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Erectile Dysfunction (ED)

Erectile Dysfunction (ED)

Erectile Dysfunction (ED) is a persistent inability to achieve or maintain an erection that is firm enough to have sexual intercourse.

How common?

In a study from John Hopkins Institute in 2007, the overall prevalence of ED in men aged above 20 years was 18.4% suggesting that ED affects 18 million men in the USA. Among men with diabetes, the prevalence of ED was 51.3%, so it’s a fairly common problem.

What causes ED?

  • Lifestyle choices (smoking, excessive alcohol, obesity, lack of exercise)
  • Diabetes
  • Medications (blood pressure, antidepressants)
  • Cardiovascular disease (high blood pressure heart disease)
  • Hormone problems
  • Prostate cancer treatment
  • Surgery (prostate, bladder, colon)
  • Spinal cord injurie

Treatment options?

Penile Doppler scan with an injection may be required occasionally in special situations.

Whatever is causing ED, there is a treatment option that can provide a satisfying solution.

If you try one of the treatment options listed and it doesn’t work for you or you aren’t completely satisfied, don’t be discouraged and give up hope.

These treatment options have varying degrees of success for each man depending on the cause of the ED. Irreversible blood vessel or nerve damage may impact the success of some of these treatments.

It is important to know all of your available options and discuss them with your doctor to determine which will be appropriate for you and your lifestyle.

Lifestyle modifications:

Exercise regularly (5 times a week), healthy weight, avoid smoking, restrict alcohol intake to 2 drinks or less per day, adopt better sleep habits, take care of your other health issues such as high blood sugar and heart, artery or kidney disease.

Non-Surgical Options: Oral medications, penile injections, vacuum erection device Surgical option: Penile implants

Oral medications:

These drugs are known as phosphodiesterase type 5 (PDE-5) inhibitors. They work to relax muscle cells in the penis for better blood flow and to produce a rigid erection. These medicines work in about 7 out of every 10 men with ED. They can be effective regardless of age or race. However, they only work if a man is sexually stimulated. Their effects last for only a set amount of time. Men should take these medications 30-60 minutes before sexual activity. These drugs do not treat a lack of sexual desire. As with any drug, some men may experience side effects when taking PDE-5 inhibitors. The most common are headaches, flushing (redness) of the face, runny or stuffy nose, upset stomach, dizziness and muscle aches. Those side effects are usually mild-moderate, but taking these drugs with alcohol may make them worse. Be sure you tell your doctor about all drugs you are taking, including prescriptions, over-the-counter medications or supplements or recreational drugs before you take any PDE-5 inhibitors.

Penile self-injection:

Alprostadil is injected into the side of penis with a very fine needle. It’s of great value to have the first shot in the doctor’s office before doing this on your own. Self-injection lessons should be given in the doctor’s office by an experienced professional. The success rate for getting an erection firm enough to have sex is as high as 85% with this treatment. Many men who do not respond to oral tablets can be ‘rescued’ with ICI.

ICI therapy often produces a reliable erection, which comes down after 20-30 minutes or with climax. Since the ICI erection is not regulated by your penile nerves, you should not be surprised if the erection lasts after orgasm. The most common side effect of ICI therapy is a prolonged erection. Prolonged erections (>1 hour) can be reversed by a second injection (antidote) in the office.

Men who have penile erections lasting longer than two to four hours should seek Emergency Room care. Priapism is a prolonged erection, lasting longer than four hours. It is very painful. Failure to undo priapism will lead to permanent penile damage and untreatable ED.

Vacuum Erection Devices (VED):

A mechanical ED pump used to pull blood into the penis can cause an erection. The system includes a plastic cylinder, an external penile pump and a tension band to place at the base of the penis. When the penis is erect, the ring is placed at the base to maintain an erection long enough to have sex (up to 30 minutes). This is a drug-free non-invasive method of treatment, but the person will not be able to ejaculate soon after the orgasm due to a constrictive ring at the penile base.

Surgical option

In use since 1971, penile implants have helped many men return to active sex life. A penile implant is a medical implant that is implanted into the penis in the operation theatre. The implant is entirely concealed within the body. Two basic types of implants are available. With malleable or bendable implants, two silicon-type cylinders are inserted into the penis. To have an erection, a man bends his penis upward into an erect position. 

The second type, an inflatable implant has a pair of inflatable cylinders which is attached to a fluid reservoir and a pump hidden inside the body. To have an erection, a man presses on the pump. This transfers fluid into the cylinders, making the penis rigid. To return the penis to a natural flaccid state, the pump is deflated.

Features of Penile Implant Surgery:

  • Permanent ED Treatment
  • Small external scar
  • Concealed within the body
  • Maintain erection as long as desired
  • Spontaneous-sex when the mood strikes
  • Doesn’t interfere with orgasm or ejaculation
  • High patient and partner satisfaction
  • Low risk of device failure. Generally inflatable implants last 10-15 years. It is possible to replace them in case the device fails.