My Penis Stuff

Seek care immediately if you use medication to treat an erection problem (erectile dysfunction) and the erection lasts longer than 4 hours.

Seek care immediately if you have taken phosphodiesterase-5 inhibitors (such as Viagra, Levitra, Cialis) in the past 24 hours and are having chest pain. Tell your health professional you are taking this medication. Do not use any form of nitroglycerin if you have chest pain and have taken Viagra, Levitra, or Cialis in the past 24 hours.

Call a health professional if erection problems occur with:

• Any type of injury to the back, legs, buttocks, groin, penis, or testicles.
• A loss of pubic or armpit hair and an enlargement of the breasts.

Make an appointment to see a health professional within 1 to 2 weeks if an erection problem occurs more than 25% of the time and the problem:

• Occurs with a persistent backache.
• Occurs after you start taking a new medication or change the dose of a medication.
• Is affecting your self-image or sense of well-being.
• Has not improved despite self-care.

If your erection problem is occasional, there is no reason to call your health professional. If it occurs frequently but does not bother you or your partner, you may or may not choose to call your doctor. However, an erection problem that develops suddenly may be a sign of a disease; it is recommended that you see your doctor.

Watchful Waiting

Watchful waiting is a period of time during which you and your health professional observe your symptoms or condition without using medical treatment. A single episode of an erection problem is often a temporary and easily reversible problem. Do not assume it will happen again. If possible, forget about it and expect a more successful experience the next time. If you or your partner is concerned about it, talk about the problem and openly discuss your fears and anxieties.

If self-care has not helped after 2 weeks and you are concerned about your inability to have an erection, see a health professional who has experience in dealing with erection problems.

Who To See

Some health professionals, including doctors and mental health professionals, may not feel comfortable discussing sexuality and erection problems. Ask your health professional if he or she feels comfortable with and has experience in working with men who have erection problems.

The following health professionals can evaluate symptoms of erection problems:

• Family medicine doctor
• Internist
• Nurse practitioner
• Physician assistant
• Urologist

If it is possible that a psychological problem is contributing to your erection problem, your doctor may refer you to a health professional such as a:

• Psychiatrist.
• Psychologist.
• Certified licensed social worker.
• Counselor with special training in sexuality or relationship problems.

Examples

Brand name — Chemical name
Viagra — sildenafil citrate
Levitra — vardenafil
Cialis — tadalafil

Phosphodiesterase-5 inhibitors (PDE-5 inhibitors) are taken at least an hour before you plan to be sexually active. PDE-5 inhibitors will result in an erection only if you are sexually stimulated.

How It Works

During an erection, blood fills tissue in the penis, causing it to enlarge and become stiff. The PDE-5 inhibitors relax smooth muscle, allowing the penis to fill with blood.

Stimulation of the penis is necessary for Levitra and Cialis to work; Viagra can produce a spontaneous erection in those men for whom it is effective.

Why It Is Used

PDE-5 inhibitors can be used when an erection problem (erectile dysfunction) is caused by:

• Diabetes.
• High blood pressure.
• Spinal cord injury or other problems affecting nerve function.
• Prostate surgery.
• Side effects of medications.
• Emotional or psychological causes.

How Well It Works

PDE-5 inhibitors are effective treatment for erection problems. A review of trials has shown that 83% of men with erection problems who used Viagra had improved erections that allowed them to have intercourse. Initial studies show Levitra and Cialis have rates of success similar to those of Viagra. Viagra has been studied extensively and used by millions of men; its side effects and long-term effects are well recognized. Levitra and Cialis are new drugs in which long-term effects have not been studied.

PDE-5 inhibitors should be taken at least an hour before you plan to be sexually active.

One study found that Cialis, called “the weekend pill,” enhanced the ability to have erections for 24 to 36 hours after taking it. Viagra and Levitra usually enable a man to get an erection at any time for 4 or more hours after taking it.

Viagra does not work as well as it would otherwise if you eat a high-fat meal around the time you take it, so many doctors recommend you take it on an empty stomach. Levitra may be slightly less effective if you eat a high-fat meal, but a moderate-fat meal does not reduce its effectiveness; Cialis works without regard to what you eat.

Side Effects

Do not take PDE-5 inhibitors if you are taking any medication that contains nitrates, such as nitroglycerin. This combination can lower blood pressure dangerously, possibly leading to a stroke, a heart attack, or death. If you are taking a medication called an alpha-blocker—used to treat high blood pressure or an enlarged prostate—check with your health professional before you take a PDE-5 medication.

Other side effects are fairly uncommon when taking PDE-5 inhibitors. They include:

• Headache.
• Skin flushing.
• Indigestion.
• Nasal congestion.

