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Chlamydia is a curable sexually transmitted infection (STI). You can get chlamydial infection during vaginal, oral, or anal sexual contact with an infected partner. It can cause serious problems in men and women, such as penile discharge and infertility respectively, as well as infections in newborn babies of infected mothers.

Chlamydia is one of the most widespread bacterial STIs in the United States. The Centers for Disease Control and Prevention (CDC) estimates 2.8 million people are infected each year.

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Understanding the basic facts about STIs—the ways in which they are spread, their common symptoms, and how they can be treated—is the first step toward preventing them. Researchers supported by the National Institute of Allergy and Infectious Diseases are looking for better methods to diagnose, treat, and prevent STIs, including supporting research on vaccines and topical microbicides.

These are some key points about STIs in the United States.

1. STIs affect men and women of all backgrounds and economic levels. They are most prevalent among teenagers and young adults. Nearly half of all STIs occur in young people 15 to 24 years old. Some STIs disproportionately affect certain minority populations, such as gonorrhea that affects African Americans 18 times more than it does whites.
2. Most of the time, STIs cause no symptoms, particularly in women. When and if symptoms develop, they may be confused with those of other diseases not transmitted through sexual contact. Even when an STI causes no symptoms, however, a person who is infected may be able to pass the disease on to a sex partner. That is why many healthcare providers recommend periodic testing or screening for people who have more than one sex partner.
3. Health problems caused by STIs tend to be more severe and more frequent for women than for men.
   • Some STIs can spread into the womb (uterus) and fallopian tubes to cause pelvic inflammatory disease, which in turn is a major cause of both infertility and tubal (ectopic) pregnancy. Tubal pregnancy can be fatal.
   • STIs in women also may be associated with cervical cancer. One STI, human papillomavirus infection, may cause genital warts and may lead to cervical and other genital cancers.
   • STIs can be passed from a mother to her baby before, during, or immediately after birth. Some of these infections of the newborn can be cured easily, but others may cause life-long disabilities or death. Examples of these STIs are gonorrhea, chlamydia, herpes simplex, and HIV.

When diagnosed and treated early, many STIs can be treated effectively. Some infections have become resistant to the medicines used to treat them and now require newer types of treatments. Experts believe that having STIs, other than HIV infection, increases one’s risk for becoming infected with HIV.

Everyone who is sexually active should learn more about STIs and then make choices about how to minimize their risk of getting these diseases and spreading them to others. Knowledge of STIs, as well as honesty and openness with sex partners and healthcare providers, can be very important in reducing the incidence and complications of STIs

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Treatment

Because the course of Peyronie’s disease is different in each patient and because some patients experience improvement without treatment, medical experts suggest waiting 1 to 2 years or longer before attempting to correct it surgically. During that wait, patients often are willing to undergo treatments whose effectiveness has not been proven.

Experimental Treatments

Some researchers have given vitamin E orally to men with Peyronie’s disease in small-scale studies and have reported improvements. Yet, no controlled studies have established the effectiveness of vitamin E therapy. Similar inconclusive success has been attributed to oral application of para-aminobenzoate, a substance belonging to the family of B-complex molecules.

Researchers have injected chemical agents such as verapamil, collagenase, steroids, calcium channel blockers, and interferon alpha-2b directly into the plaques. These interventions are still considered unproven because studies included small numbers of patients and lacked adequate control groups. Steroids, such as cortisone, have produced unwanted side effects, such as the atrophy or death of healthy tissues. Another intervention involves iontophoresis, the use of a painless current of electricity to deliver verapamil or some other agent under the skin into the plaque.

Radiation therapy, in which high-energy rays are aimed at the plaque, has also been used. Like some of the chemical treatments, radiation appears to reduce pain, but it has no effect at all on the plaque itself and can cause unwelcome side effects. Although the variety of agents and methods used points to the lack of a proven treatment, new insights into the wound healing process may one day yield more effective therapies.

Surgery

Peyronie’s disease has been treated surgically with some success. The two most common surgical procedures are removal or expansion of the plaque followed by placement of a patch of skin or artificial material, and removal or pinching of tissue from the side of the penis opposite the plaque, which cancels out the bending effect. The first method can involve partial loss of erectile function, especially rigidity. The second method, known as the Nesbit procedure, causes a shortening of the erect penis.

