My Doctor Online The Permanente Medical Group

Symptoms and Diagnosis

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Erectile dysfunction (ED) may be a very distressing condition. It can happen to any male at any time. The typical symptoms are the inability to:

• Obtain an erection
• Obtain an erection hard enough for sexual activity at any time, either with masturbation or with a partner
• Maintain an erection

Your medical and sexual histories are important in providing information about the severity of your condition and the potential causes of ED. Questions of major importance may include how long you have had the condition and whether you get erections in your sleep.

Having painful erections or curved erections (Peyronie's disease) is a separate condition from ED. If you have these problems, you should be examined by us.

Diagnosis

A complete physical examination, including blood work, done by your personal physician may give clues to underlying conditions that cause ED. Conditions that affect your blood vessels, nerves, or glands can be responsible for ED.

There are tests that can be used to examine the blood vessels and nerves of the penis and pelvic region. However, these tests are rarely performed since they do not affect treatment options and any finding is rarely reversible.

Testosterone levels. If appropriate, we may order a testosterone test to help determine if low testosterone levels are the cause of your ED.

Your use of medicines and drugs can affect erections, including:

• Prescription medicine
• Over-the-counter medicines
• Illicit or recreational drugs (including tobacco)
• Herbal remedies
• Supplements

We may talk to you about psychological evaluation if we feel psychological factors are contributing to your ED symptoms.

Causes

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Male sexual arousal and erection is a complex process that involves the brain, hormones, emotions, nerves, muscles, and blood vessels. Erectile dysfunction can result from a problem with any part of this process. In addition, stress and mental health problems can worsen erectile dysfunction.

Research shows that over 80 percent of ED is related to physical problems in the body's blood vessels and nerves or to abnormal hormone levels. If treating an underlying condition does not help your erectile dysfunction, medications or other direct treatments may work.

Common conditions leading to ED include:

• Heart disease or atherosclerosis (hardening of the arteries)
• Diabetes
• High cholesterol
• Hypertension
• Kidney disease
• Radiation to the pelvis for prostate or rectal cancer
• Pelvic injury due to trauma or surgery
• Low testosterone levels that can lead to poor erections or decreased libido (interest in sex)

Neurological diseases that can also cause ED include:

• Stroke
• Spinal cord or back injury
• Multiple sclerosis
• Dementia

ED can be a side effect caused by certain medicines, such as:

• Diuretics and other blood pressure medicines
• Antidepressant, anti-anxiety, and antiepileptic medicines
• Some antihistamines
• Muscle relaxants and nonsteroidal anti-inflammatory drugs (NSAIDs)
• Medicines for Parkinson's disease and benign prostatic hypertrophy (BPH)
• Some chemotherapy medicines

Psychological factors that may affect ED are:

• Stress
• Anxiety
• Depression
• Performance anxiety with a new relationship
• Marital or relationship problems

Lifestyle habits that can damage your blood vessels may be another cause of ED, including:

• Smoking, one of the most common causes of ED
• Lack of physical activity
• Being overweight or obese
• Alcohol and drug abuse

Activities that cause pressure on the nerves to the penis, like prolonged bicycling, may lead to ED.

Treatment

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There are many treatments for erectile dysfunction (ED). Treatments can be as simple as modifying certain lifestyle habits like quitting smoking and getting regular exercise. Or treatment might include taking medicine and/or using mechanical devices. Your problem can usually be corrected, depending on how far you are willing to go to treat it.

Treatments include:

• Oral medicines
• Self-injections
• Urethral suppository
• Vacuum erection device (VED)
• Penile implants
• Other treatments

It can be helpful to discuss the treatment options with your partner. The cause and severity of your ED, as well as your partner's wishes, may help determine the right treatment for you.

Lifestyle Management

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Erectile dysfunction (ED) is not always due to aging. You may be able to avoid ED by actively trying to prevent it. Some ED cases are improved or solved by incorporating healthy lifestyle behaviors like physical activity and maintaining a healthy weight. Here are some tips to help you get started.

Practice healthy living

It is helpful to practice healthy living tips like the following:

• Eat a healthy, balanced diet.
• Aim to maintain a healthy weight.
• Engage in physical activity. Begin with a 10-minute moderate activity such as walking, 3 times a day, 5 days a week, and if you are able, work up to 60 minutes per day, 5 days a week.
• If you use tobacco products, this is a perfect time to quit.
• Decrease and manage your stress.
• Limit alcohol to less than 2 drinks a day and avoid it before sexual intercourse.

Take care of your ongoing conditions

If you have a family history of diabetes, hypertension, high cholesterol, heart disease, and stroke or unexplained limping (claudication), talk with us about scheduling regular checkups starting in your 20s. We want to ensure that you are managing your condition to help prevent ED in the future.

If your medicines are contributing to ED, we will find alternatives that will work for you. We will ask that you stop using any supplements or over-the-counter medicines that may be contributing to your ED.

Explore counseling and sex therapy

Counseling and sex therapy may be helpful even if the cause of your ED is due to physical reasons such as chronic illness. Counseling can help if you are experiencing performance anxiety or lack of libido (interest in sex). If you are having relationship problems, counseling may help improve your relationship and make it stronger.

Your Care with Me

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If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and sexual history and I may perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

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If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

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Coordinating Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the "After Visit Summary" that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

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Convenient Resources for You

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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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