A few men find that PDE-5 inhibitors affect their vision for a few hours after taking it, usually by causing a slight bluish tinge to their vision. A few men become more sensitive to light. These effects go away in a few hours.

What To Think About

Health experts have debated the use of PDE-5 inhibitors in men with heart disease, because deaths have been reported in men who used Viagra. The 1999 American College of Cardiology/American Heart Association (ACC/AHA) Expert Consensus Document noted that PDE-5 inhibitors may be dangerous for people who: ⁵

• Have coronary artery disease (CAD).
• Have heart failure and low blood pressure.
• Are taking many different drugs for high blood pressure.

However, several studies have reported that some men with heart problems may be able to take PDE-5 inhibitors safely.

• One study found no evidence of increased risk of heart attack or CAD in men who use Viagra.
• Another study in men with CAD reported that Viagra does not lead to heart attack and that heart attacks and other cardiovascular problems reported after taking Viagra may be related more to the physical activity of intercourse than to the medication.
• A study of 35 men found that Viagra is safe for men with moderate heart failure.

Sexual activity is exercise. If you have a heart condition and have not been sexually active for a while, talk with your health professional to make sure you can safely engage in sexual activity.

PDE-5 inhibitors are not prescribed for anyone who may take nitroglycerin in an emergency.

Tell your health professional if you are using PDE-5 inhibitors and are going to have a test for heart disease (such as a stress treadmill test, cardiac catheterization, stress thallium, or stress echocardiography). You should avoid taking PDE-5 inhibitors for 24 to 48 hours before such a test.

When considering PDE-5 inhibitors for erection problems, it is important to include your partner in your discussions.

If you take any medications, discuss PDE-5 inhibitors with your health professional before using them.

PDE-5 inhibitors can be prescribed by any doctor. You do not have to see a doctor who specializes in sexual health. PDE-5 inhibitors are also available on the Internet; if you obtain the medication through this route, you should discuss its use with your doctor.

Heart failure is a condition in which the lower chambers of the heart (ventricles) are not able to pump blood effectively. When the heart muscle has been damaged by long-term high blood pressure, coronary artery disease, heart valve problems, diseases that affect the heart muscle, a heart attack, or other conditions, it is harder for the heart to pump effectively.

Chronic heart failure is a lifelong, progressive condition that may require many lifestyle changes. Symptoms may include:

• Shortness of breath at rest, with mild exertion, while lying down, or that wakes a person from sleep.
• Leg swelling.
• Fatigue.
• Dizziness or fainting (rare).

Over time, symptoms may worsen until they are always present.

Heart failure can also develop suddenly. This is called acute or sudden heart failure, a medical emergency that causes sudden, severe shortness of breath, a sudden irregular or rapid heartbeat, and a cough that brings up foamy pink mucus.

Treatment for heart failure usually involves managing the underlying causes of heart failure and relieving symptoms. Effective treatment may reduce the need for hospital stays and the risk of premature death. Diet and lifestyle changes along with medications may help to manage symptoms, and in some cases surgery may help treat underlying causes, such as coronary artery disease or heart valve problems.

Phosphodiesterase-5 inhibitors, such as Viagra, Levitra, or Cialis, have revolutionized the treatment of erection problems (erectile dysfunction). However, they can cause life-threatening side effects for anyone who also takes nitroglycerin or another medication containing an organic nitrate. This combination can make your blood pressure fall too low, possibly leading to a stroke, a heart attack, or death.

Medications that contain organic nitrates include:

• Nitroglycerin (such as Deponit, Minitran, Nitrek, Nitrodisc, Nitrodur, Nitroglyn, Nitrolingual Spray, Nitrostat).
• Isosorbide mononitrate (such as Imdur, ISMO, Monoket Tablets).
• Isosorbide dinitrate (such as Dilatrate-SR, Isordil, Sorbitrate).
• Pentaerythritol tetranitrate (such as Duotrate, Peritrate, Tetraneed).
• Sodium nitroprusside (such as Nipride, Nitropress).
• Amyl nitrite (sometimes called “poppers”), which are sometimes abused.

Nitrates found in foods are not a danger when taking phosphodiesterase-5 inhibitors.

A heart attack (also called myocardial infarction or MI) occurs when an area of heart muscle is completely deprived of blood, and the heart muscle cells die.

A heart attack may result when plaque inside the heart arteries breaks open or ruptures, forming a clot that significantly blocks blood flow through the artery.

A plaque is made up of cholesterol, white blood cells, calcium, and other components; it is surrounded by a fibrous cap. If a sudden surge in blood pressure causes the artery to constrict, the fibrous cap may tear or rupture. This signals the body to repair the injured artery lining, much as it might heal a cut on the skin, by forming a blood clot to seal the area. A blood clot that forms in an artery can completely block blood flow to the heart muscle and cause a heart attack.