Some men choose to receive an implanted device that increases rigidity of the penis. In some cases, an implant alone will straighten the penis adequately. In other cases, implantation is combined with a technique of incisions and grafting or plication (pinching or folding the skin) if the implant alone does not straighten the penis.

Most types of surgery produce positive results. But because complications can occur, and because many of the phenomena associated with Peyronie’s disease (for example, shortening of the penis) are not corrected by surgery, most doctors prefer to perform surgery only on the small number of men with curvature so severe that it prevents sexual intercourse.

Peyronie’s disease, a condition of uncertain cause, is characterized by a plaque, or hard lump, that forms on the penis. The plaque develops on the upper or lower side of the penis in layers containing erectile tissue. It begins as a localized inflammation and can develop into a hardened scar.

Cases of Peyronie’s disease range from mild to severe. Symptoms may develop slowly or appear overnight. In severe cases, the hardened plaque reduces flexibility, causing pain and forcing the penis to bend or arc during erection. In many cases, the pain decreases over time, but the bend in the penis may remain a problem, making sexual intercourse difficult. The sexual problems that result can disrupt a couple’s physical and emotional relationship and lead to lowered self-esteem in the man. In a small percentage of patients with the milder form of the disease, inflammation may resolve without causing significant pain or permanent bending.

The plaque itself is benign, or noncancerous. A plaque on the top of the shaft (most common) causes the penis to bend upward; a plaque on the underside causes it to bend downward. In some cases, the plaque develops on both top and bottom, leading to indentation and shortening of the penis. At times, pain, bending, and emotional distress prohibit sexual intercourse.

One study found Peyronie’s disease in 1 percent of men. Although the disease occurs mostly in middle age, younger and older men can develop it. About 30 percent of men with Peyronie’s disease develop fibrosis (hardened cells) in other elastic tissues of the body, such as on the hand or foot. A common example is a condition known as Dupuytren’s contracture of the hand. In some cases, men who are related by blood tend to develop Peyronie’s disease, which suggests that genetic factors might make a man vulnerable to the disease.

Men with Peyronie’s disease usually seek medical attention because of painful erections and difficulty with intercourse. Since the cause of the disease and its development are not well understood, doctors treat the disease empirically; that is, they prescribe and continue methods that seem to help. The goal of therapy is to keep the Peyronie’s patient sexually active. Providing education about the disease and its course often is all that is required. No strong evidence shows that any treatment other than surgery is effective. Experts usually recommend surgery only in long-term cases in which the disease is stabilized and the deformity prevents intercourse.

A French surgeon, François de la Peyronie, first described Peyronie’s disease in 1743. The problem was noted in print as early as 1687. Early writers classified it as a form of impotence, now called erectile dysfunction (ED). Peyronie’s disease can be associated with ED; however, experts now recognize ED as only one factor associated with the disease—a factor that is not always present.

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Most physicians suggest that treatments proceed from least to most invasive. For some men, making a few healthy lifestyle changes may solve the problem. Quitting smoking, losing excess weight, and increasing physical activity may help some men regain sexual function.

Cutting back on any drugs with harmful side effects is considered next. For example, drugs for high blood pressure work in different ways. If you think a particular drug is causing problems with erection, tell your doctor and ask whether you can try a different class of blood pressure medicine.

Psychotherapy and behavior modifications in selected patients are considered next if indicated, followed by oral or locally injected drugs, vacuum devices, and surgically implanted devices. In rare cases, surgery involving veins or arteries may be considered.

Psychotherapy

Experts often treat psychologically based ED using techniques that decrease the anxiety associated with intercourse. The patient’s partner can help with the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when ED from physical causes is being treated.

Drug Therapy

Drugs for treating ED can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis. In March 1998, the Food and Drug Administration (FDA) approved Viagra, the first pill to treat ED. Since that time, vardenafil hydrochloride (Levitra) and tadalafil (Cialis) have also been approved. Additional oral medicines are being tested for safety and effectiveness.

Viagra, Levitra, and Cialis all belong to a class of drugs called phosphodiesterase (PDE) inhibitors. Taken an hour before sexual activity, these drugs work by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow.

