Erectile Dysfunction

Erectile dysfunction (ED), also known as male impotence, is a condition in which a man either cannot have an erection or cannot sustain an erection long enough to finish having sex. Houston Methodist’s urological specialist team offers patients many treatment options for ED, including hormone therapy and specially designed penile implants to increase function.
Causes of Erectile Dysfunction
While getting older can affect a man’s ability to achieve and sustain an erection to some degree, ED is not a natural part of aging. It can be caused by many different factors, including the following:
  • Diabetes
  • High blood pressure (hypertension)
  • Atherosclerosis (hardening of the arteries)
  • Stress, anxiety or depression
  • Alcohol and tobacco use
  • Some prescription medications
  • Fatigue
  • Brain or spinal-cord injuries
  • Hypogonadism (caused by insufficient production of testosterone)
  • Peyronie’s disease (which may cause a curved or bent penis)
  • Multiple sclerosis
  • Parkinson's disease
  • Radiation therapy to the testicles
  • Stroke
  • Prior prostate or bladder surgery
  • Trauma

Diagnosing Erectile Dysfunction
Your urologist will perform a thorough physical exam and obtain your medical history. Laboratory tests may be needed to identify any underlying causes of ED. Erectile function tests and imaging studies may be ordered to provide needed information about blood flow to the penis.

Treating Erectile Dysfunction
The treatment for your erectile dysfunction will depend on what is causing it. If, for example, you are diagnosed with hypertension or diabetes, ED may resolve on its own once the condition causing it is under control. Other approaches can also be helpful, either alone or in combination.
  • Lifestyle Changes: If the cause of ED cannot be linked to a specific medical condition, your physician may recommend some healthy lifestyle changes. Steps such as stopping smoking, eating a healthy diet, getting more exercise and reducing stress may be all that is needed to attain proper erectile function. 
  • Sex Therapy: If an erection can be achieved during sleep but not for sex, consulting a sex therapist may help. Between sessions, a therapist may assign tasks such as reading books about sexuality, practicing exercises designed to reduce performance anxiety and strengthening sexual communication skills, which may help resolve the ED.
  • Medication: If it is determined that your ED is not caused by a serious medical condition, a physician may prescribe a medication such as sildenafil (Viagra®), tadalafil (Cialis®) or vardenafil (Levitra®, Staxyn ®). These drugs intensify the effects of nitric oxide, a natural chemical produced by the body that relaxes the muscles in the penis. This increases blood flow and allows an erection to occur in response to sexual stimulation. 
  • Hormone Therapy: Testosterone is one of the main contributors to a man’s sex drive and erections. Men have their highest levels of testosterone in their early 20s; as they age, they lose one percent of testosterone every year. Eventually testosterone levels drop below a certain point, and men notice a significant decline in sex drive and erectile function. Testosterone replacement has been shown to improve ED and libido in many men.
  • Penile Implants: If less invasive methods of treating ED are not effective, a penile implant (also called a penile prosthesis) may be a good option. This is a surgically implanted device that can enable you to have an erection using either a pump (inflatable implant) or a manual mechanism (malleable implant). 

Penile implant surgery usually takes 45 minutes to an hour under either general or local anesthesia. You will need to stay in the hospital overnight, and normal activities typically can be resumed about six weeks after surgery.


Our physicians at Houston Methodist specialize in treating erectile dysfunction at the following convenient locations.