Sexual Potency

Patient History

Medical and sexual histories help define the degree and nature of ED. A medical history can disclose diseases that lead to ED, while a simple recounting of sexual activity might distinguish among problems with sexual desire, erection, ejaculation, or orgasm.

Using certain prescription or illegal drugs can suggest a chemical cause, since drug effects account for 25 percent of ED cases. Cutting back on or substituting certain medications can often alleviate the problem.

Physical Examination

A physical examination can give clues to systemic problems. For example, if the penis is not sensitive to touching, a problem in the nervous system may be the cause. Abnormal secondary sex characteristics, such as hair pattern or breast enlargement, can point to hormonal problems, which would mean that the endocrine system is involved. The examiner might discover a circulatory problem by observing decreased pulses in the wrist or ankles. And unusual characteristics of the penis itself could suggest the source of the problem—for example, a penis that bends or curves when erect could be the result of Peyronie’s disease. Continue Reading »

Since an erection requires a precise sequence of events, ED can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area around the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.

Damage to nerves, arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of ED. Diseases—such as diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease, and neurologic disease—account for about 70 percent of ED cases. Between 35 and 50 percent of men with diabetes experience ED.

Lifestyle choices that contribute to heart disease and vascular problems also raise the risk of erectile dysfunction. Smoking, being overweight, and avoiding exercise are possible causes of ED. Continue Reading »

The penis contains two chambers called the corpora cavernosa, which run the length of the organ (see figure 1). A spongy tissue fills the chambers. The corpora cavernosa are surrounded by a membrane, called the tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa and is surrounded by the corpus spongiosum.

Erection begins with sensory or mental stimulation, or both. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the spaces. The blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps trap the blood in the corpora cavernosa, thereby sustaining erection. When muscles in the penis contract to stop the inflow of blood and open outflow channels, erection is reversed.

Figure 1. Arteries (top) and veins (bottom) penetrate the long, filled cavities running the length of the penis—the corpora cavernosa and the corpus spongiosum. Erection occurs when relaxed muscles allow the corpora cavernosa to fill with excess blood fed by the arteries, while drainage of blood through the veins is blocked.

Erectile dysfunction, sometimes called “impotence,” is the repeated inability to get or keep an erection firm enough for sexual intercourse. The word “impotence” may also be used to describe other problems that interfere with sexual intercourse and reproduction, such as lack of sexual desire and problems with ejaculation or orgasm. Using the term erectile dysfunction makes it clear that those other problems are not involved.

Erectile dysfunction, or ED, can be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections. These variations make defining ED and estimating its incidence difficult. Estimates range from 15 million to 30 million, depending on the definition used. According to the National Ambulatory Medical Care Survey (NAMCS), for every 1,000 men in the United States, 7.7 physician office visits were made for ED in 1985. By 1999, that rate had nearly tripled to 22.3. The increase happened gradually, presumably as treatments such as vacuum devices and injectable drugs became more widely available and discussing erectile function became accepted. Perhaps the most publicized advance was the introduction of the oral drug sildenafil citrate (Viagra) in March 1998. NAMCS data on new drugs show an estimated 2.6 million mentions of Viagra at physician office visits in 1999, and one-third of those mentions occurred during visits for a diagnosis other than ED.

In older men, ED usually has a physical cause, such as disease, injury, or side effects of drugs. Any disorder that causes injury to the nerves or impairs blood flow in the penis has the potential to cause ED. Incidence increases with age: About 5 percent of 40-year-old men and between 15 and 25 percent of 65-year-old men experience ED. But it is not an inevitable part of aging.

ED is treatable at any age, and awareness of this fact has been growing. More men have been seeking help and returning to normal sexual activity because of improved, successful treatments for ED. Urologists, who specialize in problems of the urinary tract, have traditionally treated ED; however, urologists accounted for only 25 percent of Viagra mentions in 1999.

High cholesterol is associated with erectile dysfunction (ED). The risk of ED is nearly two times greater in men with total cholesterol levels above 240 than in men with total cholesterol levels below 180.

