< back to Urology Conditions

Erectile Dysfunction

Erectile Dysfunction (ED)—the inability to maintain an erection for sex—is one of the most common health problems for men as they age.

  • ED affects about 30 million men in the U.S.
  • Half of men aged 40 – 70 suffer with ED.
  • Nearly 75% of men with ED do not seek treatment.

For each case, ED varies in terms of cause, severity, and response to treatment. But a common factor is the deep impact ED has on a man’s emotional and psychological well-being. The good news is that Erlanger has effective treatments readily available for all types and levels of ED.

Types of ED

ED has both physical and psychological origins. Both “types” of ED are often interconnected and treatment must address your mind and body.

  • Organic ED has a physical cause and can be treated though lifestyle changes, medication, and/or surgery.
  • Psychogenic ED originates in the mind and can be brought on by stress, anxiety, performance issues, and sexual conflict. 

Causes of ED

  • Aging
  • Hormonal/low testosterone
  • Obesity (being overweight)
  • Heart disease
  • Blood vessel disease
  • Peyronie’s disease
  • Smoking
  • Prostate cancer treatment (prostatectomy or radiation)
  • Metabolic syndrome
  • High blood pressure or cholesterol
  • Diabetes
  • Spinal cord injury, neurologic disease
  • Medications
  • Kidney failure
  • Benign prostatic hyperplasia (BPH) and Lower Urinary Tract Symptoms (LUTS)

Diagnosis

Academic Urologists at Erlanger will conduct a comprehensive assessment of your health, medical conditions, medications and lifestyle, with a focus on ED’s impact on the individual and couple. If you are in a relationship, we recommend that your partner join you for the consultation. This will help address all issues affecting you and your partner, and involve both in the care plan. Diagnostic tests may include:

  • Focused physical examination
  • Couples questionnaire
  • Prostate cancer screening (when appropriate)
  • Blood tests (if hormonal condition is suspected)
  • Imaging tests to check for structural and blood flow abnormalities (only in select cases)

These tests will help us tailor a treatment plan for your needs. This can include one, or a combination of, the three basic treatment approaches for ED – conservative, medical and surgical. At Erlanger, we emphasize conservative lifestyle change as part of all ED therapies offered.

Treatments

Treating your ED is about more than sexual well-being, it’s about your overall health. Because the blood vessels in the penis are so small, they get blocked by plaque (fatty build-up) before larger veins and arteries in our body. In this way, ED is an early signal for more dangerous vessel blockage—in the heart or the brain. The good news is that you can greatly reduce these risks with help from your urologist, cardiologist, and primary care physician.

Conservative Options

Lifestyle Change - Improve Your ED and Overall Health

  • Stop smoking – Our training can help you make this difficult change.
  • Eat healthy and control portions – Adopting a low-fat, high-fiber Mediterranean or Asian diet can be a good start.
  • Exercise – Start a routine that elevates your heart rate for 30 – 60 minutes, three times a week

Medical Options

Medications – When Lifestyle Change Alone Doesn’t Work

Many well-known medications are effective as a first-line therapy if lifestyle changes alone do not remedy your ED. The following drugs are equally effective, but differ in duration and side effects. Our team can guide you to the right medication, and prescribe alternatives if a drug does not work for you.

  • Viagra (Sildenafil)
  • Cialis (Tadalafil)
  • Stenda / Spedra (Avanafil)
  • Levitra (vardenafil)

Testosterone Replacement – Helpful in Some Cases

Testosterone replacement is usually not a front-line treatment for ED, but can help:

  • Increase sexual desire in men with a hormonal issue (low testosterone level)
  • Treat ED in younger men who are more likely to have isolated hormonal, non-vascular ED
  • Improve the health of men with diabetes, when taken with other common ED medications

Vacuum Pumps – Treat Mild ED with Few Side Effects

Often used with medication, vacuum devices treat mild ED, using suction to draw blood into the penis. They usually don’t work well for severe ED, but may be worth a try since there are few side effects. The Erlanger urology team offers important training to help you get started.

Penile injection therapy – A Highly Effective Option for Moderate to Severe ED

While some men take pause when this option is presented, most are amazed with the results of penile injections for moderate-to-severe ED. It works by placing a very small needle, like one that injects insulin, directly in the side of the penis. This delivers a compounded medication (Trimix) that creates an erection within 5–20 minutes. With the correct dose, it lasts as long as you want.

Urethral Suppository – An injection option without needles

The urethral suppository provides an option for men who are needle averse or who cannot undergo a procedure to correct moderate to severe ED. It works by placing a medication pellet (MUSE) in the urethra with a special applicator. An erection usually occurs in 5–20 minutes.

Surgical Options

Penile Prosthetic Implantation – A reliable option when medical therapy fails

If medical therapies don’t work, a penile implant can be a safe and reliable solution for severe ED. It’s also great for patients who’ve had prostate surgery, cancer treatments, peripheral vascular disease, renal failure, diabetes or pelvic trauma. Erlanger offers specialized expertise in both semi-rigid or inflatable implants—and we can walk you through the pros and cons of each option.

Benefits of a penile implant

  • Excellent reliability with high satisfaction levels (88-95% satisfaction for both partners)
  • Does not affect sensation, ejaculation or the ability to reach orgasm
  • Maintains erection for the duration you want
  • Remains concealed and unnoticeable

Erlanger Provider

Anand Shridharani, MD, is a board-certified, fellowship-trained specialist in male reproductive and prosthetic urology with Erlanger Urology in Chattanooga, TN. His practice offers comprehensive men’s reproductive and sexual health services including comprehensive management of the infertile male, reproductive microsurgery including vasectomy reversal, urologic cancer survivorship, and penile/urethral reconstruction.