School of Medicine

Wayne State University School of Medicine

Male Infertility and Sexual Dysfunction

It is estimated that 20 million men in the United States suffer from sexual dysfunction. Many of these men are not aware of the many options that are available for the treatment of this problem. For a large majority of men who experience sexual dysfunction, the cause is physical rather than psychological. A number of diseases such as high blood pressure, diabetes or even old age may alter sexual functioning. For example, half of all men with diabetes experience some degree of sexual dysfunction. In the past, many men were told "It's all in your mind" and sent home. Now we are able to pinpoint the cause of erection problems and successfully treat 90% to 95% of them.

The Department of Urology at Wayne State University has more than 16 years experience treating male sexual dysfunction. We have a physician dedicated to the treatment of male sexual dysfunction and our support staff is also specially trained in testing and patient education. For the convenience of our patients, we offer all of the diagnostic evaluation and testing in one place.

How an Erection Happens
For an erection to occur, a series of events must take place. The first event in this chain is psychosexual stimulation. This is promoted by the male sex drive, also known as libido. The mind then sends impulses down the nerve pathways to the penis. These nerve impulses relax the smooth muscles of the arteries which supply the penis with blood. This muscle relaxation leads to engorgement and erection of the penis. After orgasm, the blood is returned to the general circulation and the penis returns to a soft (flaccid) state. Even a minor disturbance in any of these steps such as decreased blood supply, disturbances of nerve mechanisms or psychosexual problems may lead to erection problems.

Causes of Erectile Dysfunction

  • Old Age -As men age there is a natural slowing down of many bodily functions. From a sexual viewpoint, this may occur as decreased firmness of erections, shorter lasting erections or a longer "recovery time" in between erections These changes may be caused by a decreased production of testosterone, decreased blood flow or other diseases that are more common in men as they age. Most commonly, the sexual changes associated with old age are due to a combination of the factors discussed in more detail below.
  • Decreased Bloodflow - A decrease in the blood flow to the penis will affect the quality of erections. The erections will be weak and/or short lasting. Decreased blood flow can be caused by arteriosclerosis (clogged arteries), high blood pressure or pelvic trauma. Men who have clogged arteries in their heart often have the same problem with the arteries that supply the penis with blood.
  • Diabetes -Diabetes can interfere with erections in a number of ways, and erectile problems tend to get worse the longer a man has diabetes. Half of all men with diabetes experience some degree of erectile dysfunction. Diabetes can affect the sending and receiving of nerve impulses. This condition is called peripheral neuropathy and may also affect the hands and feet of diabetics. Without good nerve function, erections are more difficult to achieve. Diabetes may affect the blood flow to the penis. Men with diabetes often experience decreased quality or number of erections. Healthy blood vessels are needed for the engorgement of penile tissue that leads to erection.
  • High Blood Pressure (Hypertension) - Hypertension can affect erections either by the changes it causes in the blood vessels, or by the medications used for treatment. Hypertension causes the arteries to lose their elasticity, and they therefore cannot accommodate the onrush of blood needed for erection. Hypertension may affect the veins, allowing the blood that does rush into the penis to exit just as quickly. The effects of hypertension on erectile function are cumulative over time and may occur even before a man knows he has hypertension.
    Pelvic Surgery (prostate, bladder, rectal)
  • Pelvic Surgery (Prostate, Bladder, Rectal) - When surgery is performed in the pelvic area, injury to the nerves and or blood vessels may result. Even with "nerve sparing" procedures, the nerves may be temporarily or permanently altered. With extensive surgery for bladder or rectal cancers, a large amount of tissue is removed and impotence may occur.
  • Spinal Cord Injury, Multiple Sclerosis and Other Nervous System Disorders - An injury to the spinal cord disrupts the nerve pathways necessary for an erection. Sometimes men with a spinal cord injury may get reflex erections. However, these are unpredictable and usually very short lasting. Multiple sclerosis interferes with the nerve impulses in the body. Also, multiple sclerosis may lead to generalized weakness and immobility which make it difficult to get an erection. Any other disorder which interferes with the nervous system can make good erections difficult or impossible.
  • Hormonal Problems - The hormones play an important part in sexual function. They are responsible for the sex drive (also called libido). Hormonal imbalances such as low testosterone or high prolactin can disrupt the libido. Hormonal imbalances can be diagnosed by a simple blood test, and further testing and treatment is based on the underlying cause of the imbalance.
  • Depression and Psychological Problems - Depression may lead to erectile dysfunction by a loss of sex drive, or by the medications used for treatment. Problems with premature ejaculation and the anxiety associated with it may lead to erectile problems.
  • Cigarette Smoking, Excessive Use of Alcohol, Drug Abuse - Habits such as smoking, heavy alcohol use and recreational drug abuse may inhibit erectile function. The effects may be temporary or permanent. Temporary erectile dysfunction may occur as a result of ingestion of large amounts of alcohol. Permanent effects may occur from the effects of smoking on the blood vessels or alcohol on the nerves. substances added to recreational drugs may damage both the vessels and nerves.
  • Medications - Medications used to treat a variety of diseases can affect erectile functioning. Some of the more common are drugs used to treat high blood pressure and depression. Switching medications may help restore sexual function. Changes in medication must always be ordered and supervised by a medical professional. Talk to your medical doctor about the possibility of switching blood pressure medications. There are many medications for hypertension which do not cause erection problems.
  • Sickle Cell Anemia - Sickle cell anemia can lead to prolonged painful erections called priapism. These prolonged erections can damage the inner tissue of the penis, destroying erectile ability. They may also cause an uncomfortable bending or kinking of the penis from scar tissue.
  • Peyronie's Disease - Peyronie's disease is a bending of the erect penis which is often painful. The exact cause of Peyronie's is not known, but there may be some association with trauma. This condition can lead to impotence and/or inability to have intercourse due to the curvature.
  • Premature Ejaculation - Premature ejaculation may affect a man for all of his adult life or only with specific partners. The traditional approach has been to treat premature ejaculation with psychological counseling, but new drugs are showing some promise with helping this disorder.

