ERECTILE DYSFUNCTION

With ED, it is difficult or impossible to achieve or maintain an erection firm enough to complete intercourse. Sometimes, the erection is hard enough but becomes soft before penetration or shortly thereafter. About 30 million men in the US are affected by ED.

When it happens to a younger man, say in his 20s-30s, it could be an early sign of arterial disease or heart disease. This young man should be screened for early coronary heart disease. Most men will start noticing a decrease in the quality of his erections starting in his 30s-40s but tends to be a very slow process.

While some men are still sexually active  into their 70s and 80s, many will experience ED starting in their 50s-60s.

For most men experiencing ED, it is usually due to a combinations of issues such as:

  • Aging
  • High Blood Pressure
  • Diabetes
  • High Cholesterol
  • Smoking
  • Arterial Disease
  • Side effect of Prostate Cancer Treatment
  • Side Effect of Medications
  • Venous Leak
  • Low Testosterone
  • Heart disease

Treatments

Pills are the simplest option and should be tried first, unless you take nitrates or experience significant angina.

Pills

These are known as PDE-5 inhibitors and include Viagra (Sildenafil), Cialis (Tadalafil) and Levitra (Vardenafil).  They work by increasing the blood flow into the penis and are a reasonable first option. Viagra and Levitra have a 4-hour window of opportunity,  should be taken at least one hour before attempting intercourse, and work better when taken on an empty stomach. These drugs will facilitate an erection if there is a sexual stimulus. 

Cialis (Tadalafil) has a 36-hour window of opportunity and should be taken at least 2-4 hrs before intercourse. Some men report better results the following day.  Cialis does not require to be taken on an empty stomach.

 Common side effects include headache, flushing, runny nose, stomach pain, back pain (Cialis), and indigestion. Lower doses are used for individuals with liver and/or kidney disease. 

You should not take a PDE-5 inhibitor if you have angina and/or taking a nitrate.

Some men report great results initially, but unfortunately, many will notice that after a few years the drug loses its efficacy. At that point, it is time to try the next option(s).

This consists of a clear cylinder into which the man places his penis and a vacuum pump  helps extend and bring blood to the penis , achieving an erection. The pump can be manually or battery operated. The battery operated tends to be easier to operate, has a higher success rate and that is the type we recommend if you will be trying this option.

It is a simple and non-invasive alternative effective in about 70% of men. It can also be used to regain the lost length typically seen after 3 months of impotence.

Learn more…

Self-injection Therapy

Alprostadil (Caverjet, Edex) is injected into the side of penis with a very fine needle. It is best to have the first shot in the doctor’s office before doing this on your own. The dosing and the technique is very important for success and safety.  The success rate is as high as 85% .

Intracavernosal Injections (ICI) may be used as a single drug (Alprostadil) or as a mixture of three drugs (Papaverine, Phentolamine and Prostaglandin). This combination therapy called trimix tends to work better than a single drug inject able.

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 PRIAPISM,  a painful erection lasting more than 4 hours.

Men who develop priapism should go to the emergency room to seek chemical or surgical reversal of this prolonged erection. If allowed to last longer than 4 hrs, priapism will lead to permanent penile damage and worsening ED.

inflatable penile prosthesis (IPP)

IPPs have been around for over 50 years and over this time the improvements in design and materials have resulted in very reliable prosthesis.  They are coated with antibiotics therefore, their infection rate has decreased tremendously and nowadays it hovers around 1%.

The modern generation of IPPs carry the highest patient and sexual partner satisfaction rates in comparison to all the other ED treatment options after pills have failed.

Not all urologists have been trained to do the insertion of IPP technique, so make sure you inquire first. The procedure is done as an outpatient, meaning that you get to go home that same day. It takes approximately one hour. You will have wound check at 2 weeks after the procedure and at 6 weeks you will be shown how to inflate and inflate the prosthesis.

Boston Scientific and Colopast are the two american manufacturers of penile prosthesis in the US.

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