is flaccid (soft), blood flows in and out of the tissue. During sexual excitement, extra blood flows into the tissue. The extra blood makes the tissue swell so the penis becomes erect (rigid) and firm enough for intercourse.

When There’s a Problem

Physical or psychological problems can keep the penile tissue from filling with extra blood or from holding the extra blood in. When this happens, the penis remains soft or gets hard but won’t stay hard. This is known as erectile dysfunction.

Self-injection is a good option for many men with erectile dysfunction (ED). A tiny needle is used to inject medication into the penis. This helps your penis get hard and stay that way long enough for sex. And sex and orgasm will feel as good as always. You may be nervous about doing self-injection at first. But with practice, it will get easier. Your healthcare provider will show you how to do self-injection the first time. The simple steps are outlined on this sheet.

Preparing for Injection

• Wash your hands well with soap and water.
• Prepare the medication (if needed).
• Sit or stand in a comfortable position in a warm, well-lit room. If you need to, sit or stand in front of a mirror.
• Find an injection site on one side of your penis, in a place with no visible veins. (Don’t inject into the top, bottom, or head of the penis.)
• Clean the injection site with an alcohol swab. Grasp the head of your penis firmly with your thumb and forefinger (don’t just pinch the skin). Stretch the penis so the skin on the shaft is taut.

Injecting the Medication

• Rest your penis against your inner thigh and pull it gently toward your knee. Don’t twist or rotate it. This way you’ll be sure to inject the medication into the spot you chose and cleaned before.
• Hold the syringe between your thumb and fingers, like you’re holding a pen. Rest your forearm on your thigh for support.
• Insert the needle at a 90-degree angle (perpendicular) to the shaft. Do this quickly to reduce discomfort. (The needle should go in easily. If it doesn’t, stop right away.)
• Move your thumb to the plunger. Press down to inject the medication, counting to 5.
• Remove the needle and dispose of it safely.

Gaining an Erection

• Apply pressure to the injection site for a few minutes. This prevents swelling and bruising and helps spread the medication. 
• Stand up. This may help your erection develop. Foreplay often helps, too.
• Your penis should become firm within 10-20 minutes. The erection will last long enough for sex, and maybe longer.

Call Your Doctor If You Have:

• An erection that lasts longer than 3-4  hours.
• Bleeding or bruising.
• Severe pain.
• Scarring or curvature of the penis.

Penile self-injection is a simple technique that may improve your sex life. Some men even find that self-injection leads to an increase in natural erections. If you have questions or concerns about self-injection or erectile dysfunction (ED), talk to your healthcare provider. The information on this sheet will help you get the best results.

Notes About Penile Self-Injection

• You may feel a mild burning during injection. This is okay. But if you feel pressure or severe pain, stop the injection. There may be a problem with the injection site.
• Only inject the medication on the side of your penis. It may not work if injected elsewhere.
• To prevent scarring, inject in a different spot each time.
• Don’t use this treatment if you have a bleeding disorder or any risk of infection.
• Get medical help right away if your erection lasts longer than 3-4 hours.

Work with Your Doctor

Ask how often you can safely repeat injections, as well as any other questions you have. You and your healthcare provider will talk about follow-up exams and how to get supplies. If the medication doesn’t work or stops working over time, tell your healthcare provider.

Call Your Doctor If You Have:

• An erection that lasts longer than 3-4  hours.
• Bleeding or bruising.
• Severe pain.
• Scarring or curvature of the penis.

The steps below show how to gain and maintain an erection with a vacuum erection therapy system.

Getting Started

• Place the rubber tension ring on the open end of the cylinder.
• Apply water-based lubricant to the end of the cylinder.
• Put the penis into the cylinder. Hold the cylinder firmly against the abdomen to create a seal, but take care not to pinch the scrotum.

Gaining an Erection

• Squeeze the hand pump or turn on the electric pump. Blood will be drawn into the penis and the penis will become erect and firm.
• Follow the instructions you’ve been given for using your particular brand of pump.
• It may take some practice before you get optimum erections.

Using the Tension Ring

• When the penis is fully erect (usually less than 5 minutes), roll the tension ring off the cylinder onto the base of the penis. The tension ring holds blood in the penis, creating an erection. The area behind the ring remains soft and flexible.
• Remove the cylinder from the penis.
• After no longer than 30minutes, remove the tension ring from the penis by grasping the tabs on the ring and pulling to stretch the ring.

When to Call Your Doctor

• A very cold penis during erection (some coolness is normal).
• A black-and-blue or significantly darkened penis (some discoloration is normal).
• Pain while using the vacuum device or tension ring.
• Lack of an erection or loss of an erection before the tension ring is removed.

Note: The tension ring may block ejaculation during orgasm. This is harmless, but will NOT prevent pregnancy.

