Male infertility

Sexual Dysfunction in Males

The most common problems related to sexual dysfunction in men include ejaculation disorders, erectile dysfunction, and inhibited sexual desire. These and other sexual dysfunction problems can be corrected by treating the underlying physical or psychological causes.

Overview Diagnosis and Tests Management and Treatment Prevention

What is sexual dysfunction in males?

Sexual dysfunction is any physical or psychological problem that prevents you or your partner from getting sexual satisfaction. Male sexual dysfunction is a common health problem affecting men of all ages, but is more common with increasing age. Treatment can often help men suffering from sexual dysfunction.

• Erectile dysfunction (difficulty getting/keeping an erection)

Premature ejaculation (reaching orgasm too quickly)

Delayed or inhibited ejaculation (reaching orgasm too slowly or not at all)

Low libido (reduced interest in sex)

What causes sexual dysfunction in males?

Physical causes of overall sexual dysfunction may be:

Low testosterone levels

Prescription drugs (antidepressants, high blood pressure medicine)

Blood vessel disorders such as atherosclerosis (hardening of the arteries) and high blood pressure

Stroke or nerve damage from diabetes or surgery

Smoking

Alcoholism and drug abuse

Psychological causes might include:

Concern about sexual performance

Marital or relationship problems

Depression, feelings of guilt

Effects of past sexual trauma

Work-related stress and anxiety

How does sexual dysfunction affect men?

The most common problems men face with sexual dysfunction are troubles with ejaculation, getting and keeping an erection, and reduced sexual desire.

Problems with ejaculation are:

Premature ejaculation (PE) — ejaculation that occurs before or too soon after penetration

Inhibited or delayed ejaculation — ejaculation does not happen or takes a very long time

Retrograde ejaculation — at orgasm, the ejaculate is forced back into the bladder rather than through the end of the penis

The exact cause of premature ejaculation (PE) is not known. While in many cases PE is due to performance anxiety during sex, other factors may be:

Stress

Temporary depression

History of sexual repression

Low self-confidence

Lack of communication or unresolved conflict with partner

Studies suggest that the breakdown of serotonin (a natural chemical that affects mood) may play a role in PE. Certain drugs, including some antidepressants, may affect ejaculation, as can nerve damage to the back or spinal cord.

Physical causes for inhibited or delayed ejaculation may include chronic (long-term) health problems, medication side effects, alcohol abuse, or surgeries. The problem can also be caused by psychological factors such as depression, anxiety, stress, or relationship problems.

Retrograde ejaculation is most common in males with diabetes who suffer from diabetic nerve damage. Problems with the nerves in the bladder and the bladder neck force the ejaculate to flow backward. In other men, retrograde ejaculation may be a side effect of some medications, or happen after

an operation on the bladder neck or prostate.

Erectile dysfunction (ED)

Erectile dysfunction (ED) is the inability to get and keep an erection for sexual intercourse. ED is quite common, with studies showing that about one half of American men over age 40 are affected. Causes of ED include:

• Diseases affecting blood flow such as hardening of the arteries

Nerve disorders

Stress, relationship conflicts, depression, and performance anxiety

Injury to the penis

Chronic illness such as diabetes and high blood pressure

Unhealthy habits like smoking, drinking too much alcohol, overeating, and lack of exercise

Low libido (reduced sexual desire)

Low libido means your desire or interest in sex has decreased. The condition is often linked with low levels of the male hormone testosterone. Testosterone maintains sex drive, sperm production, muscle, hair, and bone. Low testosterone can affect your body and mood. Reduced sexual desire may also be caused by depression, anxiety, or relationship difficulties. Diabetes, high blood pressure, and certain medications like antidepressants may also contribute to a low libido.

Sexual Dysfunction in Males: Diagnosis and Tests

Overview Diagnosis and Tests Management and Treatment Prevention

How is male sexual dysfunction diagnosed?