While oral medicines improve the response to sexual stimulation, they do not trigger an automatic erection as injections do. The recommended dose for Viagra is 50 mg, and the physician may adjust this dose to 100 mg or 25 mg, depending on the patient. The recommended dose for either Levitra or Cialis is 10 mg, and the physician may adjust this dose to 20 mg if 10 mg is insufficient. A lower dose of 5 mg is available for patients who take other medicines or have conditions that may decrease the body’s ability to use the drug. Levitra is also available in a 2.5 mg dose.

None of these PDE inhibitors should be used more than once a day. Men who take nitrate-based drugs such as nitroglycerin for heart problems should not use either drug because the combination can cause a sudden drop in blood pressure. Also, tell your doctor if you take any drugs called alpha-blockers, which are used to treat prostate enlargement or high blood pressure. Your doctor may need to adjust your ED prescription. Taking a PDE inhibitor and an alpha-blocker at the same time (within 4 hours) can cause a sudden drop in blood pressure.

Oral testosterone can reduce ED in some men with low levels of natural testosterone, but it is often ineffective and may cause liver damage. Patients also have claimed that other oral drugs—including yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone—are effective, but the results of scientific studies to substantiate these claims have been inconsistent. Improvements observed following use of these drugs may be examples of the placebo effect, that is, a change that results simply from the patient’s believing that an improvement will occur.

Many men achieve stronger erections by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine, and alprostadil (marketed as Caverject) widen blood vessels. These drugs may create unwanted side effects, however, including persistent erection (known as priapism) and scarring. Nitroglycerin, a muscle relaxant, can sometimes enhance erection when rubbed on the penis.

A system for inserting a pellet of alprostadil into the urethra is marketed as Muse. The system uses a prefilled applicator to deliver the pellet about an inch deep into the urethra. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes. The most common side effects are aching in the penis, testicles, and area between the penis and rectum; warmth or burning sensation in the urethra; redness from increased blood flow to the penis; and minor urethral bleeding or spotting.

Research on drugs for treating ED is expanding rapidly. Patients should ask their doctor about the latest advances.

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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.

Laboratory Tests

Several laboratory tests can help diagnose ED. Tests for systemic diseases include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. Measuring the amount of free testosterone in the blood can yield information about problems with the endocrine system and is indicated especially in patients with decreased sexual desire.

Other Tests

Monitoring erections that occur during sleep (nocturnal penile tumescence) can help rule out certain psychological causes of ED. Healthy men have involuntary erections during sleep. If nocturnal erections do not occur, then ED is likely to have a physical rather than psychological cause. Tests of nocturnal erections are not completely reliable, however. Scientists have not standardized such tests and have not determined when they should be applied for best results.

Psychosocial Examination

A psychosocial examination, using an interview and a questionnaire, reveals psychological factors. A man’s sexual partner may also be interviewed to determine expectations and perceptions during sexual intercourse.

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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.

Also, surgery (especially radical prostate and bladder surgery for cancer) can injure nerves and arteries near the penis, causing ED. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to ED by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa.

In addition, many common medicines—blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine (an ulcer drug)—can produce ED as a side effect.

Experts believe that psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure cause 10 to 20 percent of ED cases. Men with a physical cause for ED frequently experience the same sort of psychological reactions (stress, anxiety, guilt, depression). Other possible causes are smoking, which affects blood flow in veins and arteries, and hormonal abnormalities, such as not enough testosterone.

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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.

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Overview

Genital herpes is a sexually transmitted infection (STI). According to the Centers for Disease Control and Prevention (CDC), 1 out of 5 American teenagers and adults is infected with genital herpes. Women are more commonly infected than men. In the United States, 1 out of 4 women has herpes.

Although at least 45 million people in the United States have genital herpes infection, there has been a substantial decrease in cases from 21 percent to 17 percent, according to a 1999 to 2004 CDC survey. Much of the decrease was in the 14 to 19 year age group, and continued through the young adult group.

Cause

Genital herpes is caused by herpes simplex virus (HSV). There are two types of HSV.

• HSV type 1 most commonly infects the mouth and lips, causing sores known as fever blisters or cold sores.
• HSV type 2 is the usual cause of genital herpes, but it also can infect the mouth.

Transmission

If you have genital herpes infection, you can easily pass or transmit the virus to an uninfected partner during sex.

