Any man who has had trouble achieving or maintaining an erection knows how disturbing this can be. If it happens repeatedly to your partner, try to get him to seek help; there are now several effective treatments out there.

Here's what you need to know about erectile dysfunction (ED):
ED is far more common than many people think. In a study of about 4,000 Canadian men between the ages of 40 and 88, almost half had ED. It was one-and-a-half times more common among men with heart disease and three times more common among those with diabetes.

Factors that contribute to heart disease and diabetes also affect a man's ability to achieve or maintain an erection. These include:
• smoking
• high blood pressure
• elevated cholesterol
• raised blood-sugar levels

There is also a slight chance that bicycling can cause ED. If you sit too long on a seat, nerves and blood vessels may get compressed against the pelvic bone. “If a man develops erectile difficulties and genital numbness after cycling, he should consider stopping or at least changing the bicycle seat,” says Dr. David Bell, an associate professor of urology at Dalhousie University in Halifax.

Drugs can improve erectile function if used properly
Medications such as sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) increase blood flow to the penis, enhancing erections. However, they don't work without sexual stimulation. “Men with mild ED respond very well to these drugs, particularly if they are panicky about maintaining an erection,” says Bell.

Men with ED often also have performance anxiety, which can further affect their sexual performance. “When a man starts to panic, he'll produce adrenalin, which is what we use to reverse prolonged erections,” says Bell. His advice for first-time users? Try it out alone first to be confident that the drug does have an effect. Ideally, ED drugs should be taken on an empty stomach and in the absence of alcohol, about one hour prior to initiation of sex. Men with diabetes almost always need double the dose and should take the drug at least two hours before anticipated sexual activity. If a man has low testosterone levels, doctors may prescribe testosterone first; this may also help reverse ED difficulties.

ED drugs have side-effects
These include headaches, facial flushing and upset stomach. Less commonly, men report becoming sensitive to light or having temporarily blurred vision. A rare side-effect is an erection that lasts for more than four hours. If prolonged erections occur, men should seek immediate medical attention because long-lasting erections may damage penile tissue.

Men who take nitrates to treat chest pain could experience a sudden drop in blood pressure (and even death) if they also take an ED drug, so never mix the two. Taking an ED agent with medications called alpha blockers, which shrink the prostate, can also cause a sudden drop in blood pressure.

If ED drugs don't work, there are other treatment options, including:
• Prostaglandins (hormone-like substances that aid the dilation of blood vessels), when injected directly into the penis, produce erections quickly.

• A vacuum suction device that draws air from a plastic cylinder placed over the penis encourages blood flow to the penis, facilitating an erection.

• A silicon rod or penile prosthesis implanted inside the penis gives a man a permanent state of rigidity, although it can be bent up or down depending on whether a man wants to have sex, urinate or simply conceal the prosthesis under clothes.

• An inflatable prosthesis delivers an erection on demand.


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