Your doctor may begin the diagnosis process with a physical exam. Physical tests may include:

• Blood tests to check your testosterone levels, blood sugar (for diabetes), and cholesterol

• Blood pressure check

• Rectal exam to check your prostate

• Examination of your penis and testicles

Other tests can show if you have problems with the nerve impulses or blood flow to the penis.

Your doctor may also ask questions about your symptoms and your medical and sexual history. Though these questions may seem very personal, do not be embarrassed. It is important to answer honestly so the best treatment can be recommended. You may be sent to a different type of doctor (urologist, endocrinologist or sex therapist, for example) who can help you.

Sexual Dysfunction in Males: Management and Treatment

Overview Diagnosis and Tests Management and Treatment Prevention

How is male sexual dysfunction treated?

Many cases of sexual dysfunction can be corrected by treating the mental or physical problems that cause it. Treatments include: • Medications – drugs that help improve sexual function by increasing blood flow to the penis. Sildenafil (Viagra®), vardenafil (Levitra®), and tadalafil (Cialis®) are safe and effective for most men.

• Hormone therapy – low levels of testosterone raised by hormone replacement therapies that include injections, patches, or gels.

• Psychological therapy – a psychological counselor to help you address feelings of anxiety, depression, fear, or guilt that may affect sexual function.

• Mechanical aids – vacuum devices and penile implants that can help some men with erectile dysfunction. Sexual Dysfunction in Males: Management and Treatment

How is male sexual dysfunction treated?

Many cases of sexual dysfunction can be corrected by treating the mental or physical problems that cause it. Treatments include: • Medications – drugs that help improve sexual function by increasing blood flow to the penis. Sildenafil (Viagra®), vardenafil (Levitra®), and tadalafil (Cialis®) are safe and effective for most men.

• Hormone therapy – low levels of testosterone raised by hormone replacement therapies that include injections, patches, or gels. • Psychological therapy – a psychological counselor to help you address feelings of anxiety, depression, fear, or guilt that may affect sexual function.

• Mechanical aids – vacuum devices and penile implants that can help some men with erectile dysfunction. Sexual Dysfunction in Males: Prevention

Overview Diagnosis and Tests Management and Treatment Prevention

Can male sexual dysfunction be prevented?

While male sexual dysfunction cannot be prevented, dealing with the causes of the dysfunction can help you better understand and cope with the problem when it happens. To help maintain good sexual function:

Follow your doctor’s treatment plan for any of your medical/health conditions.

Limit your alcohol intake.

Quit smoking.

Get treatment if needed for any emotional or psychological problems such as stress, depression, and anxiety. •

Communicate better and more often with your partner.

Erectile dysfunction (impotence)

Erection problems (impotence) are very common, particularly in men over 40. It's usually nothing to worry about, but you should see a GP if it keeps happening.

Causes of erection problems

Most men occasionally fail to get or keep an erection.

This is usually due to stress, tiredness, anxiety or drinking too much alcohol, and it's nothing to worry about.

If it happens more often, it may be caused by physical or emotional problems.

Non-urgent advice: See a GP or go to a sexual health clinic if:

• erection problems keep happening

It could be a sign of an underlying health condition.

Information:

How sexual health clinics can help with erection problems Sexual health clinics treat genital problems. They can provide the same treatment you would get at your GP surgery. Many sexual health clinics offer a walk-in service, where you don't need an appointment. They'll often get test results quicker than GP practices.

Find a sexual health clinic near you What happens at your appointment

The doctor or nurse will ask about your lifestyle and relationships, and any problems you might be having.

They'll carry out basic health checks, such as taking your blood pressure. They'll also examine your genitals to rule out any obvious physical cause.

If you have symptoms like needing to pee more often, your doctor may also need to examine your prostate. They might have to examine your bottom (rectal examination).

Treatment for erection problems depends on the cause

Treatments for erectile dysfunction are much better than they used to be, and the problem often goes away. Physical causes

Possible cause Treatment

Narrowing of penis blood vessels, high blood pressure, high cholesterol medicine to lower blood pressure, statins to lower cholesterol

Hormone problems hormone replacement – for example, testosterone

Side effects of prescribed medication change to medicine following discussion with GP

You may also be asked to make lifestyle changes.

