Erectile Dysfunction
Compassionate, personalized care for erectile dysfunction—from lifestyle changes to advanced therapies.
Erectile dysfunction, also known as impotence, is a medical condition that prevents a man from having an erection firm enough for sex. According to the National Institute of Health, as many as 30 million men suffer from erectile dysfunction. It is estimated erectile dysfunction affects:
An erection occurs when the penis receives nerve signals causing arteries to dilate. Blood flow then increases to the erectile tissue of the penis. The blood that flows into the penis must then be trapped to maintain an erection.
Erectile dysfunction is typically divided into two categories — psychogenic and organic. Most cases are organic, which are typically caused by diseases of the nervous system, such as diabetes; disorders of the circulatory system, such as arteriosclerosis; or disorders allowing blood to leak out of the penis prematurely, which is also called venous leak impotence.
To determine a cause and treatment options, physicians evaluate a patient’s detailed medical history and look for obvious causes such as medications known to be linked to erectile dysfunction. Physicians then take into account the patient’s lifestyle, such as smoking and illicit drug use, which can affect a man’s ability to obtain an erection. Other health conditions are addressed as well. Medical history is important. For example, a man who has a history of decreased sex drive may have deficient production of the male hormone testosterone.
Testosterone is the hormone responsible for the physical transition into manhood. It helps with gaining muscles, facial hair, and a deeper voice. Testosterone levels also affect a man’s sex drive and erections. Aside from the sex-related symptoms, low levels of testosterone, called hypogonadism or Low-T, are characterized by increased body fat, low iron, lower energy, depression, and reduced muscle mass.
In addition to a thorough medical history and physical examination, physicians will also conduct baseline blood testing to determine if the testosterone levels are adequate. In some cases, nocturnal penile tumescence monitoring is conducted to evaluate the quality of the patient’s nocturnal erections. This is important because men normally have multiple erections during various phases of the sleep cycle, and if there is a significant decrease then the erectile dysfunction is more likely to be organic than psychogenic.
Testing will help determine if the ED is organic or psychogenic. Most men will be found to have organic impotence and treatment options will be discussed. Some men will be found to have psychogenic impotence and will be referred for counseling.
Erectile dysfunction is a medical condition that prevents a man from having an erection firm enough for sex and can be either psychogenic and organic. While counseling is the best option for psychogenic impotence, there are a variety of erectile dysfunction treatment options for men dealing with organic impotence.
Your physician can help you decide which erectile dysfunction treatment is best for you. There are several medication and medical device options to consider that do not involve surgery.
Medications
Doctors can prescribe medications that are taken orally or that are injected through the penis.
Oral Medications
Oral medications that may help a man with an erection include sildenafil, vardenafil, tadalafil, and avanafil. In general, these medications relax muscles and increase blood flow to the penis when a man is sexually stimulated.
Injectable Medications
Many men get stronger erections by injecting medicine directly into the penis. Alprostadil is the most common injectable medication. It widens blood vessels to help a man achieve an erection.
Some men who produce lower amounts of testosterone, called hypogonadism or low-T, are prescribed testosterone replacement therapy. Testosterone therapy can be either in the form of biweekly injections or patches which are applied to the skin.
In recent years, the profile of low-T has been raised and some clinics specialize in it. It’s important to remember that, as with any condition, men with low-T should talk with a physician to determine the treatment that is best for their individual condition and the anticipated results.
Medical Devices
Vacuum erection devices can produce erections that are safe. Generally, vacuum erection devices are plastic cylinders placed over the penis temporarily while a small pump is used to create negative pressure. They typically come with tension rings in various sizes and a small hand pump. When the air is pumped out, suction is created to draw blood into the penis and produce an erection. The tension ring around the penis acts as a tourniquet to keep the erection.
Other mechanical devices use rings attached to a rod. They are applied externally to provide length to the shaft of the penis, and are worn during sex. The devices can be customized to the patient’s penis length. Non-surgical penis casts available in various sizes may also serve as a more economical option than penile implants.
It is recommended that men who suffer from erectile dysfunction talk with a physician and get recommendations for erectile dysfunction treatments. For some men, surgery is preferred, or even necessary, to achieve an erection healthy enough for sex.
Penile Implant
One surgical option is a penile implant. There are two common types of penile implants, semi-rigid and inflatable.
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 the erect state.
An inflatable implant works by squeezing a pump surgically placed in the scrotum to inflate two cylinders surgically inserted into the penis. Fluid from a reservoir implanted in the lower abdomen is pumped to the cylinders. When the cylinders expand, there is an erection.
With a semi-rigid or malleable rod implant, cylinders are implanted into the penis. The implant is strong enough for sexual penetration.
Viagra®, Levitra® and Cialis® are effective and safe oral agents for appropriate candidates. For example, men with a history of cardiovascular disease and especially men who are currently taking agents from the nitroglycerine family are not candidates for treatment with this class of drugs.
Yes. The vacuum constriction device is another excellent non-surgical treatment option. This system uses a plastic cylinder that is placed over the penis; a small pump is then used to create negative pressure, which acts to “pull” blood into the penis – producing an erection. A rubber band is then applied to the base of the penis, so that blood is trapped in the erect penis to sustain the erection until the band is removed.
Penile implant surgery is always an option for men who aren’t happy with other treatments. We can do most penile implant procedures on an outpatient basis with a relatively short recovery period.
Caverject® is one popular form of treatment. The therapy involves medication that is directly injected into the penis to produce an erection.
