Erection problems - aftercare
Erectile dysfunction - self-care
Impotence does not go hand in hand with aging. Other factors, such as a person's physical health and emotional well-being, are more likely to be the reason for the lack of sexual performance in an individual.
What to Expect at Home
You have seen your health care provider for erection problems. You may get a partial erection that is insufficient for intercourse or you may be unable to get an erection at all. Or you may prematurely lose the erection during intercourse. If the condition persists, the medical term for this problem is erectile dysfunction (ED).
Erection problems are common in adult men. In fact, almost all men have a problem getting or maintaining an erection at times.
You're a man and unfortunately, you aren't able to get an erection at all, or, you lose your erection during intercourse before you are ready. What's a man to do? Let's talk about the causes of this condition, and the various ways to make erection problems a thing of the past. Erection problems are pretty common in adult men. Almost all men sometimes have trouble getting or keeping an erection. In many cases, the problem goes away with little or no treatment. In other cases, it can be an ongoing problem. If you have trouble getting or keeping an erection more than 25% of the time, it is a problem. An erection involves your brain, nerves, hormones, and blood vessels. So, anything that interferes with any of these normal functions can lead to problems getting or keeping an erection. Common causes of erection problems include diseases such as diabetes, high blood pressure, heart or thyroid conditions, poor blood flow, depression, or nervous system disorders like multiple sclerosis or Parkinson's disease. Medicines can also be a culprit, including those that treat high blood pressure, heart problems, sleeping pills, and antidepressants. Men who have prostate surgery may also have erection problems, but this is often only a short-term problem. For many men, lifestyle changes can help. Cut down on smoking, alcohol, and illegal drug use. Get plenty of rest and take time to relax. Exercise and eat a healthy diet to keep good blood circulation. Talk openly to your partner about sex and your relationship; if you can't do this, counseling can help. If the problem does not go away with lifestyle changes, or if it begins after an injury or prostate surgery, or if you have symptoms like low back pain, or abdominal pain, or a change in urination, you should call your doctor. If erection problems seem to be caused by a medication you are taking, talk to your doctor about that. You may need to lower the dose or change to another drug. But don't change or stop taking any medications without first talking to your doctor. Treatment may depend on the cause of your problem. Your doctor can prescribe many treatments, including medicines you take by mouth, injections into the penis, medicines inserted into the urethra, vacuum devices, surgery, and penis implants. Ask your doctor about the possible side effects and complications of each treatment. Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are popular medications called phosphodiesterase-5 (PDE5) inhibitors. They work, and they work when you are sexually aroused. These drugs can have side effects, which can range from muscle pain and flushing to heart attack. Do not use these drugs with medications such as nitroglycerin. The combination can cause your blood pressure to drop. As you see, there are several ways to treat erectile problems. Talk with your doctor to see what may be the best one for you.
Lifestyle
For many men, lifestyle changes can help with ED. For example, alcohol and illegal drugs may make you feel more relaxed. But they can cause ED or make it worse. Avoid illegal drugs, and consider limiting the amount of alcohol you drink.
Smoking and smokeless tobacco can cause narrowing of blood vessels all over the body, including those that supply blood to the penis. Talk to your provider about quitting.
Other lifestyle tips include:
- Get plenty of rest and take time to relax.
- Exercise and eat healthy foods to maintain good circulation.
- Use safer sex practices. Reducing your worry about STDs may help prevent negative emotions that can affect your erection.
- Talk with your provider and review your daily prescription medicine list. Many prescription medicines can cause or worsen ED. Some medicines you need to take for other medical conditions could add to ED, like medicines for high blood pressure or migraine medicines.
Talking With Your Partner
Having ED can make you feel bad about yourself. This can make it even more difficult to seek treatment and enjoy sexual activity.
ED can be a troubling issue for couples because it can be difficult for you or your partner to discuss the problem with each other. Couples who do not openly talk to each other are more likely to have problems with sexual intimacy. Likewise, men who have trouble talking about their feelings may be unable to share their sexual concerns with their partners.
If you have trouble communicating, counseling can be very helpful for you and your partner. Finding a way for both of you to express your feelings and desires, and then work on the issues together, can make a big difference.
Medicines, Herbs, and Supplements
Sildenafil (Viagra), vardenafil (Levitra, Staxyn), tadalafil (Cialis), and avanafil (Stendra) are oral medicines prescribed for ED. They cause erections only when you are sexually aroused.
- The effect is most often seen within 15 to 45 minutes. The effects of these medicines may last for several hours. Tadalafil (Cialis) may last for up to 36 hours.
- Sildenafil (Viagra) should be taken on an empty stomach. (Levitra) and tadalafil (Cialis) may be taken with or without food.
- These medicines should not be used more than once a day.
- Common side effects of these medicines include flushing, upset stomach, headache, nasal congestion, back pain, and dizziness.
Other ED medicines include drugs that are injected into the penis and tablets that can be inserted into the opening of the urethra. Your provider will teach you how to use these treatments if they are prescribed.
If you have heart disease, talk with your provider before using these medicines. Men who take nitrates for heart disease should not take ED medicines.
Many herbs and dietary supplements are marketed to help sexual performance or desire. None of these remedies have been proven effective for treating ED. Talk to your provider to see if any of these treatments are right for you. Treatment options other than medicines are available if medicines do not work for you. Talk to your provider about these treatments.
When to Call the Doctor
Call your provider right away or go to an emergency room if any ED medicine gives you an erection that lasts more than 4 hours. If this problem is not treated, you may suffer lasting damage to your penis.
To end an erection you may try to repeat climax and apply a cold pack to your genitals (wrap the pack in a cloth first). Never go to sleep with an erection.
References
Burnett AL, Nehra A, Breau RH, et al. Erectile dysfunction: AUA guideline. J Urol. 2018;200(3):633-641. PMID: 29746858
Burnett AL, Ramasamy R. Evaluation and management of erectile dysfunction. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 69.
Liu JL, Bivalacqua TJ. Erectile dysfunction. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 191.
Zagoria RJ, Dyer R, Brady C. The male genital tract. In: Zagoria RJ, Dyer R, Brady C, eds. Genitourinary Imaging: The Requisites. 3rd ed. Philadelphia, PA: Elsevier; 2016:chap 8.
Version Info
Last reviewed on: 7/1/2023
Reviewed by: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
