Men do not ask about treatment because they believe that nothing can be done. In fact, everything is different. The overwhelming majority of male erectile dysfunction can be treated.
You do not need to feel awkward while talking to your doctor. It is important to be completely candid with him that he could obtain a complete and accurate picture and assign you the right treatment, give you the necessary information and provide appropriate support.
Treatment & Care
If you think you have ED, a good first step is to talk with your doctor. The treatment you need – ranging from lifestyle changes to medication to surgery – will depend on what’s causing it.
What Tests Will a Urologist Do If I Have ED?
Men need a lot of different body parts working the right way — from the brain and glands that control hormones to bloodvessels and the penis — to get and keep an erection. Because of that, erectile dysfunction, or ED, can have a lot of causes. Some of them are physical; others are mental and emotional. Physical reasons for ED range from heart disease and diabetesto high blood pressure and obesity. Damage to your nerves or arteries can cause problems with erections, too. Lack of exercise, drinking, and smoking can lead to problems.
On the mental and emotional side of things, anxiety, depression, and stressall play a role. Relationship issues can also be a factor.
With so many possible causes, your doctor has a number of tests he can use to figure out the best treatment for you.
Medical and Sexual History
This one’s not actually a test, but your doctor will likely start with questions about your medical and sexual history. The reason is simple: He wants to better understand how ED affects you and see whether there might be a clear cause for it. When you talk about past surgeries, medicine you take, injuries, and lifestyle choices, your doctor can learn about diseases or other issues you might have that might lead to ED.
By asking about your sexual history — your relationships, sex drive, if you ever get erections — he can begin to figure out whether the problem is more likely to be physical or mental. Be honest with your doctor; he can’t help you if you withhold information.
Your doctor will check your penis and testicles to make sure they look normal and their nerves work as expected. He may also look for hair loss and larger-than-normal breasts. Both of these can be signs that you have a hormone problem.
Blood and Urine Tests
Based on your physical exam as well as your medical and sexual history, your doctor may want to order certain blood or urine tests. He’ll use these to check for problems that can lead to ED, such as:
- Heart disease
- Kidney disease
- Hormonal problems such as low testosterone
One type of blood test can check your thyroid function. A butterfly-shaped gland in your neck, it has a lot of jobs to do. One of them is to help with the flow of sex hormones. This test can check whether it’s working right.
Overnight Erection Test
Usually, men have 3 to 5 erections during the night as they sleep. Your doctor may use an overnight erection test to see whether you’re able to get an erection.
For this test, you will place a device around your penis before you go to sleep. It measures how many erections you have and how strong they are. A simpler version of this test uses a special plastic ring around your penis. If you get an erection, the ring breaks.
If the test shows that you can get erections, it’s more likely that the ED is caused by something mental or emotional.
An injection test is also called an intracavernosal test. Your doctor injects a medicine into the base of your penis that should give you an erection. If you don’t get one, you may have a problem with blood flow to your penis.
Sometimes called Doppler ultrasound, this is another way to check blood flow to the penis. It may be used along with the injection test. Your doctor takes a device that looks like a wand and holds it over your penis. It uses sound waves to create a video of your blood vessels so your doctor can look at blood flow.
Mental Health Exam
If it looks more likely that a mental or emotional issue is the source of the problem, your doctor will ask you standard questions about your mental well-being. They help him check for depression, anxiety, and other common causes of erectile dysfunction.
If you have a regular sexual partner, your doctor may ask to talk to that person as well. This can help him learn more about your relationship and how it might affect your ability to get and keep erections. If you think you have ED, a good first step is to talk with your doctor. The treatment you need will depend on what’s causing it. You may find that simple lifestyle changes will help, like losing weight, drinking less alcohol, or quitting smoking.
If a medication is causing your ED, your doctor may lower your dose or try a different drug altogether.
There are also other treatments. They include:
If anxiety or stress is causing your ED, it may help to talk to a professional therapist.
Life-changing problems or even everyday stress can trigger erectile dysfunction. Talking about these things with a licensed therapist can ease sexual anxiety and help you feel more confident in your relationship. Usually you’ll only need a handful of sessions. You may want to include your partner, as well.
ED medicines can be pills, drugs inserted into the tip of the penis, or injections into the penis
- Avanafil (Stendra)
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Levitra, Staxyn)
They are taken anywhere from 15 minutes to 36 hours before having sex, depending on the drug. You shouldn’t use these more than once a day.
Staxyn dissolves in the mouth. The other medications are swallowed.
