An erection occurs when arousal causes the muscles around the penis to relax, letting blood flow into the penis, expanding the spongy tissue there so that the penis swells and hardens.
Impotence or "erectile dysfunction" (ED) makes it difficult for a man to achieve and/or maintain an erect penis. The condition is common, especially after the age of 40, with incidence increasing as men age.
Many things can cause or contribute to ED, including both physical ailments — including diabetes, high blood pressure, vascular disease, obesity, smoking, certain medications, drug abuse and more — and psychological issues such as stress and depression. Additionally, prostate surgery for urinary obstruction or prostate cancer may cause ED.
ED is highly treatable, but treatment varies widely— from medications that allow blood to flow into the penis more freely to penis pumps, lifestyle modification, counseling and sex therapy. Each patient's treatment will vary depending on his specific needs. In select cases, surgical treatment may be recommended Surgery for ED involves implantation of penile prosthesis. There are two types of prosthesis, the first involving saline-filled cylinders that the patient inflates and deflates as needed using a small pump that is placed in the scrotum Alternatively, semi-rigid cylinders of silicone or polyurethane may be used. These keep the penis in a semi-rigid state at all times.
The choice of device depends on many factors, including the cause of ED, patient preference and surgeon expertise.