Difficulty getting and keeping an erection that lasts long enough to finish having sex is known as ED. Some men have trouble getting an erection in the first place, while others have difficulty keeping one. And these problems may occur frequently or just occasionally.

If there is too much cholesterol in your body, it sticks to the walls of the arteries. When cholesterol builds up, it creates a smaller opening for blood to pass through. This leads to less blood flow to the penis, which can create erectile problems.
It’s natural and normal to want a healthy sex life, so if you think your high cholesterol may be affecting the quality of your erections, talk to your doctor about LEVITRA, a medication designed to help treat mild to severe ED.

LEVITRA is effective and well tolerated. Its side effects are generally mild and do not last very long.

Do not take LEVITRA if:

• You take any form of medication known as “nitrates” (a type of medicine used to relieve chest pain that can occur as a result of heart disease) or recreational drugs called “poppers” like amyl nitrate or butyl nitrate. Taking LEVITRA in combination with nitrates (such as nitroglycerin, isosorbide mononitrate, and isosorbide dinitrate) may result in serious side effects
• Your doctor determines that sexual activity poses a health risk for you
• You have a known sensitivity or allergy to any component of LEVITRA

Discuss your medical conditions, including heart problems, and medications, including alpha blockers prescribed for prostate problems or high blood pressure, with your doctor to ensure LEVITRA is right for you and that you are healthy enough for sexual activity.

The most common side effects with LEVITRA are:

• Headache
• Flushing
• Stuffy or runny nose

LEVITRA may uncommonly cause:

• An erection that won’t go away (priapism). If you get an erection that lasts more than four hours, get medical help right away. Priapism must be treated as soon as possible or lasting damage can happen to your penis, including the inability to have erections
• Vision changes, such as seeing a blue tinge to objects or having difficulty telling the difference between the colors blue and green

In rare instances, men taking PDE5 inhibitors (oral erectile dysfunction medicines, including LEVITRA) reported a sudden decrease or loss of vision in one or both eyes. It is not possible to determine whether these events are related directly to these medicines, to other factors such as high blood pressure or diabetes, or to a combination of these. If you experience sudden decrease or loss of vision, stop taking PDE5 inhibitors, including LEVITRA, and call a doctor right away.

These are not all the side effects of LEVITRA. For more information, ask your doctor or pharmacist.

In patients taking certain medications such as ritonavir, indinavir, ketoconazole, itraconazole, and erythromycin, lower doses of LEVITRA are recommended, and time between doses of LEVITRA may need to be extended.

LEVITRA does not protect against sexually transmitted diseases.

Currently, there is no cure for erectile dysfunction (ED), but LEVITRA may be able to help you get and keep a quality erection so that you can make the most of each sexual experience. You may notice improvements in both erection hardness and your ability to maintain your erection during sex.

Of course, LEVITRA alone will not give you an erection. You’ll need sexual stimulation for an erection to happen. After you’re finished having sex, blood flow to the penis should decrease and your erection should go away.

• LEVITRA is a prescription medication approved by the FDA. It’s not an over-the-counter herbal or magic pill
• LEVITRA works on the body, not the mind. It does not increase libido (sexual drive). It’s not an aphrodisiac (a substance such as a food or drug that arouses or is believed to arouse sexual desire). It won’t make you want to have sex all the time
• You won’t get an embarrassing instant erection. To get an erection with LEVITRA, you need to be sexually stimulated
• While LEVITRA may work for several hours, you shouldn’t have an erection for longer than you are sexually stimulated
• LEVITRA does not protect a man or his partner from sexually transmitted diseases, including HIV. Speak to your doctor about ways to guard against sexually transmitted diseases
• LEVITRA does not serve as a male form of birth control
• LEVITRA is only for men with ED. LEVITRA is not for women or children

LEVITRA belongs to a class of drugs called “PDE5 inhibitors.” It works by increasing blood flow to the penis to improve erectile function. The active ingredient in LEVITRA works specifically on the chain of events that occurs in the penis during arousal, when two large chambers in a man’s penis fill with blood.

In clinical trials, LEVITRA was shown to help men get and keep an erection that lasted long enough for successful intercourse.