These pills work for about 80% of men who take them. But if your erection lasts more than 4 hours, seek emergency medical help. Side effects include:
- Stuffy nose
- Muscle ache
- In rare cases, a temporary blue-green shading of your vision.
You shouldn’t take these pills if you take nitrate drugs for heart disease. Doing so can cause a dangerous drop in blood pressure.
Also use caution if you’re taking alpha-blockers for prostate problems or blood pressure. Tell your doctor about all medications you’re taking, including over-the-counter drugs, herbs, and supplements.
Injections and Suppositories
If the pills don’t work or aren’t safe for you to take, your doctor may prescribe a drug called alprostadil. It helps boost bloodflow to the penis, triggering an erection within minutes.
It can be given in two ways:
Injection: The medication is put into the side of the penis by a needle. This raises your risk for dangerously prolonged erections and scarring.
Suppositories . Pellets are placed inside the penis. You may hear this procedure called MUSE (medicated urethral system for erections). This may be less successful than injections.
Not Recommended for ED
Testosterone. It’s a male hormone. If you have a normal testosterone level, you don’t need more.
Trazodone. This is an antidepressant. It’s still uncertain whether it works for ED. It’s not recommended.
A lot of over-the-counter products have been hailed as all-natural ways treat ED. But it’s not sure if they’re effective or if they’re safe. The FDA warns that some products may contain harmful substances or the active ingredient in some prescription medications.
Some of these products have been found to contain sildenafil (the active ingredient in Viagra) or a substance similar to vardenafil (the active ingredient in Levitra and Staxyn). These products can be dangerous for people who take nitrates to treat chest pain or heart disease. In recent years, the FDA has seized many over-the-counter products for male sex problems because they contained dangerous or undeclared ingredients. Lab tests have discovered these risky ingredients in nearly 300 products.
The FDA’s web site states that you should beware of products that:
- Promise quick results (within 30 to 40 minutes)
- Are advertised as alternatives to FDA-approved prescription drugs
- Are sold in single servings
- Advertise via spam or unsolicited emails
- Have labels written primarily in a foreign language
- Have directions and warnings that mimic FDA-approved products
Vacuum Erection Device
A vacuum device improves firmness by boosting blood flow to the penis. About 80% of men who use the device correctly get an erection hard enough for sex. They’re often used for penis rehabilitation, usually after prostate surgery. Your doctor will put you on a regimen designed to restore normal blood flow to the penis. This will allow you to get a spontaneous erection.
It may take several months to see results.
Vacuum erection device, also called vacuum constriction devices, are made of three parts:
- A clear, plastic tube that slides over the penis
- A manual or battery-operated pump that sucks air out of the cylinder, sending more blood to the penis
- An elastic ring that is placed around the base of the penis after an erection is obtained. It’s like a rubber band. It helps maintain firmness by preventing blood from draining out of the penis. If you have venous leak syndrome, this may help you.
A vacuum device can be cumbersome. It also will hinder spontaneity. The elastic ring may lead to skin irritation, bruising, loss of feeling or sensitivity, or pain.
Vacuum devices are available with or without a prescription. Talk to your doctor before getting one.
If all other ED treatments have failed, your doctor may recommend surgery.
The operations are:
- Placement of an implant (prosthesis) in the penis
- Vascular reconstruction surgery to improve blood flow to or reduce blood leakage from the penis and surrounding structures. This procedure works in very few cases.
Implants, or prostheses, help restore firmness for many men with ED. There are two types:
Malleable implants are a pair of bendable rods placed inside the penis. You manually move your penis, and therefore rods, into a position suitable for sex. Such implants do not affect penis size.
Inflatable implants are a pair of tubes placed in the penis and connected to a squeezable pump inside the scrotum. You squeeze the pump to get an erection. Inflatable implants can also help slightly increase length and width.
Once you have a penile implant, you must always use it to get an erection.
Implants may cause infection. If you have a urinary tract infection, skin infection, or systemic (body-wide) infection, you shouldn’t get one
- It may auto inflate.
- The device may break down.
- The pump may shift.
Implants also make it more difficult to do surgery for an enlarged prostate, bladder cancer, or other urological conditions.
Vascular reconstruction surgery can:
- Repair blood vessel blockages to improve blood flow to the penis
- Block veins to prevent blood from leaking out of the penis
Blood vessel repair is best for men with a small blockage. It usually doesn’t work well for men who have more widespread blockages.
Other medications for erectile dysfunction include:
With this method, you use a fine needle to inject alprostadil (Caverject Impulse, Edex) into the base or side of your penis. In some cases, medications generally used for other conditions are used for penile injections on their own or in combination. Examples include papaverine, alprostadil and phentolamine. Often these combination medications are known as bimix (if two medications are included) or trimix (if three are included).
