Diagnóstico

For many men, a physical exam and answering questions (medical history) are all that's needed for a doctor to diagnose erectile dysfunction and recommend a treatment. If you have chronic health conditions or your doctor suspects that an underlying condition might be involved, you might need further tests or a consultation with a specialist.

Tests for underlying conditions might include:

  • Physical exam. This might include careful examination of your penis and testicles and checking your nerves for sensation.
  • Blood tests. A sample of your blood might be sent to a lab to check for signs of heart disease, diabetes, low testosterone levels and other health conditions.
  • Urine tests (urinalysis). Like blood tests, urine tests are used to look for signs of diabetes and other underlying health conditions.
  • Ultrasound. This test is usually performed by a specialist in an office. It involves using a wandlike device (transducer) held over the blood vessels that supply the penis. It creates a video image to let your doctor see if you have blood flow problems.

    This test is sometimes done in combination with an injection of medications into the penis to stimulate blood flow and produce an erection.

  • Psychological exam. Your doctor might ask questions to screen for depression and other possible psychological causes of erectile dysfunction.

Tratamiento

The first thing your doctor will do is to make sure you're getting the right treatment for any health conditions that could be causing or worsening your erectile dysfunction.

Depending on the cause and severity of your erectile dysfunction and any underlying health conditions, you might have various treatment options. Your doctor can explain the risks and benefits of each treatment and will consider your preferences. Your partner's preferences also might play a role in your treatment choices.

Medicamentos orales

Los medicamentos orales son un tratamiento eficaz contra la disfunción eréctil para muchos hombres. Algunos de ellos son:

  • Sildenafil (Viagra)
  • Tadalafilo (Adcirca, Cialis)
  • Vardenafil (Levitra, Staxyn)
  • Avanafil (Stendra)

Los cuatro medicamentos mejoran los efectos del óxido nítrico, una sustancia química natural que el organismo produce y que relaja los músculos del pene. Esto aumenta la irrigación sanguínea y permite lograr una erección en respuesta a la estimulación sexual.

Tomar una de estas tabletas no hará que la erección se produzca automáticamente. Primero es necesaria la estimulación sexual para provocar la liberación de óxido nítrico de los nervios penianos. Estos medicamentos amplifican esa señal, lo que permite a algunos hombres desempeñarse con normalidad. Los medicamentos orales para la disfunción eréctil no son afrodisíacos, no provocan excitación y no son necesarios para los hombres que tienen erecciones normales.

Los medicamentos varían en la dosis, en la duración de su funcionamiento y en sus efectos secundarios. Los posibles efectos secundarios comprenden enrojecimiento, congestión nasal, dolor de cabeza, alteraciones visuales, malestar estomacal y dolor de espalda.

El médico tendrá en cuenta tu situación particular para determinar qué medicamento podría funcionar mejor. Es posible que estos medicamentos no traten de inmediato tu disfunción eréctil. Puede que necesites trabajar con el médico para encontrar el medicamento y la dosis adecuados para ti.

Antes de tomar cualquier medicamento para la disfunción eréctil, como suplementos de venta libre y medicamentos a base de hierbas, obtén la aprobación del médico. Los medicamentos para la disfunción eréctil no les dan resultado a todos los hombres y pueden ser menos efectivos en ciertas condiciones, como después de una cirugía de próstata o si tienes diabetes. Algunos medicamentos también pueden ser peligrosos si ocurre lo siguiente:

  • Tomas medicamentos con nitrato —comúnmente recetados para el dolor en el pecho (angina de pecho)— como la nitroglicerina (Minitran, Nitro-Dur, Nitrostat u otros), el mononitrato de isosorbida (Monoket) y el dinitrato de isosorbida (Dilatrate-SR, Isordil)
  • Tienes una enfermedad cardíaca o insuficiencia cardíaca
  • Tienes presión arterial muy baja (hipotensión)

Other medications

Other medications for erectile dysfunction include:

  • Alprostadil self-injection. With this method, you use a fine needle to inject alprostadil (Caverject Impulse, Edex) into the base or side of your penis. In some cases, medications generally used for other conditions are used for penile injections on their own or in combination. Examples include papaverine, alprostadil and phentolamine. Often these combination medications are known as bimix (if two medications are included) or trimix (if three are included).