Most people get genital herpes by having sex with someone who is shedding the herpes virus either during an outbreak or an asymptomatic (without symptoms) period. People who do not know they have herpes play an important role in transmission because they are unaware they can infect a sexual partner.

You can transmit herpes through close contact other than sexual intercourse, through oral sex or close skin-to-skin contact, for example.

The virus is spread rarely, if at all, by objects such as a toilet seat or hot tub.

Reduce your risk of spreading herpes

People with herpes should follow a few simple steps to avoid spreading the infection to other places on their body or other people.

• Avoid touching the infected area during an outbreak, and wash your hands after contact with that area.
• Do not have sexual contact (vaginal, oral, or anal) from the time of your first genital symptoms until your symptoms are completely gone.

Symptoms

Symptoms of herpes are called outbreaks. The first outbreak appears within 2 weeks after you become infected and can last for several weeks. These symptoms might include tingling or sores (lesions) near the area where the virus has entered your body, such as on your genital or rectal area, on your buttocks or thighs. Occasionally, these sores may appear on other parts of your body where the virus has entered through broken skin. Sores also can appear inside the vagina and on the cervix (opening to the womb) in women, or in the urinary passage of women and men. Small red bumps appear first, develop into small blisters, and then become itchy, painful sores that might develop a crust and will heal without leaving a scar.

Sometimes, there is a crack or raw area or some redness without pain, itching, or tingling. Other symptoms that may accompany the first (and less often future) outbreak of genital herpes are fever, headache, muscle aches, painful or difficult urination, vaginal discharge, and swollen glands in the groin area.

Often, though, people don’t recognize their first or subsequent outbreaks. People who have mild or no symptoms at all may not think they are infected with herpes. They can still transmit the virus to others, however.

Recurrence of herpes outbreaks

In most people, the virus can become active and cause outbreaks several times a year. This is called a recurrence, and infected people can have symptoms. HSV remains in certain nerve cells of your body for life. When the virus is triggered to be active, it travels along the nerves to your skin. There, it makes more virus and sometimes new sores near the site of the first outbreak. Recurrences are generally much milder than the first outbreak of genital herpes. HSV-2 genital infection is more likely to result in recurrences than HSV-1 genital infection. Recurrences become less common over time.

Symptoms from recurrences might include itching, tingling, vaginal discharge, and a burning feeling or pain in the genital or anal area. Sores may be present during a recurrence, but sometimes they are small and easily overlooked.

Sometimes, the virus can become active but not cause any visible sores or any symptoms. During these times, small amounts of the virus may be shed at or near places of the first infection, in fluids from the mouth, penis, or vagina, or from barely noticeable sores. This is called asymptomatic shedding. Even though you are not aware of the shedding, you can infect a sexual partner during this time. Asymptomatic shedding is an important factor in the spread of herpes.

Diagnosis

Your health care provider can diagnose typical genital herpes by looking at the sores. Some cases, however, are more difficult to diagnose.

The virus sometimes, but not always, can be detected by a laboratory test called a culture. A culture is done when your health care provider uses a swab to get and study material from a suspected herpes sore. You may still have genital herpes, however, even if your culture is negative (which means it does not show HSV).

A blood test called type-specific test can tell whether you are infected with HSV-1 or HSV-2. The type-specific test results plus the location of the sores will help your health care provider to find out whether you have genital infection.

Coping with herpes

A diagnosis of genital herpes can have substantial emotional effects on you and your sexual partner, whether or not you have symptoms. Proper counseling and treatment can help you and your partner learn to cope with the disease, recurrent episodes, personal relationships, and fertility issues.

Treatment

Although there is no cure for genital herpes, your health care provider might prescribe an antiviral medicine to treat your symptoms and to help prevent future outbreaks. This can decrease the risk of passing herpes to sexual partners. Medicines to treat genital herpes are

• Acyclovir (Zovirax)
• Famciclovir (Famvir)
• Valacyclovir (Valtrex)

For updated information on treatment for genital herpes, read the CDC STD Treatment Guidelines.

Prevention

Because herpes can be transmitted from someone who has no symptoms, using the precautions listed below is not enough to prevent transmission. Recently, the Food and Drug Administration approved Valtrex for use in preventing transmission of genital herpes. It has to be taken continuously by the infected person, and while it significantly decreases the risk of the transmission of herpes, transmission can still occur.