Each injection is dosed to create an erection lasting no longer than an hour. Because the needle used is very fine, pain from the injection site is usually minor. Side effects can include mild bleeding from the injection, prolonged erection (priapism) and, rarely, formation of fibrous tissue at the injection site.
Alprostadil urethral suppository.
Alprostadil intraurethral (Muse) therapy involves placing a tiny alprostadil suppository inside your penis in the penile urethra. You use a special applicator to insert the suppository into your penile urethra.
The erection usually starts within 10 minutes and, when effective, lasts between 30 and 60 minutes. Side effects can include pain, minor bleeding in the urethra and formation of fibrous tissue inside your penis.
Some men have erectile dysfunction that might be complicated by low levels of the hormone testosterone. In this case, testosterone replacement therapy might be recommended as the first step or given in combination with other therapies.
Penis pumps, surgery and implants
Penis pumps. A penis pump (vacuum erection device) is a hollow tube with a hand-powered or battery-powered pump. The tube is placed over your penis, and then the pump is used to suck out the air inside the tube. This creates a vacuum that pulls blood into your penis.
Once you get an erection, you slip a tension ring around the base of your penis to hold in the blood and keep it firm. You then remove the vacuum device.
The erection typically lasts long enough for a couple to have sex. You remove the tension ring after intercourse. Bruising of the penis is a possible side effect, and ejaculation will be restricted by the band. Your penis might feel cold to the touch.
If a penis pump is a good treatment choice for you, your doctor might recommend or prescribe a specific model. That way, you can be sure it suits your needs and that it’s made by a reputable manufacturer.
Penile implants. This treatment involves surgically placing devices into both sides of the penis. These implants consist of either inflatable or malleable (bendable) rods. Inflatable devices allow you to control when and how long you have an erection. The malleable rods keep your penis firm but bendable.
Penile implants are usually not recommended until other methods have been tried first. Implants have a high degree of satisfaction among men who have tried and failed more-conservative therapies. As with any surgery, there’s a risk of complications, such as infection.
Recent studies have found that exercise, especially moderate to vigorous aerobic activity, can improve erectile dysfunction. However, benefits might be less in some men, including those with established heart disease or other significant medical conditions.
Even less strenuous, regular exercise might reduce the risk of erectile dysfunction. Increasing your level of activity might also further reduce your risk.
If your erectile dysfunction is caused by stress, anxiety or depression — or the condition is creating stress and relationship tension — your doctor might suggest that you, or you and your partner, visit a psychologist or counselor.
Before using any supplement, check with your doctor to make sure it’s safe for you — especially if you have chronic health conditions. Some alternative products that claim to work for erectile dysfunction can be dangerous. The Food and Drug Administration (FDA) has issued warnings about several types of “herbal viagra” because they contain potentially harmful drugs not listed on the label. The dosages might also be unknown, or they might have been contaminated during formulation.
Some of these drugs can interact with prescription drugs and cause dangerously low blood pressure. These products are especially dangerous for men who take nitrates.
New Ed Treatments
Future treatments for erectile dysfunction focus on providing medicationsthat are more effective, work rapidly, and have fewer, if any, side effects than currently available treatments. Currently there are five oral drugs available to treat ED — Cialis, Levitra, Stendra, Staxyn, and Viagra. A number of pharmaceutical companies are researching new treatments for ED, and many new options may be just around the corner. These include:
Uprima: Uprima (apomorphine) comes in a tablet form that dissolves under the tongue. Uprima works by stimulating the brain chemical dopamine, which heightens sexual interest and sensations. Its major side effects are nausea and vomiting. Additionally, a small number of people passed out after taking Uprima. Therefore, its release in the U.S. is on hold. It is currently available in Europe. Clinical trials are also currently being conducted on a nasal spray form of this drug, which may cause less nausea.
Topiglan: Still under investigation, a cream applied to the penis called topiglan uses the same drug (alprostadil) that is injected and also used in suppositories to treat ED. If topiglan proves to be safe and effective, it is still not entirely clear which patients would benefit from its application and whether patients on injection and suppository therapy would no longer have to use these techniques.
Melanocortin activators: These are drugs that appear to act through the central nervous system (for example, the brain). They have been shown in animal studies to produce an erection. Initial studies in humans suggest that the drug (PT-141) can be effective if given intranasally (through the nose) in men with nonmedical (psychological/emotional) rather than physical causes of ED and mild to moderate ED. Larger studies will be necessary to demonstrate the safety and overall effectiveness of these drugs.