The pain of a heart attack often occurs with other symptoms, including:

• Chest discomfort or pain that is crushing or squeezing or feels like a heavy weight on the chest.
• Chest discomfort or pain that occurs with:
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain that spreads from the chest to the neck, the jaw, or one or both shoulders or arms.
  • Dizziness or lightheadedness.
  • A fast or irregular heartbeat.
  • Loss of consciousness.

The pain of a heart attack usually will not go away with rest.

It is important to recognize the early stages of a heart attack and to seek emergency care. Medical treatment is needed to prevent death. Sometimes medicines can be given to reduce the damage to the heart muscle caused by a heart attack.

Your risk of developing an erection problem (erectile dysfunction) increases with age.

• About 40% of men in their 40s report at least occasional problems getting and maintaining erections.
• 52% of men between ages 40 and 70 report erection problems.
• About 70% of men in their 70s report erection problems.

Diseases, physical or psychological problems, and certain activities also may increase your risk.

Diseases that affect blood vessels include:

• Diabetes. About half of men with diabetes develop erection problems. ²
• High blood pressure or other blood vessel diseases.
• High cholesterol or low HDL (high-density lipoprotein) cholesterol.

Diseases or procedures that affect nerves include:

• Diabetes.
• Multiple sclerosis.
• Stroke.
• Parkinson’s disease.
• Having had surgery involving the prostate, bladder, rectum, or urethra. These procedures may cause injury to nerves involved in achieving and maintaining an erection.

Other conditions include:

• Thyroid problems.
• Low levels of the hormones needed for the normal development and function of the sex organs (hypogonadism), leading to low testosterone levels.

Injuries or treatment include:

• Injury to the penis or pelvic region.
• Injury to the spinal cord or nerves to the penis.
• Pelvic surgery.

Medications and other substances that increase your risk include:

• Medications to treat high blood pressure or depression.
• Long-term (chronic) alcohol abuse.
• Drug abuse.
• Tobacco use.

Psychological risk factors include:

• Depression.
• Anxiety or stress.
• Relationship problems.
• A recent major life change (birth of a child, retirement, job change, loss or death of a partner, divorce, or marriage).

Activities that constrict blood flow to the penis—such as frequent long-distance bicycle riding on a hard, narrow saddle—may increase a man’s risk of developing an erection problem. However, experts continue to debate this issue.

A vasectomy usually does not cause erection problems. However, pain after the operation may affect sexual performance for a time, and if a man was not comfortable with his decision to have a vasectomy, or is having second thoughts, it could affect him psychologically.

Symptoms of erection problems (erectile dysfunction) include being unable to:

• Have an erection at any time, either with masturbation or with a sex partner.
• Maintain an erection firm enough for sexual intercourse.
• Maintain an erection long enough to complete sexual intercourse.

Even with an erection problem, a man may still have sexual desire and be able to have an orgasm and to ejaculate.

Erection problems (erectile dysfunction) may be caused by physical problems related to the blood vessels, nerves, and hormones or by psychological issues. Current evidence suggests that physical causes account for about 80% of erection problems.

Physical causes of erection problems include long-term (chronic) and short-term (acute) injuries and complications of prostate or other surgery that interfere with nerve impulses or blood flow to the penis. Physical problems are often the cause of erection difficulties in men 50 or older.

• Problems with the blood vessels (vascular problems) may prevent blood from filling the penis or from remaining there long enough to maintain an erection.
• Problems with the nerves (neurologic problems) may prevent arousal signals from traveling from the brain and spinal cord to the penis. Nerve disorders such as Parkinson’s disease, Alzheimer’s disease, multiple sclerosis, and stroke may interfere with a man’s ability to have an erection and may lower sexual desire. Nerve damage from diabetes, complications from surgery, and spinal cord injury also may cause problems.
• Problems with the structure of the penis or its surrounding tissues may prevent an erection.
• Hormonal factors, such as a low level of the hormone testosterone, may be involved in causing erection problems.
• Side effects of medications (for example, those taken for high blood pressure or depression) may cause erection problems. In some cases, it may be possible to change the dose of the medication or to use another medication.
• The use of tobacco, alcohol, or illegal drugs can lead to erection problems. Stopping or reducing the use of these substances may reduce the severity of a man’s erection problem.

Activities that restrict blood flow to the penis also may result in erection problems. Some doctors have observed that men who regularly ride bicycles over long distances are more likely to have erection problems than men who ride only occasionally, especially if they ride on a narrow, unpadded saddle. However, the possible link between bicycle riding and erection problems has not been proven.

A vasectomy usually does not cause an erection problem. However, pain after the operation may affect sexual performance for a time, and if a man was not comfortable with his decision to have a vasectomy, or is having second thoughts, it could affect him psychologically.

