When a man can’t get an erection to have sex or can’t keep an erection long enough to finish having sex, it’s called erectile dysfunction or impotence. Erectile dysfunction can occur at any age, but it is more common in men older than 65.
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Erectile dysfunction doesn’t have to be a part of getting older. It’s true that as you get older, you may need more stimulation (such as stroking and touching) to get an erection. You might also need more time between erections. But older men should still be able to get an erection and enjoy sex.
Symptoms of erectile dysfunction are the inability to have an erection or inability to sustain an erection long enough to finish having sex. An occasional difficulty may be considered normal, however, frequent episodes or prolonged problems lasting more than a couple of weeks may require further evaluation by a physician.
Treatment of erectile dysfunction is tailored to each individual and depends upon the cause. Psychological causes may be treated with therapy or medication, and proper treatment can result in improved sexual function. A six to twelve week course of sex therapy has been useful in such cases as well.
Various medications can be used to improve penile blood flow and allow for an erection. A relatively new class of drugs, called PDE inhibitors, create increased blood flow by enhancing the levels of nitric oxide in the blood vessels in the penis. The first drug of this new class, Sildenafil, has received widespread attention and use. More recently, a new drug in this class, Tadalafil, was approved which functions using the same mechanism. Both drugs require sexual arousal in order to work. Tadalafil can be taken, with or without an empty stomach, 30 to 60 minutes prior to sex. About 60 to 70% of men who take the drugs experience longer and more rigid erections. Side effects for both drugs include headaches, flushing, indigestion, dizziness, and stuffy or runny nose. Both drugs may rarely cause blue-tinged vision and diarrhea. Neither drug should be used by patients taking nitrates, such as nitroglycerine, or in patients with recent heart attack or stroke. Neither drug should be taken more than once every 24 hours.
For patients that do not respond to PDE inhibitors, medications can be injected directly into the penis. Such drugs include alprostadil, papaverine and phentolamine.
Devices such as vacuum devices or penile implants may also be recommended by your doctor depending upon the specific cause of erectile dysfunction or your medical condition.
Tadalafil is changing the way doctors and patients think about treating erectile dysfunction by offering two important benefits: a 36-hour window of opportunity for intimacy and the ability to take the tablet on an empty stomach or with a meal, without concern that high-fat food will reduce the absorption of the medicine. Because Tadalafil works for up to 36 hours, it allows a man and his partner to relax, forget about planning intimacy and let it happen when the moment is right for them.