Gene therapy: This novel therapy would deliver genes that produce products or proteins that may not be functioning properly in the penile tissue of men with ED. Replacement of these proteins may result in improvement in erectile function. Experimental animal models have demonstrated improvement in erectile function with gene therapy. Human studies may also demonstrate success with this therapy. Gene therapy may take a long time for regulatory approval and public acceptance.
Natural Treatments for ED
Called the herbal Viagra, Panax ginseng (red ginseng) has solid research behind it. Researchers reviewed seven studies of red ginseng and ED in 2008. Dosages ranged from 600 to 1,000 milligrams (mg) three times daily. They concluded there was “suggestive evidence for the effectiveness of red ginseng in the treatment of erectile dysfunction.”
More current research is examining how red ginseng influences ED. Ginsenosides are one element present in Panax ginseng extract that have action at the cellular level to improve erection.
The action of Panax ginseng appears to be most effective for those with high lipids in their blood and metabolic syndrome. This herb is known to have anti-inflammatory action, improve lung function, and improve blood flow in other diseases — all characteristics that may reduce ED.
One small study indicated that Rhodiola rosea may be helpful. Twenty-six out of 35 men were given 150 to 200 mg a day for three months. They experienced substantially improved sexual function. This herb has been shown to improve energy and reduce fatigue. More studies are needed to understand action and ensure safety.
Dehydroepiandrosterone (DHEA) is a natural hormone produced by your adrenal glands. It can be converted to both estrogen and testosterone in the body. Scientists make the dietary supplement from wild yam and soy.
The influential Massachusetts male aging study showed that men with ED were more likely to have low levels of DHEA. In 2009, 40 men with ED participated in another study in which half receiving 50 mg DHEA and half receiving a placebo once a day for six months. Those receiving the DHEA were more likely to achieve and maintain an erection. More recently, DHEA has been identified as an option for treatment of ED for men with concurrent diabetes. ED commonly affects these men because of hormonal issues as well as diabetes complications that interfere with blood flow to organs.
L-arginine is an amino acid naturally present in your body. It helps make nitric oxide. Nitric oxide relaxes blood vessels to facilitate a successful erection and is essential for healthy sexual functioning. Researchers studied the effects of L-arginine on ED. Thirty-one percent of men with ED taking 5 grams of L-arginine per day experienced significant improvements in sexual function. A second study showed that L-arginine combined with pycnogenol, a plant product from tree bark, restored sexual ability to 80 percent of participants after two months. Ninety-two percent had restored sexual ability after three months.
Another placebo-controlled study found that L-arginine in combination with other medications was well-tolerated, safe, and effective for mild-to-moderate ED.
Though studies are mixed, many show positive results when acupuncture is used to treat ED. A 1999 study, for example, found that acupuncture improved the quality of erections and restored sexual activity in 39 percent of participants. A later study published in 2003 reported that 21 percent of ED patients who received acupuncture had improved erections. Other studies have shown conflicting results, but this treatment has potential and may work for you.
The risks of acupuncture are low if provided by a licensed acupuncturist. Acupuncture shows promise for treating ED, but more studies are needed.
This supplement is extracted from the bark of the African yohimbe tree. Some studies have shown positive effects on sexual performance with use of this drug.
However, the American Urological Association doesn’t recommend yohimbe as an ED treatment. This is because there’s not a lot of evidence proving it works. Its side effects might be damaging to health. These include increased blood pressure and heart rate, irritability, and tremor.
If you decide you want to try yohimbe, be sure to talk to your doctor beforehand.
A vacuum erection device is a plastic tube that slips over the penis, making a seal with the skin of the body. A pump at the other end of the tube creates a low-pressure vacuum around the erectile tissue, which results in an erection. An elastic ring is then slipped onto the base of the penis. This holds the blood in the penis (and keeps it hard) for up to 30 minutes. With proper training, 75 out of 100 men can get a working erection using a vacuum erection device.
Drugs known as PDE-5 inhibitors relax muscle cells in the penis and increase blood flow. (These are the drugs you often see on TV and in Internet ads.)
- Viagra® (sildenafil citrate)
- Levitra® (vardenafil HCl)
- Cialis® (tadalafil)
Men with ED take these pills before having sex. The drugs boost the natural signals that are generated during sex to help you have a better erection that lasts longer. The drug works by relaxing the muscle cells in the penis, letting the blood flow better to give a firm erection. These drugs often work well, and nearly 80 out 100 men show improvement once they start using them.