Do

• lose weight if you're overweight

• stop smoking

• exercise daily

• try to reduce stress and anxiety

Don't

• do not cycle for a while (if you cycle for more than 3 hours a week)

• do not drink more than 14 units of alcohol a week

Medicine such as sildenafil (sold as Viagra) is often used by doctors to treat erectile dysfunction. It is also available from chemists. Because of changes in regulations, you no longer need a prescription to get sildenafil. But you will have to have a consultation with the pharmacist to make sure it's safe for you to take it.

There are other similar medicines called tadalafil (Cialis), vardenafil (Levitra) and avanafil (Spedra) that work in a similar way. You will still need a prescription to get these medicines.

Buying Viagra online

The Sexual Advice Association has factsheets on medicines and other treatments, including injections, implants and creams.

Do vacuum pumps work?

Vacuum pumps encourage blood to flow to the penis, causing an erection. They work for most men and can be used if medicine isn't suitable.

They're not always available on the NHS. Speak to your doctor about where to get one.

Emotional (psychological) problems

It's more likely to be an emotional problem if you only have erection problems some of the time – for example, you still get erections in the mornings but not during sexual activity.

Anxiety and depression can be treated with counselling and cognitive behavioural therapy (CBT).

Flaccid and erect penis - Erectlile dysfunction/ Impotence

Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.Flaccid and erect penis

Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.

Having erection trouble from time to time isn't necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect your self-confidence and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.

If you're concerned about erectile dysfunction, talk to your doctor — even if you're embarrassed. Sometimes, treating an underlying condition is enough to reverse erectile dysfunction. In other cases, medications or other direct treatments might be needed.

Erectile dysfunction care at Dr. Dc.Sharma.Clinic

Symptoms

Erectile dysfunction symptoms might include persistent:

Trouble getting an erection

Trouble keeping an erection

Reduced sexual desire

When to see a doctor

A family doctor is a good place to start when you have erectile problems. See your doctor if:

• v You have concerns about your erections or you're experiencing other sexual problems such as premature or delayed ejaculation

You have diabetes, heart disease or another known health condition that might be linked to erectile dysfunction

You have other symptoms along with erectile dysfunction

Request an Appointment at Dr.DC. Clinic

Causes

Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Likewise, stress and mental health concerns can cause or worsen erectile dysfunction.

Sometimes a combination of physical and psychological issues causes erectile dysfunction. For instance, a minor physical condition that slows your sexual response might cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen erectile dysfunction.

Physical causes of erectile dysfunction

Heart disease

Clogged blood vessels (atherosclerosis)

High cholesterol

High blood pressure

Diabetes

Obesity

Metabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol •

Parkinson's disease

Multiple sclerosis

• Certain prescription medications

Tobacco use

Peyronie's disease — development of scar tissue inside the penis

Alcoholism and other forms of substance abuse

Sleep disorders

Treatments for prostate cancer or enlarged prostate

Surgeries or injuries that affect the pelvic area or spinal cord

Psychological causes of erectile dysfunction

The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include: •

Depression, anxiety or other mental health conditions

Stress

Relationship problems due to stress, poor communication or other concerns

Risk factors

As you get older, erections might take longer to develop and might not be as firm. You might need more direct touch to your penis to get and keep an erection.

Various risk factors can contribute to erectile dysfunction, including: •

Medical conditions, particularly diabetes or heart conditions

Tobacco use, which restricts blood flow to veins and arteries, can — over time — cause chronic health conditions that lead to erectile dysfunction

Being overweight, especially if you're obese

Certain medical treatments, such as prostate surgery or radiation treatment for cancerv

Injuries, particularly if they damage the nerves or arteries that control erections

Medications, including antidepressants, antihistamines and medications to treat high blood pressure, pain or prostate conditions •

Psychological conditions, such as stress, anxiety or depression

Drug and alcohol use, especially if you're a long-term drug user or heavy drinker

Complications

Complications resulting from erectile dysfunction can include:

An unsatisfactory sex life

Stress or anxiety

Embarrassment or low self-esteem

Relationship problems

The inability to get your partner pregnant

Prevention

The best way to prevent erectile dysfunction is to make healthy lifestyle choices and to manage any existing health conditions. For example: •

Work with your doctor to manage diabetes, heart disease or other chronic health conditions. •

See your doctor for regular checkups and medical screening tests.