If you have trouble getting or keeping an erection, you have lots of company. Erectile dysfunction (ED) is a problem getting an erection firm enough or keeping it long enough for intercourse. The problem can happen to any man at any age. But health problems that can lead to ED become more common as a man ages. Up to half of men over age 40 experience ED at some point.

Causes of ED

ED can have many causes. Most are physical. Some are emotional issues. Often, a combination of causes is involved. Causes of ED may include:

• Medical conditions such as diabetes or depression.
• Smoking tobacco or marijuana.
• Drinking too much alcohol.
• Side effects of medications.
• Injury to nerves or blood vessels.
• Emotional issues such as stress or relationship problems.

ED Can Be Treated

Prescription medications for ED are now available. They help many men who try them. Depending upon the cause of the ED, though, medications may not be enough. In these cases, other treatment options are available. These include erectile aids and surgery. Your healthcare provider can tell you more about the treatment that is right for you. And new treatments for ED are being studied. No matter what the treatment you decide on, stay in touch with your doctor. If your symptoms persist, he or she may be able to adjust your current treatment or try something new.

An erection requires a healthy mind-body “team effort” led by the brain. Upon receiving signals from the brain, the blood vessels, nerves, and hormones work together to cause and maintain an erection.

1.) The Soft (Flaccid) Penis

If nothing is causing a man to become aroused, then his body’s erection “team” of brain, nerves, blood vessels, and hormones won’t begin working to cause an erection. The amount of blood flowing into the penis’s spongy chambers (corpora cavernosa and corpus spongiosum) equals the amount flowing out. His penis remains soft.

2.) The Swollen (Tumescent) Penis

A man becomes aroused through his senses (such as sight or touch) or his thoughts (such as memories or fantasies). During arousal, messages brought by nerves cause the blood vessels and spongy chambers to dilate (open up). More blood flows into his penis than flows out. His penis starts to swell.

3.) The Erect (Rigid) Penis

As arousal continues, nerves keep carrying messages of arousal between the penis and brain. Blood keeps moving into the man’s penis. Blood-swollen tissues press against the veins. Some of the blood is kept from flowing back out. Filled with blood, his penis becomes rigid. The man is able to have intercourse.

Many men feel embarrassed to talk to a doctor about ED. This common problem can be treated, but only if your doctor knows about it. Your doctor will likely ask you questions about your ED. Whether you’re asked or not, tell your doctor anything that might help your doctor understand the problem. Your doctor may do an exam and may run some tests to help find the cause of your ED.

A Simple Exam

A medical exam may help your doctor understand what is causing your problem. ED is sometimes the first sign of some other health problem, so your doctor may check your overall health. He or she may also examine your penis, scrotum, and testicles. Tell your doctor about all of the medications you take, including prescribed and over-the-counter medications, as well as any herbs or supplements.

You May Have Some Tests

Your doctor may recommend some or all of these tests:

• Blood tests measure your levels of hormones or lipids (fatty substances in the blood, including cholesterol). Other tests check for diabetes or help show the health of your liver, kidneys, and prostate.
• Blood flow tests check how well blood moves through your penis.
• A rectal exam checks for an enlarged prostate gland. An enlarged prostate and ED have been linked in recent studies.
• Additional tests check for other conditions that limit your ability to have intercourse.

Your Treatment Plan

Based on what you say and what any exam shows, your doctor will recommend a treatment plan. The first step may be to try ED medications, since they help most men. If they don’t help you, your doctor can suggest other kinds of treatment. You and your partner may also want to discuss which options would work best in your relationship. Treatment may include addressing the cause of health problems, such as lowering your cholesterol. And counseling may be recommended to talk about underlying emotional issues.

Prescription oral medications are often very successful in treating ED. But men with certain health problems or who are taking certain other medications should not use them. And all medications may cause side effects. Talk with your doctor about whether oral ED medication is right for you, and the risks and benefits of the medication.

Types of Oral ED Medications

There are three types of prescription oral ED medications on the market. Each increase blood flow to the penis. When the penis is stimulated, the result is an erection. The three medications are:

• Sildenafil citrate (Viagra).
• Tadalafil (Cialis).
• Vardenafil HCL (Levitra).

What Oral ED Medications Don’t Do

• Medications don’t cure the underlying cause of ED. Without the medication, you’ll still have trouble getting an erection.
• Medications cannot produce an erection in the absence of sexual stimulation.
• Medications won’t increase sexual desire or solve any other sexual issues beyond getting an erection. They also won’t solve any psychological, emotional, or relationship issues.

Taking Oral ED Medications Safely

• Don’t combine ED medications with other treatments unless your doctor suggests doing so.
• Don’t take ED medications more often or in larger doses than prescribed.
• Tell your doctor your health history and all medications you take, including over-the-counter medications, supplements, and herbs.
• Ask your doctor about the effects of combining alcohol with your medication.

Possible Side Effects of Oral ED Medications

• Headache.
• Facial flushing.
• Runny or stuffy nose.
• Indigestion.
• Distortion of your color vision for a short time.
• Sudden vision loss or hearing loss (rare).