The side effects of PDE-5 inhibitors are mild and often last just a short time. The side effects also get weaker the longer you use the drug. The most common side effects are:
- Stuffy nose
- Muscle aches
In rare cases, sildenafil can cause blue-green shading of vision that lasts for a short time. There is no long-term risk and the problem goes away as the amount of the drug in the body lowers. It is important to follow the instructions for taking this drug to get the best results.
If you are taking nitrates for your heart, you should speak with your health care provider before using a PDE-5 inhibitor to learn how it might affect your health.
Drugs in the Penis
If oral drugs don’t work, another drug, alprostadil, is approved for use in men with ED. This drug comes in two forms, depending on how it is to be used:
- Self-Injection Therapy
- Medical Injections for Impotence
The drug is injected into the side of penis with a very fine needle. The success rate for getting an erection firm enough to have sex is as high as 85%.
- Intraurethral Therapy
- Transurethral Therapy for Impotence
A tiny medicated pellet of the drug is placed in the urethra (the tube that carries urine out of your body). Using the drug this way avoids having to give yourself a shot, but makes it less likely to work.
The most common side effects of alprostadil are a burning feeling in the penis, and an erection that can last for over four hours and need medical attention to make it go down.
When other treatments do not improve ED, your health care provider may offer you surgery. Surgeries that help treat ED are penile implant surgery and surgeries to fix problems with blood vessels in the penis. Fixing blood vessels only helps in very specific cases.
Penile implants (also called penile prostheses) are devices that are placed completely inside your body. They produce a stiff penis that lets you have normal sex. Penile implants are a good treatment choice for some men. There are two types of penile implants.
The simplest kind of implant consists of 2 easy-to-bend rods that are most often made of silicone. These silicone rods give the man’s penis the firmness needed to have sex. The implant can be bent downward for peeing or upward for sex.
Penile Pump Implant – Inflatable
With an inflatable implant, fluid-filled cylinders are placed lengthwise in the penis. Tubing connects these rods to a pump that is placed inside the scrotum (the sac that holds the testicles). When the pump pushes fluid into the cylinders, they make the penis hard. Inflatable implants are the most natural feeling of the penile implants, as they let you control firmness and size.
In the simplest inflatable implants, the pump moves a small amount of fluid into the cylinders for erection then out again when erection is no longer needed. These devices are often called 2-part (or 2-component) penile implants. One part is the paired cylinders and the second part is the scrotal pump.
A 3-part inflatable penile implant has paired cylinders, a scrotal pump, and a fluid reservoir in the belly. With these three-part devices, a larger volume of fluid is pumped into the cylinders for erection and out of the cylinders when erection is no longer needed.
What is the Surgery Like?
Penile implants are usually placed under anesthesia, during a 1-hour surgery. Usually 1 small surgical cut is made either above the penis where it joins the abdomen or under the penis where it joins the scrotum. No tissue is removed, blood loss is small and blood transfusion is almost never needed. A patient will usually spend 1 night in the hospital for observation.
Most men have pain after the surgery for about 4 weeks. During this time, oral pain medicine is needed and you are not allowed to drive. If men limit their physical activity while pain is present, the pain usually ends sooner. Men can often be taught how to use the prosthesis for sex 1 month after surgery, but if there is still pain and soreness this may be delayed for another month. If there is an infection, or the implant fails to work, it will usually have to be removed. On rare occasions, the device can cause pain or reduced feeling. It is important to know that after an implant is placed, other non-surgical treatments will no longer work if that prosthesis is removed. Fortunately, most men with penile implants and their partners say that they’re satisfied with the results.
Penile Arterial Revascularization
Young men (under 45) who have had injuries to the pelvis or penis are most likely to be helped by this treatment. This surgery fixes problems with blocked or injured blood vessels in the penis. It may help in rare cases. It is mostly considered for men with no known risk factors for hardened arteries. When an accident leaves a penile vessel too injured or blocked to carry blood, the surgeon may connect to a nearby artery to get around the site. This can clear a pathway so enough blood can be supplied to the penis to cause an erection.
Venous Ligation Surgery
This procedure binds leaky penile vessels that cause the penis to soften during an erection. Because proper firmness depends on blood flow through the arteries and relaxation of the spongy tissue in the penis, blocking off leaky veins makes sure there is enough blood trapped in the penis to create a good erection. Since long-term success rates are less than 5%, this technique is rarely a choice for correcting ED.
Vascular surgeries are still thought of as experimental by some, and may not be covered by your health plan.
Neither the penile arterial revascularization or venous ligation surgeries are recommended if you use tobacco or have:
- insulin-dependent high blood sugar
- widespread hardened arteries
- high blood serum cholesterol levels
- injured nerves
- diseased and/or wide-spread damaged blood vessels
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