Stop smoking, limit or avoid alcohol, and don't use illegal drugs.

Exercise regularly.

Take steps to reduce stress.

Get help for anxiety, depression or other mental health concerns

Diagnosis

For many men, a physical exam and answering questions (medical history) are all that's needed for a doctor to diagnose erectile dysfunction and recommend a treatment. If you have chronic health conditions or your doctor suspects that an underlying condition might be involved, you might need further tests or a consultation with a specialist. Tests for underlying conditions might include:

Physical exam. This might include careful examination of your penis and testicles and checking your nerves for sensation. •

Blood tests. A sample of your blood might be sent to a lab to check for signs of heart disease, diabetes, low testosterone levels and other health conditions.

• Urine tests (urinalysis). Like blood tests, urine tests are used to look for signs of diabetes and other underlying health conditions. •

Ultrasound. This test is usually performed by a specialist in an office. It involves using a wandlike device (transducer) held over the blood vessels that supply the penis. It creates a video image to let your doctor see if you have blood flow problems. This test is sometimes done in combination with an injection of medications into the penis to stimulate blood flow and produce an erection. •

Psychological exam. Your doctor might ask questions to screen for depression and other possible psychological causes of erectile dysfunction.

Treatment

The first thing your doctor will do is to make sure you're getting the right treatment for any health conditions that could be causing or worsening your erectile dysfunction.

Depending on the cause and severity of your erectile dysfunction and any underlying health conditions, you might have various treatment options. Your doctor can explain the risks and benefits of each treatment and will consider your preferences. Your partner's preferences also might play a role in your treatment choices.

Oral medications

Oral medications are a successful erectile dysfunction treatment for many men. They include:

Sildenafil (Viagra)

Tadalafil (Adcirca, Cialis)

Vardenafil (Levitra, Staxyn)

Avanafil (Stendra)

All four medications enhance the effects of nitric oxide — a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow and allows you to get an erection in response to sexual stimulation.

Taking one of these tablets will not automatically produce an erection. Sexual stimulation is needed first to cause the release of nitric oxide from your penile nerves. These medications amplify that signal, allowing some men to function normally. Oral erectile dysfunction medications are not aphrodisiacs, will not cause excitement and are not needed in men who get normal erections.

The medications vary in dosage, how long they work and side effects. Possible side effects include flushing, nasal congestion, headache, visual changes, backache and stomach upset.

Your doctor will consider your particular situation to determine which medication might work best. These medications might not treat your erectile dysfunction immediately. You might need to work with your doctor to find the right medication and dosage for you. Before taking any medication for erectile dysfunction, including over-the-counter supplements and herbal remedies, get your doctor's OK. Medications for erectile dysfunction do not work in all men and might be less effective in certain conditions, such as after prostate surgery or if you have diabetes. Some medications might also be dangerous if you:

Take nitrate drugs — commonly prescribed for chest pain (angina) — such as nitroglycerin (Minitran, Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Monoket) and isosorbide dinitrate (Dilatrate-SR, Isordil)

Have heart disease or heart failure

Have very low blood pressure (hypotension)

Other medications

Other medications for erectile dysfunction include:

Alprostadil self-injection. With this method, you use a fine needle to inject alprostadil (Caverject Impulse, Edex) into the base or side of your penis. In some cases, medications generally used for other conditions are used for penile injections on their own or in combination. Examples include papaverine, alprostadil and phentolamine. Often these combination medications are known as bimix (if two medications are included) or trimix (if three are included).

Each injection is dosed to create an erection lasting no longer than an hour. Because the needle used is very fine, pain from the injection site is usually minor.