Taking LEVITRA

• Take it about an hour before sex. In clinical studies, most men were able to successfully begin sexual activity before this time
• LEVITRA may be taken with or without food

Forget the Rumors

• LEVITRA is not a magic pill or an aphrodisiac (a substance such as a food or drug that arouses or is believed to arouse sexual desire); it won’t make you want to have sex all the time
• It should not give you an instant erection; you’ll need to be sexually excited for it to work
• It should not leave you erect for hours

Getting Results

• Many men were successful the first time they used LEVITRA, but if it doesn’t work the first couple of times, ask your doctor about adjusting the dose
• LEVITRA works for men with a broad range of conditions, including diabetes, high cholesterol, or high blood pressure
• LEVITRA works for most men, including those taking one or more types of blood pressure medication (ask your doctor about drug interactions)

LEVITRA is an FDA-approved oral prescription medication for the treatment of erectile dysfunction (ED) in men. It is available in 2.5-mg, 5-mg, 10-mg, and 20-mg tablets and is taken only when needed. Take LEVITRA no more than once a day.

What LEVITRA does:

• LEVITRA helps increase blood flow to the penis, so it may help men with ED get and keep an erection that lasts long enough to finish having sex. Once a man has completed sexual activity, blood flow to his penis should decrease and his erection should go away
• LEVITRA has been clinically shown to improve erectile function, even in men who had other health factors, like high cholesterol, high blood pressure, or diabetes
• LEVITRA provided first-time success and reliable improvement of erection quality for many men, including those with high cholesterol, high blood pressure, or diabetes
• Men taking LEVITRA reported having harder erections and greater success at maintaining their erections long enough to finish having sex

A lot of men who took LEVITRA were successful the first time they tried it. It’s for the man who needs a little help once in a while and the man who needs more frequent help.

LEVITRA:

• Works for many men with a broad range of conditions, including high cholesterol
• Works for most men, including those taking one or more types of blood pressure medication (ask your doctor about drug interactions)
• Works for many men with type 1 or type 2 diabetes, across all levels of ED severity
• May work when other oral treatments do not

LEVITRA is a proven, effective treatment that works for most men. And it has been taken with medications used to treat other common medical conditions (ask your doctor about drug interactions). So why not see your doctor and find out for yourself?

The pituitary gland, the prostate and testosterone all have an important role in the process of erection of a penis.

A penile erection occurs when two tubular structures that run the length of the penis, the corpora cavernosa, become engorged with venous blood. This may result from any of various physiological stimuli. The corpus spongiosum is a single tubular structure located just below the corpora cavernosa, which contains the urethra, through which urine and semen pass during urination and ejaculation, respectively. This may also become slightly engorged with blood, but less so than the corpora cavernosa.

Penile erection usually results from sexual stimulation and/or arousal, but can also occur by such causes as a full urinary bladder or spontaneously during the course of a day or at night, often during erotic or wet dreams (see “nocturnal penile tumescence”). An erection results in swelling and enlargement of the penis. Erection enables sexual intercourse and other sexual activities (sexual functions), though it is not essential for all sexual activities.
A circumcised penis flaccid (left) and erect (right)

In the presence of mechanical stimulation, erection is initiated by the parasympathetic division of the autonomic nervous system (ANS) with minimal input from the central nervous system. Parasympathetic branches extend from the sacral plexus into the arteries supplying the erectile tissue; upon stimulation, these nerve branches initiate the release of nitric oxide, a vasodilating agent, in the target arteries. The arteries dilate, filling the corpora spongiosum and cavernosa with blood. Erection subsides when parasympathetic stimulation is discontinued; baseline stimulation from the sympathetic division of the ANS causes constriction of the penile arteries, forcing blood out of the erectile tissue.

The cerebral cortex can initiate erection in the absence of direct mechanical stimulation (in response to visual, auditory, olfactory, imagined, or tactile stimuli) acting through erectile centers in the lumbar and sacral regions of the spinal cord. The cortex can suppress erection even in the presence of mechanical stimulation, as can other psychological, emotional, and environmental factors.