Diagnostic Testing for Erectile Dysfunction

  • Hormone Levels - A simple blood test is all that is needed to detect abnormal hormone levels. If the levels are abnormal, further testing may be ordered to determine the cause of the imbalance, however this is not always necessary.
    Vascular Studies
  • Vascular Studies - A test used to evaluate the functioning of the arteries and veins responsible for blood flow to and from the penis is a penile doppler study. A penile doppler is a non-invasive test similar to an ultrasound. This test is done in the office and involves medications that increase blood flow. Your body' s response to the medicine is then evaluated. This test helps us to decide which type of treatment may be the best for you as well as providing information about the possible cause of erection problems.
  • Sleep Studies (RIGISCAN) - About four or five times a night, during the R.E.M. phase of sleep, men usually get some degree of erection. This erection ranges from just fullness to a complete erection. Men with psychological erection problems will usually get a good strong erection lasting 15 minutes or more during sleep. men with circulatory or other physical problems may get only partial erections and/or erections of very short duration. some patients with severe problems may not get any erections at all. The presence or absence of these nighttime erections give the doctor valuable information about erectile function. Most sleep studies are done with a small monitor that is taken home for two nights and returned to the clinic.


Treatment Options

  • Psychological Help, Including Sex Therapy - A man may experience temporary erection problems as a result of excessive alcohol intake, psychological stress or family discord etc. some of these men may respond by excessive worry or fear during sexual activity.
  • Medication Applied Inside the Urethra (Urine Passage) - Prostaglandin E-1 is a drug that has recently become available for use as a urethral suppository for the treatment of erection problems. This drug works by dilating the arteries in the penis, allowing improved blood flow. This medicine must be used each time an erection is desired as the effects are temporary. Up to 60% of men who try this method may get an erection adequate for sexual intercourse.
  • Medication Injected into the Penis - Prostaglandin E-1 is a drug that has recently been approved by the FDA for use as an injection for the treatment of erection problems. This medicine must be used each time an erection is desired as the effects are temporary.
  • Vacuum Erection Pumps - Vacuum pumps are used outside the body to draw blood into the penis. The blood is held in the penis by a small rubber ring at the base of the penis. The erection goes away as soon as the ring is removed.
  • Penile Implant - Penile implants are surgically placed inside the penis. The surgery takes approximately 60 minutes and involves a 1 or 2 night stay in the hospital. The whole device is implanted internally and is not visible form the outside. A small pump is placed in the scrotum to activate the implant. Squeezing the pump in the scrotum produces a very strong erection which lasts as long as the man desires. Pushing on the deflate button makes the erection disappear. Sensation in the penis and ejaculation are not affected by this device. The penis retains its natural appearance when deflated. Penile implants are the only permanent treatment for erectile dysfunction. With current technology these implants have a high mechanical reliability.

    Another type of penile implant is the semi-rigid implant. The semi-rigid implant is also implanted inside the penis and is not visible from the outside. A semi-rigid implant does not require pumping, but simply bends down when not in use. These implants do not get as firm as the inflatable type, and always appear slightly erect. At Wayne State University, Department of Urology, we have done more than 500 penile implants with a very low complication rate. Our infection rate is less than 3%.

Appointments:
Please call (313) 271-0430 to schedule an appointment.