Erectile Dysfunction

Erectile dysfunction (ED) or impotence is the inability of a man to achieve or maintain a firm erection long enough to have sex. Although erectile dysfunction is more common in older men, this common problem can occur at any age. Erectile dysfunction can cause stress and relationship problems and affect self-esteem.  Although ED can result from emotional issues it is now known that erectile dysfunction is more often caused by physical problems rather than by psychological ones.  Sometimes impotence is caused by an underlying condition such as heart disease. Thus it is very important to take erectile trouble seriously because it can be a sign of a more serious health problem.

Common causes of erectile dysfunction (impotence), include:

  • Heart disease
  • Clogged blood vessels (atherosclerosis)
  • High blood pressure
  • Diabetes
  • Obesity
  • Metabolic syndrome

Other causes of erectile dysfunction (impotence) include:

  • Certain prescription medications
  • Tobacco use
  • Alcoholism and other forms of drug abuse
  • Treatments for prostate cancer
  • Parkinson’s disease
  • Multiple sclerosis
  • Hormonal disorders such as low testosterone (hypogonadism)
  • Peyronie’s disease
  • Surgeries or injuries that affect the pelvic area or spinal cord
  • Depression
  • Anxiety
  • Stress
  • Fatigue
  • Poor communication or conflict with your partner

In addition to the patient’s history, several diagnostic tests can assist in the diagnosis of ED.  Ultrasounds can be performed on the penis to check for adequate blood flow during an erection.  Testing for nocturnal erections with a device termed “rigiscan” can also assist in diagnosing ED.  A thorough neurological exam will confirm whether sensations are intact.

Treatment of Erectile Fysfunction

Oral Medications.  Many patients are familiar with Viagra, Levitra and Cialis.  All three of these medications improve blood flow to the penis during an erection by dilating the penile arteries.  They have excellent success rates with minimal side effects.  As these medications have interactions with other prescription medications such as nitrates and prostate medications, they should only be taken under the supervision of a physician.

The medications do not automatically produce an erection.  They must be used in conjunction with stimulation.  All three medications vary in dosage, duration and side effects.  We would be happy to discuss the medications with you and determine which if any is right for you.

Intra-urethral Therapy.  Muse (alprostadil) is a small suppository that is inserted into the tip of penis.  The medication dissolves into the penile tissue and helps to promote an erection.  Varying doses are available.  Success rates are variable.  No needles are involved but the medication may cause discomfort in the urethra.

Injectable Therapy.  This treatment for ED is used in men who have failed oral medications, have known neurological conditions, advanced diabetes, previous pelvic surgery or several other conditions.  Medications can include alprostadil alone or alprostadil, papaverine and phentolamine triple therapy.  A fine needle is used to inject the medication directly into the base of the penis.  Erections occur within 5-15 minutes.  Erections last up to an hour.  This treatment is extremely effective and generally produces minimal discomfort as the needles used are extremely fine.

Penile Pumps.  This treatment option is most effective in men who have trouble retaining blood in their penis during an erection.  A hollow cylinder is placed over the penis.  Using a manual pump, air is evacuated from the cylinder causing an erection to occur.  A small rubber band is slipped around the base of penis to maintain the erection.

Penile Implants.  A plastic device is surgically inserted into the two cylinders of the penis that achieve an erection.  Either a semi-rigid device or an inflatable device can be inserted.  The device can be activated whenever the patient wants and remains activated for however long the patient likes.