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Removal of the prostate can affect the ability to have an erection. This is the invariable result of the most commonly performed procedure, known as the radical prostatectomy. A newer surgical technique now attempts to preserve the appropriate nerves in order to safeguard erectile function. However, 50 percent of the men will experience erectile difficulties, even with this technique. Hopefully, improvements in this technique and newer surgical procedures will be able to reduce the incidence of postsurgical erectile problems.

Testosterone deficiency is also believed to cause ED in men with abnormally low levels of the hormone. Some men who have come to see me have already been on a testosterone supplementation program. They took regular intramuscular injections or used a patch in order to bring back their libido and erections. Replacement of testosterone in this small group of men—and only in this group—is helpful in overcoming ED.

Finally, there is the dated belief that psychological problems are the fundamental cause for ED. While there are men who do have serious psychological components to their problem, in most there is also a physiological cause. The psychological part is often a response to their ED, manifested as depression or anxiety. Rarely is the situation one where psychological problems are the sole cause of ED.

Vein trouble

For an erection to occur, the veins that carry the blood from the penis must shut down, trapping the blood in the two chambers. If the veins don’t close, the blood, obviously, will run out. The analogy is like running water in a sink with an open drain. No matter how much water flows, nothing is stopping it from continuing on. Thankfully, this is a very rare problem. Even an ED specialist, who may see hundreds of cases a year, will, typically, only see fewer than ten men with vein trouble. To date, surgery on the veins and arteries of the penis has not been very successful.

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