Psychological causes of erection problems include depression (which also has a physical component), anxiety, stress, grief, or problems with current or past relationships. These interfere with the erection process by distracting the man from things that would normally arouse him. Erection problems in men younger than 40 who have no physical risk factors are more likely to be caused by psychological factors than physical causes.

• Relationship problems can lead to erection problems. This may happen when a man has been widowed or loses sexual interest in a particular partner.
• Some men develop erection problems when they contemplate marriage.
• Some men may have difficulty having sexual intercourse with their partner after their first child is born.

What is erectile dysfunction?

Erectile dysfunction, sometimes called impotence, refers to a man’s consistent inability to get or maintain an erection sufficient to have satisfactory sex. It does not mean a lack of sexual interest or desire or the occasional difficulty achieving or maintaining an erection that affects all men at some time in their life.

Normally, an erection occurs when your imagination or one or more senses (vision, hearing, touch, smell, taste) are stimulated and you become aroused. Your central nervous system sends nerve impulses that increase blood flow to your penis. Four requirements for a normal erection are:

• A properly functioning nervous system that sends the necessary signals to the penis.
• An intact system of blood vessels to allow blood to flow into and out of the penis.
• Normal smooth muscle in the penis, which must relax so the penis can fill with blood and enlarge.
• The ability to trap the blood in the penis so that it stays firm.

See an illustration of the male reproductive system below.

Illustration copyright 2000, 2003 Nucleus Communications, Inc. All rights reserved.

The male reproductive system consists of the penis, two testicles, two epididymides, two vas deferentia, two seminal vesicles, and the prostate gland.

Erectile dysfunction can occur at any age but is more common in older men, who often have additional health problems or who may be taking medications that may interfere with normal erectile function. Treatment of erection problems in older men can be as effective as in younger men.

Doctors prefer to use the term erectile dysfunction instead of impotence. A man’s sexual function involves more than an erection, and the term impotence often carries negative implications. For ease of reading, this post uses the term erection problems to refer to erectile dysfunction.

Erection problems can affect your sexual life and your relationship. Discussing the issue with your partner and exploring other forms of intimacy can help improve your relationship and the erection problem.

What causes erection problems?

The cause of erection problems may be physical (such as injury to nerves or loss of blood supply to the penis) or psychological (such as anxiety or depression). Medications you are taking for other conditions, alcohol consumption, smoking, or illegal drug use also can cause erection problems.

Certain conditions may affect the nervous system or blood flow to the penis, increasing the risk for erection problems. These include diabetes, high blood pressure, high cholesterol, atherosclerosis, multiple sclerosis, and Parkinson’s disease.

What are the symptoms?

The only symptom of an erection problem is the inability to have or maintain an erection that is firm enough to consistently have sexual intercourse. This inability may or may not be related to sexual interest or the ability to have an orgasm and to ejaculate.

How are erection problems diagnosed?

A health professional can diagnose an erection problem using a medical and sexual history and a physical examination. Your health professional will want to know whether the erection problem occurs all the time or occasionally. The initial exam, laboratory tests, and possibly psychological tests can help determine whether the problem is physical, psychological, or a combination of the two.

How are they treated?

Treatment often includes lifestyle changes, such as avoiding tobacco, drugs, and alcohol. Discussing the issue with your partner, participating in sensual exercises, and seeking counseling may help. Further treatment may include oral medications (such as Viagra, Levitra, or Cialis), vacuum devices, or injection of medications into the penis. Surgery to place an implant in the penis also is an option.

Do not take Viagra, Levitra, or Cialis if you are taking nitrate medications—such as nitroglycerin—for heart problems. The combination of nitrates and any of these medications can lower your blood pressure to a dangerous level. You also should not take certain alpha-blockers (used to lower blood pressure and to treat an enlarged prostate) with these medications because of the risk of a dangerous drop in blood pressure. Check with your health professional to see whether you can take Viagra, Levitra, or Cialis with your alpha-blocker.

Can I prevent erection problems?

To reduce your risk of developing an erection problem, avoid smoking, drinking too much alcohol, and using illegal drugs.

Because erection difficulties are most often caused by a physical problem, maintaining good health through diet and exercise is very important. A relaxed approach to lovemaking and good communication with your partner can help prevent erection problems caused by psychological factors.

Author: Marianne Flagg

When a man becomes aroused, his brain sends nerve impulses that increase blood flow to his penis. The blood fills the spongy chambers (corpora cavernosa) in the penis, causing it to expand and become rigid. The veins that would normally drain blood from the penis constrict, trapping the blood inside and maintaining the erection.

After ejaculation or when the man is no longer sexually aroused, the arteries narrow, the veins expand, and the blood drains out of the penis. The penis returns to its normal size and is no longer rigid.