Treatment options for erectile dysfunction.
Thousands of men have been diagnosed with erectile dysfunction. Fortunately, it is a treatable condition that allows men to continue or resume their sexual experience. Erectile dysfunction treatments are based on several factors including:
- Patient overall health including current medical conditions
- Current medications / other medical treatments
- Patient (and partner) preference
- The effectiveness of each treatment
- A patient’s ability (or inability) to use specific treatments (i.e., is the patient able to self-inject?)
- Cause of the erection problem
Through the process of evaluation, the provider will be able to determine the cause of the erection problem – whether physical or psychological. Oftentimes, the doctor will follow an algorithm of erectile dysfunction treatments, from conservative to surgical.
Erectile Dysfunction Treatments
Oral Medication is a first-line conservative treatment option. Three common oral medications used to treat erectile dysfunction include Sildenafil (Viagra®), Vardenafil (Lavetra®), Tadalafil (Cialis®), also known as PDE-5 inhibitors. PDE-5 inhibitors act by narrowing the exit of the blood from the cavernous bodies, thus enhancing erection. PDE-5 inhibitors have helped men with erectile dysfunction associated with diabetes, spinal cord injury, and after a radical prostatectomy. A word of caution about PDE-5 inhibitors: they amplify the effects of Nitrate medication, used by many patients with heart problems. As a result, the combination of PDE-5 inhibitors and Nitrates may prove hazardous to the heart. Therefore, check with your physician before taking any of these medications.
Self-injections: Injection involves using a short needle to inject medication through the side of the penis directly into the corpus cavernosum, Injections are relatively painless and create an erection in five to fifteen minutes that lasts from thirty minutes to several hours. It is recommended that self-injection be performed no more than once every 4 to 7 days. There is a small risk for Priapism, an erection that lasts for several hours and requires medical attention. Repeated injections may cause scarring of erectile tissue, which can further impair erection.
Urethral Suppositories: In 1997 a new product was introduced called MUSE®. It consists of a very small tablet that is inserted into the urethra while using a special tube-like device. This pre-filled applicator delivers a pellet about an inch deep into the urethra. An erection will begin within eight to ten minutes and may last thirty to sixty minutes. The pellet helps the blood vessels to open, filling the penis with blood, which causes an erection.
Hormone Treatment: Testosterone is the male hormone produced by the testis that effects libido (sexual drive). A decrease in testosterone may cause a loss of sexual desire and erection problems. Testosterone levels are routinely checked for men who are experiencing erection problems. If testosterone is low, it can be boosted by cremes or topic gels, injection, medication, skin pads, or pellets. When testosterone is being administered, blood testing will be done on a regular basis to gauge levels.
Vacuum Erection Devices: Vacuum constrictive devices (VCD) are a first-line therapy for non-endocrine related organic erectile dysfunction. Vacuum devices are external penile appliances that generate a negative pressure on the penis, thus creating an erection. The device causes a partial vacuum, which draws blood into the penis, engorging and expanding it. The penis is removed from the tube and a soft, rubber ring is placed around the base of the penis to trap the blood and maintain the erection until it is removed.
Surgery: Surgery for erectile dysfunction consists of surgically inserting a penile implant for long-term use. Although both semi-rigid and inflatable devices are available, most men choose an inflatable prosthesis because it results in a much more normal looking penis in both the flaccid and erect state. An implant does not change the ability to urinate, ejaculate, or have an orgasm. During surgery, cylinders are placed inside the cavernous bodies that will take over their function in erection. Following surgery, it will usually take 4 to 6 weeks before normal intercourse is possible. Penile implant surgery will permanently damage the cavernous bodies and should be regarded as a last resort.
Vascular Surgery: For men who experience erectile dysfunction due to venous leak, surgery may be an option. This involves locating the vein causing the leak and suturing it. Additionally, surgery to repair obstructions in arteries that block sufficient flow of blood to the penis is an option. The best candidates for these surgeries are young men with discrete blockage of an artery due to a perineum injury or fracture of the pelvis. The procedure is less successful in older men with widespread blockage.
Sex Therapy: A significant number of men develop impotence from psychological causes. Experts often treat psychologically based erectile dysfunction using techniques that decrease the anxiety associated with intercourse. The patient’s partner can help with the techniques, which include gradual development of intimacy and stimulation. Psychological therapy may be effective in conjunction with medical or surgical treatment.
If you are experiencing problem with erection, and would like to discuss erectile dysfunction treatments with one of our providers, contact the Urology Austin office nearest you to schedule an appointment.