Do not have oral-genital contact if you or your sexual partner has any symptoms or findings of oral herpes.

Using barriers such as latex condoms during sexual activity may decrease transmission when you use them consistently and correctly, but transmission can still occur since condoms may not cover all infected areas.

You can get tested to find out if you are infected with the herpes virus

Complications

Genital herpes infections usually do not cause serious health problems in healthy adults. In some people whose immune systems do not work properly, however, genital herpes outbreaks can be unusually severe and long lasting.

Occasionally, people with normal immune systems can get herpes infection of the eye, called ocular herpes. Ocular herpes is usually caused by HSV-1 but sometimes by HSV-2. It can occasionally result in serious eye disease, including blindness.

A woman with herpes who is pregnant can pass the infection to her baby. A baby born with herpes might die or have serious brain, skin, or eye problems. Pregnant women who have herpes, or whose sex partner has herpes should discuss the situation with her health care provider. Together they can make a plan to reduce her or her baby’s risk of getting infected. Babies who are born with herpes do better if the disease is recognized and treated early.

Genital herpes, like other genital diseases that cause sores, is important in the spread of HIV infection. A person infected with herpes may have a greater risk of getting HIV. This may be due to the open sores caused by the herpes infection or by other factors in the immune system. In addition, HIV-positive people may be more contagious for herpes.

Source: National Institute of Allergy and Infectious Diseases (NIAID)

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What I need to know about erection problems
Some people can talk with their doctors about sex. Others feel that sex is private. They do not want to share details with anyone. But if you have problems getting or keeping an erection, you have good reasons to talk to a doctor: your health and your quality of life.

Erection problems used to be called “impotence.” Now the term “erectile dysfunction” is more common. Sometimes people just use the initials ED.

ED can be a sign of health problems. It may mean your blood vessels are clogged. It may mean you have nerve damage from diabetes. If you don’t see your doctor, these problems will go untreated.
ED is a medical problem. Your doctor can help.
Another reason to see your doctor is to treat ED itself. Your doctor can offer several new treatments. For many men, the answer is as simple as taking a pill. Other men have to try two or three options before they find a treatment that works for them. Don’t give up if the first treatment doesn’t work. Finding the right treatment can take time.

What causes an erection?
Hormones, blood vessels, nerves, and muscles must all work together to make an erection. Your brain starts an erection by sending nerve signals to the penis when it senses sexual stimulation. Touching may cause this arousal. Another trigger may be something you see or hear. It may be a sexual thought or dream.
Your brain starts an erection by sending nerve signals to the penis.
The nerve signals cause the muscles within the penis to relax and let blood flow into the spongy tissue within the penis. Blood collects in this tissue like water filling a sponge. The penis becomes larger and firmer, like an inflated balloon. The veins then get shut off to keep blood from flowing out.

After climax, or after the sexual arousal has passed, the veins open back up and blood flows back into the body.
Healthy blood vessels are needed for an erection.

What causes erectile dysfunction?
Many different conditions can lead to ED. Most of the causes of ED are health problems requiring treatment to help prevent more serious complications than ED:

High blood pressure and high cholesterol can injure the arteries that supply blood to the penis.
Diabetes injures blood vessels and the nerves that control erections.
Alcohol and drug abuse can cause ED by damaging blood vessels and deadening the nerves that control erections.
Some prescription drugs such as some antidepressants or some high blood pressure medicines can cause ED. Your doctor may be able to change your drug treatment. Never stop taking a prescribed drug without talking to your doctor.
Unhealthy habits like smoking, overeating, and avoiding exercise can also contribute to ED.
Anything that’s bad for your heart is also bad for your sexual health.
An injury to the spinal cord can cause ED by interfering with nerve signals.
Treatments for prostate cancer, including radiation and prostate removal, can damage the nerves that control erections.
Diseases that affect the nerves, like multiple sclerosis, can also lead to erection problems.
A small number of ED cases result from a reduced level of the male hormone testosterone.
Doctors used to believe that most cases of ED resulted from mental or emotional problems. We now know that most ED has a physical cause. But depression and worry or anxiety can still cause ED. And ED from physical causes can lead to depression and worry, making physical ED worse.
A person should not assume that ED is part of the normal process of aging. There is quite likely an underlying cause.