    Each injection is dosed to create an erection lasting no longer than an hour. Because the needle used is very fine, pain from the injection site is usually minor.

    Side effects can include mild bleeding from the injection, prolonged erection (priapism) and, rarely, formation of fibrous tissue at the injection site.

  • Alprostadil urethral suppository. Alprostadil intraurethral (Muse) therapy involves placing a tiny alprostadil suppository inside your penis in the penile urethra. You use a special applicator to insert the suppository into your penile urethra.

    The erection usually starts within 10 minutes and, when effective, lasts between 30 and 60 minutes. Side effects can include pain, minor bleeding in the urethra and formation of fibrous tissue inside your penis.

  • Testosterone replacement. Some men have erectile dysfunction that might be complicated by low levels of the hormone testosterone. In this case, testosterone replacement therapy might be recommended as the first step or given in combination with other therapies.

Penis pumps, surgery and implants

If medications aren't effective or appropriate in your case, your doctor might recommend a different treatment. Other treatments include:

  • Penis pumps. A penis pump (vacuum erection device) is a hollow tube with a hand-powered or battery-powered pump. The tube is placed over your penis, and then the pump is used to suck out the air inside the tube. This creates a vacuum that pulls blood into your penis.

    Once you get an erection, you slip a tension ring around the base of your penis to hold in the blood and keep it firm. You then remove the vacuum device.

    The erection typically lasts long enough for a couple to have sex. You remove the tension ring after intercourse. Bruising of the penis is a possible side effect, and ejaculation will be restricted by the band. Your penis might feel cold to the touch.

    If a penis pump is a good treatment choice for you, your doctor might recommend or prescribe a specific model. That way, you can be sure it suits your needs and that it's made by a reputable manufacturer.

  • Penile implants. This treatment involves surgically placing devices into both sides of the penis. These implants consist of either inflatable or malleable (bendable) rods. Inflatable devices allow you to control when and how long you have an erection. The malleable rods keep your penis firm but bendable.

    Penile implants are usually not recommended until other methods have been tried first. Implants have a high degree of satisfaction among men who have tried and failed more-conservative therapies. As with any surgery, there's a risk of complications, such as infection.

Exercise

Recent studies have found that exercise, especially moderate to vigorous aerobic activity, can improve erectile dysfunction. However, benefits might be less in some men, including those with established heart disease or other significant medical conditions.

Even less strenuous, regular exercise might reduce the risk of erectile dysfunction. Increasing your level of activity might also further reduce your risk.

Discuss an exercise plan with your doctor.

Psychological counseling

If your erectile dysfunction is caused by stress, anxiety or depression — or the condition is creating stress and relationship tension — your doctor might suggest that you, or you and your partner, visit a psychologist or counselor.

Alternative medicine

Before using any supplement, check with your doctor to make sure it's safe for you — especially if you have chronic health conditions. Some alternative products that claim to work for erectile dysfunction can be dangerous.

The Food and Drug Administration (FDA) has issued warnings about several types of "herbal viagra" because they contain potentially harmful drugs not listed on the label. The dosages might also be unknown, or they might have been contaminated during formulation.

Some of these drugs can interact with prescription drugs and cause dangerously low blood pressure. These products are especially dangerous for men who take nitrates.

Estilo de vida y remedios caseros

En muchos hombres, la disfunción eréctil es causada o empeorada por su estilo de vida. A continuación te damos algunas medidas que podrían ayudar:

