Male Genitourinary Disorders: Erectile Dysfunction

5th September 2017 Mark Ward

Erectile Dysfunction

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Erectile dysfunction (ED) is when a man is unable to gain or maintain an erection sufficient for penetrative sex, this is also known as impotence.

Erectile dysfunction is a very common condition, particularly in older men. It is estimated that half of all men between the ages of 40 and 70 will have it to some degree.

Why does erectile dysfunction happen?

Erectile dysfunction can have a range of causes, both physical and psychological. Physical causes include:

narrowing of the blood vessels going to the penis – commonly associated with high blood pressure (hypertension), high cholesterol or diabetes
hormonal problems
surgery or injury

Psychological causes of ED include:

anxiety
depression
relationship problems

Sometimes erectile dysfunction only occurs in certain situations. For example, you may be able to get an erection during masturbation, or you may find that you sometimes wake up with an erection but you are unable to get an erection with your sexual partner.

If this is the case, it is likely the underlying cause of erectile dysfunction is psychological (stress related). If you are unable to get an erection under any circumstances, it is likely that the underlying cause is physical.

Erectile dysfunction can also be a side-effect of using certain medicines.

Read more about the causes of erectile dysfunction.

Diagnosis

Although you may be embarrassed, it’s important to get a diagnosis so that the cause can be identified.

Your GP can usually diagnose erectile dysfunction. This will involve answering questions about your symptoms, as well as a physical examination and some simple tests.

Read more about diagnosing erectile dysfunction.

While sexual dysfunction can be a problem for anyone, people living with HIV may be particularly affected. If sexual problems are serious or prolonged, they can contribute to emotional problems, including anxiety and depression.

Loss of sexual drive or desire (libido), the inability to obtain and sustain an erection or to have an orgasm, or experiencing pain during sex can have a significant impact on quality of life and feelings of self-worth.

For further information on HIV related sexual dysfunction click on the link below:

HIV Related Sexual Dysfunction

Medicines & drugs which may cause sexual dysfunction

Many medicines and recreational drugs can affect a man’s sexual arousal and sexual performance. What causes impotence in one man may not affect another man.

Talk to your health care provider if you think that a drug is having a negative effect on your sexual performance. Never stop taking any medicine without first talking to your provider. Some medicines may lead to life-threatening reactions if you do not take care when stopping or changing them.

The following is a list of some medicines and drugs that may cause impotence in men. There may be additional drugs other than those on this list that can cause erectile difficulties.

Antidepressants and other psychiatric medicines:

Amitriptyline (Elavil)
Amoxapine (Asendin)
Buspirone (Buspar)
Chlordiazepoxide (Librium)
Chlorpromazine (Thorazine)
Clomipramine (Anafranil)
Clorazepate (Tranxene)
Desipramine (Norpramin)
Diazepam (Valium)
Doxepin (Sinequan)
Fluoxetine (Prozac)
Fluphenazine (Prolixin)
Imipramine (Tofranil)
Isocarboxazid (Marplan)
Lorazepam (Ativan)
Meprobamate (Equanil)
Mesoridazine (Serentil)
Nortriptyline (Pamelor)
Oxazepam (Serax)
Phenelzine (Nardil)
Phenytoin (Dilantin)
Sertraline (Zoloft)
Thioridazine (Mellaril)
Thiothixene (Navane)
Tranylcypromine (Parnate)
Trifluoperazine (Stelazine)

Antihistamine medicines (certain classes of antihistamines are also used to treat heartburn):

Cimetidine (Tagamet)
Dimenhydrinate (Dramamine)
Diphenhydramine (Benadryl)
Hydroxyzine (Vistaril)
Meclizine (Antivert)
Nizatidine (Axid)
Promethazine (Phenergan)
Ranitidine (Zantac)

High blood pressure medicines and diuretics (water pills):

Atenolol (Tenormin)
Bethanidine
Bumetanide (Bumex)
Captopril (Capoten)
Chlorothiazide (Diuril)
Chlorthalidone (Hygroton)
Clonidine (Catapres)
Enalapril (Vasotec)
Furosemide (Lasix)
Guanabenz (Wytensin)
Guanethidine (Ismelin)
Guanfacine (Tenex)
Haloperidol (Haldol)
Hydralazine (Apresoline)
Hydrochlorothiazide (Esidrix)
Labetalol (Normodyne)
Methyldopa (Aldomet)
Metoprolol (Lopressor)
Nifedipine (Adalat, Procardia)
Phenoxybenzamine (Dibenzyline)
Phentolamine (Regitine)
Prazosin (Minipress)
Propranolol (Inderal)
Reserpine (Serpasil)
Spironolactone (Aldactone)
Triamterene (Maxzide)
Verapamil (Calan)

Thiazides are the most common cause of impotence among the high blood pressure medicines. The next most common cause is beta blockers. Alpha blockers tend to be less likely to cause this problem.

Parkinson disease medicines:

Benztropine (Cogentin)
Biperiden (Akineton)
Bromocriptine (Parlodel)
Levodopa (Sinemet)
Procyclidine (Kemadrin)
Trihexyphenidyl (Artane)

Chemotherapy and hormonal medicines:

Antiandrogens (Casodex, Flutamide, Nilutamide)
Busulfan (Myleran)
Cyclophosphamide (Cytoxan)
Ketoconazole
LHRH agonists (Lupron, Zoladex)

Other medicines:

Aminocaproic acid (Amicar)
Atropine
Clofibrate (Atromid-S)
Cyclobenzaprine (Flexeril)
Cyproterone
Digoxin (Lanoxin)
Disopyramide (Norpace)
Estrogen
Finasteride (Propecia, Proscar, Avodart)
Furazolidone (Furoxone)
H2 blockers (Tagamet, Zantac, Pepcid)
Indomethacin (Indocin)
Lipid-lowering agents
Licorice
Metoclopramide (Reglan)
NSAIDs (ibuprofen, etc.)
Orphenadrine (Norflex)
Prochlorperazine (Compazine)
Pseudoephedrine (Sudafed)
Sumatriptan (Imitrex)

Opiate analgesics (painkillers):

Codeine
Fentanyl (Innovar)
Hydromorphone (Dilaudid)
Meperidine (Demerol)
Methadone
Morphine
Oxycodone (Oxycontin, Percodan)

Recreational drugs:

Alcohol
Amphetamines
Barbiturates
Cocaine
Marijuana
Heroin
Nicotine

Alternative Names

Impotence caused by medications; Drug-induced erectile dysfunction; Prescription medicines and impotence

References

Burnett AL. Evaluation and management of erectile dysfunction. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 27.

McVary KT. Clinical practice: erectile dysfunction. N Engl J Med. 2007;357(24):2472-2481. PMID: 18077811 www.ncbi.nlm.nih.gov/pubmed/18077811.

Waller DG, Sampson AP, Renwick AG, Hillier K. Erectile dysfunction. In: Waller DG, Sampson AP, Renwick AG, Hillier K, eds. Medical Pharmacology and Therapeutics. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 16.

Review Date 2/5/2017

Updated by: Jennifer Sobol, DO, urologist with the Michigan Institute of Urology, West Bloomfield, MI. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.