Side effects can include mild bleeding from the injection, prolonged erection (priapism) and, rarely, formation of fibrous tissue at the injection site.

Alprostadil urethral suppository. Alprostadil intraurethral (Muse) therapy involves placing a tiny alprostadil suppository inside your penis in the penile urethra. You use a special applicator to insert the suppository into your penile urethra. The erection usually starts within 10 minutes and, when effective, lasts between 30 and 60 minutes. Side effects can include pain, minor bleeding in the urethra and formation of fibrous tissue inside your penis.

Testosterone replacement. Some men have erectile dysfunction that might be complicated by low levels of the hormone testosterone. In this case, testosterone replacement therapy might be recommended as the first step or given in combination with other therapies. Penis pumps, surgery and implants

Battery-powered penis pump for erectile dysfunction

If medications aren't effective or appropriate in your case, your doctor might recommend a different treatment. Other treatments include: •

Penis pumps. A penis pump (vacuum erection device) is a hollow tube with a hand-powered or battery-powered pump. The tube is placed over your penis, and then the pump is used to suck out the air inside the tube. This creates a vacuum that pulls blood into your penis. Once you get an erection, you slip a tension ring around the base of your penis to hold in the blood and keep it firm. You then remove the vacuum device.

The erection typically lasts long enough for a couple to have sex. You remove the tension ring after intercourse. Bruising of the penis is a possible side effect, and ejaculation will be restricted by the band. Your penis might feel cold to the touch.

If a penis pump is a good treatment choice for you, your doctor might recommend or prescribe a specific model. That way, you can be sure it suits your needs and that it's made by a reputable manufacturer.

Penile implants. This treatment involves surgically placing devices into both sides of the penis. These implants consist of either inflatable or malleable (bendable) rods. Inflatable devices allow you to control when and how long you have an erection. The malleable rods keep your penis firm but bendable.

Penile implants are usually not recommended until other methods have been tried first. Implants have a high degree of satisfaction among men who have tried and failed more-conservative therapies. As with any surgery, there's a risk of complications, such as infection.

Exercise

Recent studies have found that exercise, especially moderate to vigorous aerobic activity, can improve erectile dysfunction. However, benefits might be less in some men, including those with established heart disease or other significant medical conditions.

Even less strenuous, regular exercise might reduce the risk of erectile dysfunction. Increasing your level of activity might also further reduce your risk.

Discuss an exercise plan with your doctor.

Psychological counseling

If your erectile dysfunction is caused by stress, anxiety or depression — or the condition is creating stress and relationship tension — your doctor might suggest that you, or you and your partner, visit a psychologist or counselor.

Alternative medicine

Before using any supplement, check with your doctor to make sure it's safe for you — especially if you have chronic health conditions. Some alternative products that claim to work for erectile dysfunction can be dangerous.

The Food and Drug Administration (FDA) has issued warnings about several types of "herbal viagra" because they contain potentially harmful drugs not listed on the label. The dosages might also be unknown, or they might have been contaminated during formulation.

Some of these drugs can interact with prescription drugs and cause dangerously low blood pressure. These products are especially dangerous for men who take nitrates.

Lifestyle and home remedies

For many men, erectile dysfunction is caused or worsened by lifestyle choices. Here are some steps that might help: •

If you smoke, quit. If you have trouble quitting, get help. Try nicotine replacement, such as over-the-counter gum or lozenges, or ask your doctor about a prescription medication that can help you quit.

• Lose excess pounds. Being overweight can cause — or worsen — erectile dysfunction.

Include physical activity in your daily routine. Exercise can help with underlying conditions that play a part in erectile dysfunction in a number of ways, including reducing stress, helping you lose weight and increasing blood flow.

Get treatment for alcohol or drug problems. Drinking too much or taking certain illegal drugs can worsen erectile dysfunction directly or by causing long-term health problems.