  • Si fumas, deja de hacerlo. Si te resulta difícil dejar el cigarrillo, busca ayuda. Prueba productos de reemplazo de nicotina, como la goma de mascar o pastillas de venta libre, o pregunta a tu médico sobre medicamentos con receta que pueden ayudarte a dejar de fumar.
  • Baja los kilos de más. El sobrepeso puede causar o empeorar la disfunción eréctil.
  • Incorpora la actividad física a tu rutina diaria. El ejercicio puede ayudar con los trastornos no diagnosticados que juegan un papel en la disfunción eréctil de varias maneras, entre ellas, reduce el estrés, te ayudar a bajar de peso y aumenta el flujo sanguíneo.
  • Obtén tratamiento para problemas de alcohol o drogas. Beber demasiado alcohol o consumir algunas drogas ilegales puede empeorar la disfunción eréctil directamente o provocar problemas de salud a largo plazo.
  • Resuelve los problemas en tu relación de pareja. Si tienes problemas para mejorar la comunicación con tu pareja o para resolver los problemas por ti mismo, considera la posibilidad de recibir asesoramiento psicológico para parejas

Estrategias de afrontamiento y apoyo

Ya sea por una causa física, psicológica o una combinación de ambas, la disfunción eréctil puede transformarse en una fuente de estrés emocional y mental para ti y para tu pareja. A continuación te damos algunas medidas que puedes tomar:

  • No des por sentado que tienes un problema a largo plazo. No veas los problemas de erección ocasionales como un reflejo de tu salud o de tu masculinidad, y no creas automáticamente que volverás a tener problemas de erección durante el próximo encuentro sexual. Esto puede causar ansiedad, lo que podría empeorar la disfunción eréctil.
  • Involucra a tu pareja sexual. Tu pareja podría creer que tu incapacidad para tener una erección es un signo de disminución del interés sexual. Tu confirmación de que ese no es el motivo puede ayudar. Habla de manera abierta y sincera acerca de tu trastorno. A menudo, el tratamiento es más exitoso cuando el hombre involucra a su pareja.
  • No ignores el estrés, la ansiedad u otros trastornos de salud mental. Conversa con el médico o consulta con un profesional de salud mental para abordar estos temas.

Preparación para la consulta

You're likely to start by seeing your family doctor or a general practitioner. Depending on your particular health concerns, you might go directly to a specialist — such as a doctor who specializes in male genital problems (urologist) or a doctor who specializes in the hormonal systems (endocrinologist).

Because appointments can be brief and there's often a lot of ground to cover, it's a good idea to be well-prepared. Here's some information to help you get ready and know what to expect from your doctor.

What you can do

Take these steps to prepare for your appointment:

  • Ask what you need to do ahead of time. When you make the appointment, be sure to ask if there's anything you need to do in advance. For example, your doctor might ask you not to eat before having a blood test.
  • Write down any symptoms you've had, including any that might seem unrelated to erectile dysfunction.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins, herbal remedies and supplements you take.
  • Take your partner along, if possible. Your partner can help you remember something that you missed or forgot during the appointment.
  • Write down questions to ask your doctor.

For erectile dysfunction, some basic questions to ask your doctor include:

  • What's the most likely cause of my erection problems?
  • What are other possible causes?
  • What kinds of tests do I need?
  • Is my erectile dysfunction most likely temporary or chronic?
  • What's the best treatment?
  • What are the alternatives to the primary approach that you're suggesting?
  • How can I best manage other health conditions with my erectile dysfunction?
  • Are there any restrictions that I need to follow?
  • Should I see a specialist? What will that cost, and will the visit be covered by my insurance?
  • If medication is prescribed, is there a generic alternative?
  • Are there any brochures or other printed material that I can take home with me? What websites do you recommend?

In addition to your prepared questions, don't hesitate to ask additional questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Be prepared for questions such as these:

  • What other health concerns or chronic conditions do you have?
  • Have you had any other sexual problems?
  • Have you had any changes in sexual desire?
  • Do you get erections during masturbation, with a partner or while you sleep?
  • Are there any problems in your relationship with your sexual partner?
  • Does your partner have any sexual problems?
  • Are you anxious, depressed or under stress?
  • Have you ever been diagnosed with a mental health condition? If so, do you currently take any medications or get psychological counseling (psychotherapy) for it?
  • When did you first begin noticing sexual problems?
  • Do your erectile problems occur only sometimes, often or all of the time?
  • What medications do you take, including any herbal remedies or supplements?
  • Do you drink alcohol? If so, how much?
  • Do you use any illegal drugs?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, seems to worsen your symptoms?

Disfunción eréctil care at Mayo Clinic

June 23, 2017
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