Treatment Options for Men with Erectile Dysfunction
Medicines that can help produce an erection may be used to treat erection problems (erectile dysfunction) that are caused by blood vessel (vascular), hormonal, nervous system, or psychological problems. They also may be used along with counseling to treat erection problems that have psychological causes.
Commonly used oral medicines include:
- Phosphodiesterase-5 inhibitors (PDE-5 inhibitors) such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra).
Other medicines that may be used include:
- Injected medicines.
- Intraurethral alprostadil (MUSE).
Hormones and other medicines may be prescribed for men who have low testosterone or high prolactin levels.
Intracavernous injection therapy is the process whereby a small amount of a chemical is injected directly into the corpora cavernosa. These chemicals are smooth muscle relaxants and thus help increase blood flow into the penis. The advantage of injection therapy is that it does not depend on oral absorption, as pills do, and does not depend on absorption through the tissues, as with MUSE. The disadvantage is that it requires a small injection.
Most men are anxious when they initially start with injection therapy but find that the procedure itself is usually not that uncomfortable. In most patients who do not respond to first-line, oral therapy or who are not candidates for oral therapy, injection therapy provides satisfactory erections.
Vacuum Erection Device
A vacuum device, which is sometimes used to treat erection problems (erectile dysfunction), is a tube made of plastic that fits around the penis. You coat the base of the penis with lubricant and insert it into the tube. Air is pumped out of the tube, which creates a vacuum. The vacuum helps blood flow into the penis, producing an erection-like state in about 5 minutes. A constrictive band is placed around the base of the penis to maintain the erection, and the tube is removed.
The constrictive band may be left in place for up to 30 minutes. If you want the erection to last longer, you may remove the band for a few minutes and then repeat the process. Vacuum devices block ejaculation. You still have an orgasm but do not ejaculate (release semen).
Some men say the erection is “wobbly” or has a “hinge-like” feeling, since the tissues beneath the ring on the base of the penis don’t get hard. A small number of men consider this a major problem, and it may make penetration difficult.
A prescription is not needed to buy these devices. They are reusable and should be cleaned after each use.
If you are troubled by occasional erectile dysfunction, remember that arousal takes longer as you get older and that satisfaction should not be equated with performance. If your dysfunction is severe and persistent, you should seek medical help. The number of treatment options has increased in recent years. Many doctors will recommend changes in lifestyle as a first step in treatment.
In a lengthening procedure, a small incision is made above the base of the penis, and the ligament which suspends it, running from the pubic bone to the top of the penis is cut. This causes the penis to drop forward, thereby lengthening its appearance from the outside by 1 – 2 inches (20 – 50%), although the actual gain will depend from person to person.
This lengthening operation only affects the non-erect (flaccid) length of the penis, any post-operative erection will remain the same size but the angle of it may be slightly lower than it was prior to surgery.
A penile prosthesis is another treatment option for men with erectile dysfunction. These devices are either malleable (bendable) or inflatable. The simplest type of prosthesis consists of a pair of malleable rods surgically implanted within the erection chambers of the penis. With this type of implant, the penis is always semi-rigid and merely needs to be lifted or adjusted into the erect position to initiate sex. Today, many men choose a hydraulic, inflatable prosthesis, which allows a man to have an erection whenever he chooses and is much easier to conceal. It is also more natural.
A penile implant is usually used when there is a clear medical cause for ED and when the problem is unlikely to resolve or improve naturally or with other medical treatments.
Ultrasound Doppler Evaluation
Doppler ultrasound (also called color duplex Doppler) uses a handheld tool passed lightly over the penis. The tool uses reflected sound waves to estimate the speed and direction of blood as it flows through a blood vessel. The sound waves go to a computer that changes the sounds to colors that are overlaid on a picture of the blood vessel. This shows the speed and direction of blood flow. You may need to have medicine injected into your penis (intracavernosal injection) to cause an erection before the Doppler test is done.
The results of your tests may show which kind of treatment is a good choice for you.
Tests such as the bulbocavernosus reflex test are used to determine if there is sufficient nerve sensation in the penis. The physician squeezes the glans (head) of the penis, which immediately causes the anus to contract if nerve function is normal. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger inserted past the anus. Specific nerve tests are used in patients with suspected nerve damage as a result of diabetes or nerve disease.
Circumcision is also performed on adults and differs dramatically from infant circumcision in terms of surgical accuracy and skill required to achieve optimal patient results. Surgeons who specialize in cosmetic circumcision usually use a scalpel rather than scissors or a clamp, and use absorbable sutures of the highest quality (suitable for facial plastic surgery).
Your doctor can offer several new treatments for ED. For many men, the answer is as simple as taking a pill. Getting more exercise, losing weight or stopping smoking may also help.
If you’re suffering from erectile dysfunction, call our office today for a confidential consultation.Request an Appointment