Work through relationship issues. Consider couples counseling if you're having trouble improving communication with your partner or working through problems on your own

Coping and support Whether the cause is physical, psychological or a combination of both, erectile dysfunction can become a source of mental and emotional stress for you and your partner. Here are some steps you can take:

Don't assume you have a long-term problem. Don't view occasional erection problems as a reflection on your health or masculinity, and don't automatically expect to have erection trouble again during your next sexual encounter. This can cause anxiety, which might make erectile dysfunction worse.

Involve your sexual partner. Your partner might see your inability to have an erection as a sign of diminished sexual interest. Your reassurance that this isn't the case can help. Communicate openly and honestly about your condition. Treatment is often more successful when a man involves his partner.

Don't ignore stress, anxiety or other mental health concerns. Talk to your doctor or consult a mental health provider to address these issues.

Decreased of Male Sexual Arousal or decreased libidu

Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Likewise, stress and mental health concerns can cause or worsen erectile dysfunction.

Sometimes a combination of physical and psychological issues causes erectile dysfunction. For instance, a minor physical condition that slows your sexual response might cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen erectile dysfunction.

Physical causes of erectile dysfunction

In many cases, erectile dysfunction is caused by something physical. Common causes include:

• Heart disease

Clogged blood vessels (atherosclerosis)

High cholesterol

High blood pressure

Diabetes

Obesity

Metabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol •

Parkinson's disease

Multiple sclerosis

Certain prescription medications

Tobacco use

Peyronie's disease — development of scar tissue inside the penis

Alcoholism and other forms of substance abuse

Sleep disorders

Treatments for prostate cancer or enlarged prostate

Surgeries or injuries that affect the pelvic area or spinal cord

Psychological causes of erectile dysfunction

Psychological and other causes of Erectile dysfunction

that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:

• Depression, anxiety or other mental health conditions

• Stress

• Relationship problems due to stress, poor communication or other concerns Risk factors

As you get older, erections might take longer to develop and might not be as firm. You might need more direct touch to your penis to get and keep an erection.

Various risk factors can contribute to erectile dysfunction, including:

• Medical conditions, particularly diabetes or heart conditions

• Tobacco use, which restricts blood flow to veins and arteries, can — over time — cause chronic health conditions that lead to erectile dysfunction

• Being overweight, especially if you're obese

• Certain medical treatments, such as prostate surgery or radiation treatment for cancer

• Injuries, particularly if they damage the nerves or arteries that control erections

• Medications, including antidepressants, antihistamines and medications to treat high blood pressure, pain or prostate conditions

• Psychological conditions, such as stress, anxiety or depression

• Drug and alcohol use, especially if you're a long-term drug user or heavy drinker

Complications resulting from erectile dysfunction can include:

• An unsatisfactory sex life

• Stress or anxiety

• Embarrassment or low self-esteem

• Relationship problems

• The inability to get your partner pregnant

Treatment

of erectile Dysfunction first thing your doctor will do is to make sure you're getting the right treatment for any health conditions that could be causing or worsening your erectile dysfunction.

Depending on the cause and severity of your erectile dysfunction and any underlying health conditions, you might have various treatment options. Your doctor can explain the risks and benefits of each treatment and will consider your preferences. Your partner's preferences also might play a role in your treatment choices.

Oral medications

Oral medications are a successful erectile dysfunction treatment for many men. They include:

• Sildenafil (Viagra)

• Tadalafil (Adcirca, Cialis)

• Vardenafil (Levitra, Staxyn)

• Avanafil (Stendra)

All four medications enhance the effects of nitric oxide — a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow and allows you to get an erection in response to sexual stimulation.

Taking one of these tablets will not automatically produce an erection. Sexual stimulation is needed first to cause the release of nitric oxide from your penile nerves. These medications amplify that signal, allowing some men to function normally. Oral erectile dysfunction medications are not aphrodisiacs, will not cause excitement and are not needed in men who get normal erections.

The medications vary in dosage, how long they work and side effects. Possible side effects include flushing, nasal congestion, headache, visual changes, backache and stomach upset.

