Urological Associates | Erectile Dysfunction Treatment

The Treatment of Erectile Dysfunction - A Patient's Guide

What is Erectile Dysfunction?

Erectile dysfunction is the inability to achieve or maintain a hard, erect penis sufficient for sexual intercourse. Traditionally, this inability has been called "impotence". The term "erectile dysfunction" is more precise, because it refers only to erection problems. Men with erection problems often retain other sexual functions such as the ability to ejaculate and have an orgasm.

What Causes Erectile Dysfunction?

Psychological causes of erectile dysfunction include stress and anxiety due to marital, financial, or other external problems. It is possible for a man's stress and anxiety to interfere with nerve impulses from his brain when he attempts sexual intercourse. Physical causes of erectile dysfunction are frequently related to vascular diseases. Hardening of the arteries and other diseases affecting the vascular system can impede the flow of blood to the penis and effect a man's ability to maintain an erection. Diseases that affect the nervous system, such as multiple sclerosis and alcoholism, can also cause erectile dysfunction. Accident victims who receive injuries to their spines or pelvic regions are also at risk for erectile dysfunction.

How is Erectile Dysfunction Diagnosed?

Medical History. The patient will be asked questions covering a wide range of risk factors in order to determine whether or not his medical history is in any way related to his erectile dysfunction problems.

Sexual History. Questions like "When was the last time you had an erection?" and "Do you ever wake up in the morning with an erection" are both typical questions patients are asked about their sexual histories.

Physical Examination. The doctor will pay particular attention to the genitalia and will test nervous and vascular function as well as check for Peyronie's disease.

Lab Tests. Testosterone level tests and tests for diabetes and vascular problems such as elevated cholesterol or fat in the blood are routine.

Treatment Options. For the majority of men whose erectile dysfunction has mainly physical causes, there are three generally accepted treatment options:

Vacuum constriction devices consist of a plastic cylinder, a vacuum pump and an elastic constriction band. Using the pump, the patient creates a vacuum around the penis inside the cylinder, forcing blood into the penis. The constriction band maintains the erection.
In penile injection therapy, vasoactive drugs are injected into the erection chambers. These drugs work by expanding arteries and relaxing penile tissue. Blood flow increases into the two erection chambers, helping to cause an erection.
A penile prosthesis is a plastic device surgically implanted into the penis so it can be made rigid. A prosthesis does not change the ability to urinate, ejaculate, or have an orgasm. There are two kinds of penile prostheses: inflatable and semirigid.

Advantages and Disadvantages

Vacuum constriction devices are reliable and safe, with no serious side effects when reputable prescription devices are used properly by patients who have been instructed by trained professionals. Interruption of lovemaking is the most common complaint. Some men report coldness or numbness of the penis and/or discomfort when ejaculating.

Penile injection therapy tends to produce a firm erection, which may last an hour or more. A man can inject himself before activity begins; erection occurs five to fifteen minutes later. The procedure is easy and usually painless, though some men report discomfort following injection. Possible side effects include prolonged erections. If an erection lasts too long, the penis can be injured. The chances of a prolonged erection with this type of therapy range from one to eight percent, but it rarely occurs once a patient has been properly trained. Another possible side effect is the eventual formation of scar tissue in the penis.

Penile prostheses enjoy a high satisfaction rate among those electing this course of treatment. With a prosthesis, a man can create an erection whenever he wishes. Although the erection may be slightly shorter than a natural one would be, it is rigid enough for sexual intercourse. There is no change in either skin sensation or the ability to have an orgasm. Once a prosthesis is implanted, however, it is difficult for a man to change his mind and choose a different treatment option. Also, as is the case with any mechanical device, failure of the prosthesis is possible. For the more complex inflatable prostheses, the chances of failure are one out of ten. For the simpler semirigid malleable prosthesis, chances of failure are one out of twenty. Possible complications from surgery, such as infection, may require removal of the device.

Cost and Time Considerations

If cost is a consideration, vacuum constriction devices have a decided advantage. They are far, less expensive than the operation necessary to implant a prosthesis and less expensive over time than the drugs needed for injection therapy. Vacuum constriction devices also require the smallest investment of time. Only one training session is required in addition to follow-up as scheduled with your doctor.

For injection therapy, several visits to the doctor are necessary to learn self-injection, adjust the dosage if necessary, and check for any complications. Implanting a prosthesis usually means one or two days in the hospital, 10 to 21 days before resuming usual activities after surgery and one to two follow-up visits.

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