What will happen in the doctor’s office?
Talking about ED can be difficult. You might use a phrase like “I’ve been having problems in the bedroom” or “I’ve been having erection problems.” Remember that a healthy sex life is part of a healthy life. Don’t feel embarrassed about seeking help. ED is a medical problem, and your doctor treats medical problems every day.

If the interaction with your doctor doesn’t put you at ease, ask for a referral to another doctor. Your doctor may send you to a urologist-a doctor who specializes in sexual and urologic problems.

Your partner may want to come with you to see the doctor. Many doctors say ED is easier to treat when both partners are involved.

To find the cause of your ED, your doctor will take a complete medical history and do a physical examination.

Medical History
Your doctor will ask general questions about your health, as well as specific questions about your erection problems and your relationship with your partner. Bring a list of all the medications you take, or bring them with you to show to your doctor. Tell your doctor about any surgery you have had.

Your doctor will ask about habits like alcohol use, smoking, and exercise.

Your doctor might ask you questions like

How do you rate your confidence that you can get and keep an erection?
When you have erections with sexual stimulation, how often are your erections hard enough for penetration?
During sexual intercourse, how often are you able to maintain your erection after you have penetrated (entered) your partner?
When you attempt sexual intercourse, how often is it satisfactory for you?
How would you rate your level of sexual desire?
How often are you able to reach climax and have an ejaculation?
Do you have an erection when you wake up in the morning?

The answers to these questions will help your doctor understand the problem.

Physical Exam
A physical exam can help your doctor find the cause of your ED. As part of the exam, the doctor will examine your testes and penis, take your blood pressure, and check your reflexes. A blood sample will be taken to test for diabetes, cholesterol level, and other conditions that may be associated with ED.

How is erectile dysfunction treated?
Your doctor can offer a number of treatments for ED. You may want to talk with your partner about which treatment fits you best as a couple. Most people want the simplest treatment possible. You may need to try a number of treatments before you find the one that works best for you.

Lifestyle Changes
For some men, the answer is to make a few lifestyle changes. Getting more exercise, quitting smoking, losing weight, and cutting back on alcohol solve some erection problems.

Counseling
Even though most cases of ED have a physical cause, counseling can help couples deal with the emotional effects. Some couples find that counseling adds to the medical treatment by making their relationship stronger.

Oral Medication
Since 1998, doctors have been able to prescribe a pill to treat ED. Current brands include Viagra, Levitra, and Cialis. If your doctor finds that your health is generally good, you may be given a prescription for one of these drugs. You should not take any of these pills to treat ED if you take any of the heart medicines called nitrates. All of the ED pills work by increasing blood flow to the penis. They do not cause automatic erections. Talk with your doctor about when to take the pill. You may need to experiment to find out how soon the pill takes effect.

Even if taking a pill solves your erection problem, you should still take care of the other health issues that may have caused your ED.

Injection
Taking a pill doesn’t work for everybody. Many men use medicines that go directly into the penis. Caverject and Edex are injected into the shaft of the penis with a needle. MUSE is a tiny pill inserted into the urethra at the tip of the penis. These medicines usually cause an erection within minutes. These medications can be very successful, even if other treatments fail.

Vacuum device
Another way to create an erection is to use a vacuum tube. The penis is inserted in the tube. As air is pumped out of the tube, the volume of the penis expands. Blood then flows into the penis and makes it larger. A specially designed rubber band is then placed at the base of the penis to keep the blood from flowing out.
When air is pumped out of the tube, blood flows into the penis and makes an erection.
Penile Implant
If the other options fail, some men need surgery to treat ED. A surgeon can implant a device that inflates or unbends to create an erection. Implanted devices do not interfere with the way sex feels.

This operation cannot be reversed. Once a man has a penile implant, he must use a device to have an erection. Talk with your doctor about the advantages and possible drawbacks of having a penile implant.

Points to Remember

Erection problems may be a sign of health problems.
A doctor can help you overcome erection problems.
Smoking, being overweight, and avoiding exercise can contribute to erection problems.
Most cases of ED have a physical cause, but counseling can help couples build a stronger relationship.
Many men can take a pill to treat ED. These men should still treat the health conditions that caused ED.
Taking a pill doesn’t work for everybody.
Men who take any of the medicines called nitrates should not take a pill to treat ED

Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). , National Institutes of Health

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