Your doctor will consider your particular situation to determine which medication might work best. These medications might not treat your erectile dysfunction immediately. You might need to work with your doctor to find the right medication and dosage for you.

Before taking any medication for erectile dysfunction, including over-the-counter supplements and herbal remedies, get your doctor's OK. Medications for erectile dysfunction do not work in all men and might be less effective in certain conditions, such as after prostate surgery or if you have diabetes. Some medications might also be dangerous if you:

• Take nitrate drugs — commonly prescribed for chest pain (angina) — such as nitroglycerin (Minitran, Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Monoket) and isosorbide dinitrate (Dilatrate-SR, Isordil)

• Have heart disease or heart failure

• Have very low blood pressure (hypotension)

Other medications

Other medications for erectile dysfunction include:

• Alprostadil self-injection. With this method, you use a fine needle to inject alprostadil (Caverject Impulse, Edex) into the base or side of your penis. In some cases, medications generally used for other conditions are used for penile injections on their own or in combination. Examples include papaverine, alprostadil and phentolamine. Often these combination medications are known as bimix (if two medications are included) or trimix (if three are included).

Each injection is dosed to create an erection lasting no longer than an hour. Because the needle used is very fine, pain from the injection site is usually minor.

Side effects can include mild bleeding from the injection, prolonged erection (priapism) and, rarely, formation of fibrous tissue at the injection site.

• Alprostadil urethral suppository. Alprostadil intraurethral (Muse) therapy involves placing a tiny alprostadil suppository inside your penis in the penile urethra. You use a special applicator to insert the suppository into your penile urethra.

The erection usually starts within 10 minutes and, when effective, lasts between 30 and 60 minutes. Side effects can include pain, minor bleeding in the urethra and formation of fibrous tissue inside your penis.

• Testosterone replacement. Some men have erectile dysfunction that might be complicated by low levels of the hormone testosterone. In this case, testosterone replacement therapy might be recommended as the first step or given in combination with other therapies. Penis pumps, surgery and implants

Battery-powered penis pump for erectile dysfunction

If medications aren't effective or appropriate in your case, your doctor might recommend a different treatment. Other treatments include:

• Penis pumps. A penis pump (vacuum erection device) is a hollow tube with a hand-powered or battery-powered pump. The tube is placed over your penis, and then the pump is used to suck out the air inside the tube. This creates a vacuum that pulls blood into your penis. Once you get an erection, you slip a tension ring around the base of your penis to hold in the blood and keep it firm. You then remove the vacuum device.

The erection typically lasts long enough for a couple to have sex. You remove the tension ring after intercourse. Bruising of the penis is a possible side effect, and ejaculation will be restricted by the band. Your penis might feel cold to the touch.

If a penis pump is a good treatment choice for you, your doctor might recommend or prescribe a specific model. That way, you can be sure it suits your needs and that it's made by a reputable manufacturer.

• Penile implants. This treatment involves surgically placing devices into both sides of the penis. These implants consist of either inflatable or malleable (bendable) rods. Inflatable devices allow you to control when and how long you have an erection. The malleable rods keep your penis firm but bendable.

Penile implants are usually not recommended until other methods have been tried first. Implants have a high degree of satisfaction among men who have tried and failed more-conservative therapies. As with any surgery, there's a risk of complications, such as infection. Exercise

Recent studies have found that exercise, especially moderate to vigorous aerobic activity, can improve erectile dysfunction. However, benefits might be less in some men, including those with established heart disease or other significant medical conditions.

Even less strenuous, regular exercise might reduce the risk of erectile dysfunction. Increasing your level of activity might also further reduce your risk.

Discuss an exercise plan with your doctor.

Psychological counseling

If your erectile dysfunction is caused by stress, anxiety or depression — or the condition is creating stress and relationship tension — your doctor might suggest that you, or you and your partner, visit a psychologist or counselor. Alternative medicine

Before using any supplement, check with your doctor to make sure it's safe for you — especially if you have chronic health conditions. Some alternative products that claim to work for erectile dysfunction can be dangerous.