If you are a man who is experiencing sexual problems, you are not alone. These problems become increasingly common as men age. In fact, erectile dysfunction (ED) affects about 40 percent of men at age 40 and 70 percent of men at age 70.
Sexual problems may be embarrassing to discuss, but it’s important to speak with your doctor about them. At MUSC Health Urology, we have one of the fellowship-trained doctors in South Carolina who is specially trained to treat ED and other sexual health conditions. We work closely with you to diagnose the specific condition and find the treatment solution that meets your individual needs.
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To request more information about our men’s sexual conditions’ services or make an appointment, please call 843-792-7888. You can also learn more about MUSC Health urology, including who’s on our team and where we’re located.
Erectile Dysfunction: Causes, Diagnosis & Treatment
ED, also known as impotence, is the inability to achieve or maintain an erection. Many men experience erection difficulty on occasion. If you experience difficulty about half of the times you attempt sexual intercourse, you may have ED.
If you suspect you have ED, rest assured that you don’t have to live with it. Many effective treatments exist, and it’s important to consult a specialist about options that may be right for you.
Because ED can be an early warning sign of more serious conditions such as cardiovascular disease, we evaluate your overall health during our diagnostic process. Working with MUSC Health’s Cardiac & Vascular Center, we make sure you receive comprehensive care to address any related conditions.
What causes erectile dysfunction?
Erectile dysfunction can result from physical causes, including:
- Cardiovascular disease (affecting the heart, arteries and veins)
- High blood pressure
- Prostate and bladder cancer treatments, including surgery and radiation
- Tobacco use
Psychological causes of ED include:
- Depression, anxiety or other mental health conditions
Diagnosing erectile dysfunction
To diagnose ED, our doctors start with a physical exam, medical history and sexual history. If necessary, we also conduct the following tests:
- Penile duplex study: An ultrasound to measure blood flow in the penis.
- Urine test: To look for signs of an underlying health condition such as diabetes.
- Blood test: To check for signs of other health conditions such as heart disease or low testosterone.
- Psychological evaluation: To screen for depression, anxiety or other mental health issues that can impact your ability to have an erection.
Treatment for erectile dysfunction
The first line of treatment for ED is oral medications to increase blood flow to the penis. In addition to Viagra™ (sildenafil) and Cialis® (tadalafil), we offer newer oral medications such as Stendra™ (avanafil) and versions that dissolve under the tongue. These newer drugs can take effect more quickly than the first generation pills.
We do not recommend oral medications for ED if you are taking nitrates for a heart condition. If medications are not effective for you, or you are taking nitrates, you may be a candidate for the latest treatment options and devices, including:
- Intracorporeal injections (ICI): Medicine that you inject into the penile tissue to create an erection.
- Vacuum erection device: A cylinder that slips over the penis with a pump to pull blood into the penis.
- Penile prosthesis surgery: A device (prosthesis) implanted inside the penis that helps you achieve an erection.
Low Testosterone (Hypogonadism): Causes, Symptoms & Treatment
Testosterone is a male hormone important for sperm production, sex drive, and bone and muscle mass. The hormone also affects hair growth, body fat distribution, mood and energy level. Women’s bodies also produce testosterone but in much smaller amounts.
Causes & symptoms of low testosterone
As men age, their testosterone levels naturally begin to decrease. Other causes of low testosterone include:
- Certain prescription medications
- Testicle injury
- Underactive thyroid (hypothyroidism)
- AIDS and HIV
- Long-term opioid (prescription pain relief medication) use
Low testosterone symptoms include:
- Low sex drive
- Problems achieving an erection
- Low energy
- Reduced muscle mass
- Increased body fat
- Increased risk of heart disease
Low testosterone diagnosis & treatment
A blood test can determine if your testosterone levels are low. We also conduct a comprehensive physical exam and medical history to rule out other possible causes.
The main treatment for low testosterone is testosterone replacement therapy (TRT), as a gel, injection or pellet. At MUSC Health, our specialists have years of expertise assessing specific health needs to determine the best form of TRT for you. You can rest assured knowing that an urologist is providing your care. We carefully monitor your therapy in a safe, controlled environment to:
- Boost your testosterone levels.
- Improve your symptoms.
- Manage possible side effects of TRT, which include infertility and increased risk for heart attack and stroke.
Peyronie’s disease develops when abnormal scar tissue builds up inside the penis, causing it to bend or curve. This penile curvature causes painful erections, which make sexual intercourse difficult. Experts are not certain what causes Peyronie’s disease, but it may result from a minor injury to the penis.
Diagnosis & treatment for Peyronie's disease
To diagnose Peyronie’s disease, our urologists conduct a physical exam, medical history and imaging tests, when necessary. Based on our thorough evaluation, we may recommend treatment options such as:
- Medication: We inject collagenase clostridium histolyticum (Xiaflex®), a medication that breaks down the scar tissue and restores the penis’ normal shape.
- Surgery: Options to correct the shape of the penis include:
- Penile plication surgery: This procedure straightens penile curvature by placing sutures to correct the angulation.
- Surgical graft surgery: The scar tissue causing the curvature is surgically removed and replaced by synthetic graft material.
- Penile prosthesis surgery: An inflatable penile prosthesis is inserted to provide more rigid and reliable erections, overcoming the curvature caused by scar tissue.