Risks of Oral ED Medications

• You should not take ED medications if you take medications containing nitrates. The combination may drop your blood pressure to a dangerous level. Nitrates include nitroglycerin (a treatment for angina) and “poppers” (an inhaled recreational drug). If you’re not sure whether you’re taking nitrates, ask your doctor or pharmacist.
• Medications called alpha blockers can interact with ED medications and cause a sudden drop in blood pressure. Alpha-blockers are a common treatment for prostate problems and high blood pressure. Be sure your doctor knows if you take these medications.
• If your heart is already weak from a heart attack or heart disease and you have not had sex for a while, having sex again can put extra strain on your heart. Check with your doctor first to see if your heart is healthy enough for sex.
• In rare cases, sudden vision loss may occur while taking ED medications. This may be related to high blood pressure, diabetes, or other conditions. Ask your doctor whether you are at risk of this type of vision loss.
• In rare cases, an erection may last too long. This can badly damage the blood vessels in your penis. If an erection lasts longer than 4 hours, go to the emergency room right away.

If you have erectile dysfunction (ED), treatment can help. Certain treatments work directly on the penis. Talk to your doctor about the pros and cons of each. And be sure to learn the correct technique.

Vacuum Pump

• You slip a tube over the penis. A simple pump then creates a vacuum that pulls blood into the penis. This causes an erection. You then put a tension ring around the base of the penis to hold in the blood. You then remove the tube. The tension ring must not stay on for more than 30 minutes.
• Risks and complications may include pain in the penis or scrotum. The penis may also feel cool or change color during the erection.

Tension Ring

• A tension ring is usually used along with another type of treatment. Once enough blood has flowed into the penis to cause an erection, the tension ring will keep the blood from flowing out again. This maintains the erection. The ring must not stay on for more than 30 minutes. A tension ring is also called a constriction ring or venous flow controller.

• Risks and complications may include pinched, bruised, or irritated skin. If you have an allergic reaction to latex rings, try a silicone ring.

Self-Injections

• You inject a special drug into the penis. The drug relaxes blood vessels so they can fill with blood. Within about 10 minutes, the penis can become rigid enough for sexual intercourse. A tension ring is not needed to maintain the erection. Your doctor can explain the injection process to you.

• Risks and complications may include pain, bleeding, bruising, or scarring. Get medical help right away if you have an erection that lasts for longer than 4 hours.

Transurethral Medication

• You insert the end of a small applicator into the urethra to place a tiny, soft medication pellet. The medication is absorbed into the penis. The drugs relax blood vessels so they can fill with blood. Within about 10 minutes, the penis can become rigid enough for sexual intercourse. To keep the erection, you may need to use a tension ring.
• Risks and complications may include pain and irritation of the urethra. Get medical help right away if you have an erection that lasts for longer than 4 hours.

Surgery for erectile dysfunction is not common, but it may be the best treatment in some cases. During surgery, an implant (also called prosthesis) is placed inside the spongy chambers of the penis. Then, the implant can be used to provide an erection.

Mechanical Implants

This type of implant is easy to use. Bendable rods can make the penis appear erect. When not in use, the rods can be bent downward. Some implants have joints that lock into position.

Inflatable Implants

This is the most complex type of implant. It allows the penis to look and feel either erect or flaccid. You pump fluid from a storage bulb to make the penis erect. A release valve makes the penis flaccid again. Using the device properly takes some skill and practice.

Risks and Complications

• Infection.
• Bleeding.
• Failure or leakage of the prosthesis.

Being intimate means being close as a couple, with sex as just one part of intimacy. A hug, a kind remark, or a gift can be very romantic, even if sex doesn’t follow. So renew your intimacy along with your sex life. Learn to talk with, and listen to, your partner. And remember that your value as a man goes beyond what you do in bed.

Tips for Intimacy

As you and your partner become closer to each other, you might find that you can enjoy sex more.

• Show and tell your partner what you like. If you don’t, your partner might not know what you want.
• Ask your partner to show you how he or she wants to be touched.
• Be patient. Take your time. Relax. Give yourselves a chance to become aroused.
• Try being intimate without intercourse. Instead, exchange back rubs. Or try kissing, or just a soft touch.
• Focus on what you and your partner like about each other. This could be a certain laugh or smile, or other joys you share together.

Tips for Talking

It’s okay to be shy when you talk about sex with your partner. But talking gets easier with practice. Use these tips when you talk with each other.

• Choose a time and place when you’re both relaxed and comfortable.
• Listen to your partner. Try repeating back what you think the other has said. This will help show if you’ve understood each other.
• Don’t judge what your partner says. Talking feels safer if you don’t criticize each other.
• Don’t be defensive. You may not like something your partner says. But you can still thank your partner for being honest.
• Think about meeting with a counselor. They’re trained to help couples who are being treated for ED.