Many Options Available to Help with Erectile Dysfunction

By Alvaro Lucioni, MD **

Erectile dysfunction (ED) or impotence is a common condition. More than 30 million men in America experience ED. Unfortunately, many think the cause is “all in their head.”


Men’s Health Talk: Impotence: Causes and Treatments
When: 6 p.m., Wednesday, Sept. 11
Where: Virginia Mason Federal Way, 33501 1st Way S.
Admission: Free
Registration: Call (253) 874-1604, press 0

There is a medical or physiological cause for the condition in up to 90 percent of cases.  Psychological causes are not common. After an appropriate evaluation, most men can undergo successful treatment. However, many do not want to talk about the issue and some are even embarrassed to bring it up with their physician. Physicians can also be uncomfortable managing ED, and thus many men do not undergo evaluation and treatment.

The most common reason for impotence is an alteration in the normal physiology of erection. There are four main steps in the process of achieving an erection:

  1. Desire for an erection
  2. Signals from the brain to the pelvis urging an erection
  3. Increased blood flow to the penis
  4.  Blood stasis in the penis to maintain an erection.

ED can result due to a problem at any one of these steps. When I evaluate a patient experiencing impotence, I check each of these steps to ensure the treatment is targeted appropriately. The evaluation also includes obtaining a detailed medical history, conducting a thorough examination, performing blood tests (such as checking testosterone levels), and recommending radiological tests as needed (for instance, penile color Doppler ultrasound).

Treatment depends on the cause of the condition. Some men can have a reversible cause, such as low testosterone. Replenishing testosterone can help.  For those who experience ED due to a vascular or neurological issue, the initial treatment involves the use of a medication, such as Viagra®, Cialis®, or Levitra®. Men who do not respond to these medications, or who do not wish or cannot take these medications, have other options that include:

  • Vacuum Erection Device: a manually or battery operated pump that helps increase blood flow to the penis.
  • Muse® (alprostadil): a small suppository placed into the urethra that is rapidly absorbed and increases blood flow to the penis.
  • Penile injections (alprostadil, Bimix, Trimix, Quadmix): a small quantity of medication is injected into the penis to increase blood flow.
  • Penile prosthesis (IPP): surgical procedure involving placement of a penile implant with a pump. While this treatment does involve surgery, it is highly successful and more than 90 percent of patients are satisfied with the outcome. IPP restores spontaneity to sexual encounters.

Erectile dysfunction affects quality of life. Importantly, the condition is treatable.


Urologist Alvaro Lucioni, MD,  will speak about impotence at a free men’s health event at 6 p.m. Wednesday, Sept. 11, at Virginia Mason Federal Way. To register, call (253) 874-1604, then press 0, between 8 a.m. and 5 p.m. Monday-Friday.


  1. I quote “Unfortunately, many think the cause is “all in their head.””. Herein lies one of the main stigmas concerning ED and ED treatments. From my understanding, ED treatments such as Viagra®, Cialis®, or Levitra® do not treat psychological factors (nor do they make your partner seem more sexually attractive). If you cannot become sexually aroused, or at least interested, one’s penis will remain flaccid regardless of treatment. However, the fact that Viagra®, Cialis® and Levitra® are well known to be successful in many cases shows that the most often the cause of erectile dysfunction is usually more physical than psychological.

    BTW, this is a very good informative article that discusses ED without all the hype usually associated with the subject. I’s funny how our brain goes fuzzy whenever topics about sex comes up. Good to read a refreshing exception.

  2. Smoking constricts the blood vessels thereby reducing the flow of blood to the organs.
    When the penis receives a lesser flow of blood, it leads to weaker erections and shortened sexual encounters. For those who do not know, proper or increased flow of blood to the penis results in exactly the opposite. The lesson here is that giving up smoking can directly and indirectly increase your libido and sexual stamina.

  3. Nice post. Beside surgical treatments (like Vacuum Erection Device, Penile injections and Penile prosthesis), non-surgical treatment is the best option to cure erectile dysfunction. One can have generic drugs like Generic Viagra, Cialis and Levitra that works by increasing the flow of blood into the penis resulting hard erections.

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  5. Newton Murray says:

    For more than 12 years i have suffered from the problem of weak erection, and for that 12 years you have no idea what i went through in the hands of my various partners. It got to a point that i was running away from my duty as a man.I started searching for solution every were and i became addicted to some certain drugs all because i want to make a difference and show my strength sexually. One day i decided to open up to a friend of mine and that was how i was told about Dr Hillary. I was given his contact i contacted him and i was told what to do and how to get his products which i did and within the space of days i was cured permanently without any side effects. Today i am super active sexually (lol) and i can perform extensively in bed today as a real man. For his product on erectile dysfunction,premature ejaculation and weak erection problems contact him on (hillaconn @

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    NATURAL CURE TO IMPOTENCE. Men who have problem maintaining there erection. The two-minute man is a title no man wants to claim, pride aside.
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    Men who have issues with their sexual performance may be reluctant to talk to their doctor, seeing it as an embarrassing issue which i equally did for many years.
    It was quit embarrassing for me taking different kind of western medication which made me to rely on taking pills before sex.
    It is over 2 months now which a friend referred me to Dr. Leonard that his herbal medicine worked for him, which made me to order his product and now i am a strong man.
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  9. enzo lucas says:

    4 years ago my prostate were removed because

    of cancer and 3 months later i could not

    achieve any erection, this was bad for me

    because i enjoyed sex alot. I tried to seek

    medical help from my family doctor and others

    who were introduced to me by friends but all

    failed. A colleague of my wife actually told

    her about ED life and she decided to give a

    try. They told her about a medication that can

    cure me and make me normal again, When my wife

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    side effects from a lot of Viagra and

    stimulants. She talked me into taking it and

    when i was done with it, i must say it’s

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    no side effects and it’s been 2 years now and

    i am still very much okay. I decided to take

    this time out to reach out to people out there

    with this little story of mine to in return

    derve as a word of encouragement too. If you

    have a similar problem or any ED related problem do not hesitate to contact i am very 100% sure they can help you too.

  10. wesley blake says:

    Weak erection is one of the most embarrassing problems in this world because i was always shy to meet new partners due to the fact that i already know that i cannot perform at all and even when i did i was so weak. I could only last 45 seconds and this this made me to ask myself many a times if i am a man, four of my girlfriends left me due to this problem. In my search for a cure and a solution i told an old friend all i have been facing and he told me about Dr. Hillary how he helped him save his marriage using his very effective ED medicine which restored back his erection. I contacted him and he sent me the medicine and that is one of the best decision i have ever made in my entire life. I think this will help someone out there if you have any ED related problem do not hesitate to contact i know he can help you.

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  16. Medications that physicians prescribe to control blood pressure, depression, anxiety, and an enlarged prostate can result in ED. Lifestyle choices such as smoking, obesity, lack of exercise also contribute to ED. Finally, psychologic factors such as stress, anxiety, and depression can worsen or lead to ED as well.

  17. It is interesting to me that there are so many causes of erectile dysfunction. As I have gotten older, I think that I might need to look for an erectile dysfunction solution. It is good to know that there are a bunch of different options for it and I can see what works best for me.

  18. The reason why a lot of people still think that ED is a psychological thing is because men don’t like talking about this problem. For them, it is taboo and it is emasculating. So I’m glad you talked about it. If I may just add to the alternatives you just mentioned: 1) testosterone therapy 2) GAINSWave solution 3) P-shot.

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