What Is ED?
Naturally, all medical conditions should be discussed privately with your health care provider. We are just discussing a few suggestions about erectile dysfunction treatment. These will be the first steps for you to take to your provider for expounding on further detail.
What Do You Want To Achieve With Erection?
The first question is – what do you want to achieve that erection? Is it for better sex drive, better sexual gratification, closer intimate relationships? That’s one of the first questions that we ask of our patients who want to improve their sexual function.
The first thing you have to know is the definition of erectile dysfunction. Many people confuse other terminology, such as curvature of the penis, low sex drive, premature ejaculation. While all of those may play a part in erectile dysfunction, the keyword is “repeated.”
So, erectile dysfunction is the repeated inability to have sexual performance that gratifies both partners of the couple. It’s usually happening as men get older, sometimes associated with medical conditions such as diabetes, high blood pressure, and other medical conditions.
How Does Erections Start?
There are two basic principles. You have to have adequate blood flow that goes into the penis, and you also have to have occlusion of the vein. So it does not let that blood flow get out. Any malfunction between the blood flow going into the penis or too much blood leaving the penis in the veins can lead to erectile dysfunction or inability to maintain an erection.
Some causes of ED may be obesity, smoking, drinking, sleep apnea. Simple remedies can fix a lot of these things to improve erections. For example, smoking constricts the blood vessels in the penis. Just stopping smoking can improve erections within a 12 to 24 month period without taking anything else.
Obesity can decrease testosterone, a necessary ingredient for good erectile function and libido. Losing weight, exercising, eating the right foods can lower obesity. This way, you will have a more significant amount of testosterone in the circulating system.
Some people have been concerned that testosterone supplementation can lead to a stroke or heart attack. The data shows that there’s no strong correlation between those occurrences and testosterone. However, it may suppress your fertility. For young men who want to take testosterone supplementation, please discuss that with your clinician or your health care provider first.
Is Erectile Dysfunction a Barometer for Health?
We know that if the blood vessels of the penis are not getting adequate blood flow, could that also suggest that blood vessels in other parts of the body are not getting enough blood flow? That’s why, depending upon other medical comorbidities in the patient, we will refer them to a cardiologist to ensure that in addition to treating erectile dysfunction, we’re making sure that no other disease processes are going on.
Treatment Options
When a typical patient comes into our office, we assess if there is low, intermediate, or high medication risk. Depending on which category they fall into, we will determine how the type of treatment.
ED Medications
Many of you have heard the medications such as Viagra (Sildenafil), Cialis (Tadalafil), Levitra (Vardenafil). These drugs are smooth muscle vessel dilators. Their action allows blood to go into the blood vessels of the penis to get sufficient erection.
You can buy them from your local pharmacy or order online, which is probably not the best thing. There have been some instances of drugs that weren’t quite as strong or not quite mixed properly. Or not good manufacturers. We suggest you buy Viagra or Cialis from a standard regular pharmaceutical company interaction, using your physician writing the prescription.
Sildenafil, Tadalafil, and Vardenafil are very safe for erectile dysfunction treatment. The side effects are minimal and mild.
It would be best to avoid stuff like yohimbine and testosterone supplements that you see over the counter and on the Internet. If it’s too good to be true, then it’s too good to be true. Stick with the erectile dysfunction drugs with proved efficiency.
If medications do not work for patients, we look at other factors.
- Are they still smoking or drinking?
- Is their diabetes out of control?
- Are there other factors going on that could affect the blood flow in the penis?
These are all things that can affect the efficiency of the medication.
Sometimes one treatment, such as pills, may have a suboptimal or less than optimal benefit. Another treatment also may be suboptimal. When we put them together in combination therapy, the patient gets excellent satisfaction because they are better than either alone.
However, you, as the patient, also have your role. You can eat a better diet, stop smoking, and better control your blood pressure and diabetes. You can lose weight and exercise. All these corrections in the behavior modification can help the medications and other treatments work more effectively.
Vacuum Pump
The vacuum device is a device used to create an erection through an external suction. When you apply the vacuum pressure, it creates suction inside the tube. When your penis is in there, it causes the blood to rush into your penis and becomes engorged.
After the penis becomes fall, we flip one of the bands back on the base of the penis to trap the ball in the penis so that the man can have sex.
The vacuum constriction device is a non-invasive treatment that works if the patient is adequately trained. It takes proper training to use the tool because it is tricky. However, about 85 to 90 percent of the men get rid of erectile dysfunction with a vacuum pump.
As you can see, it can be a little cumbersome. You do have to wear a band during sex. And those are some of the disadvantages to the vacuum device. However, every treatment has good and bad sides. The vacuum device has pros and cons, just like all treatments.
Intraurethral Suppository (MUSE)
MUSE stands for a medicated urethral suppository for erections. It is the intraurethral suppository that we stick right down the urethra to dilate blood vessels.
You tear open the packet, drop the applicator in your hand. The applicator has the drug already preloaded inside of it. After you urinate, you’re going to stick the applicator down the tip of your penis. Then push the button to drop the drug inside. The drug gets into your urethra.
When the drug gets into the wet urethra, you’re going to take out the applicator from the tip of your penis and roll the penis between your hands for about 10 to 30 seconds. We have patients doing it for about 30 seconds to make sure it’s good and dissolved in there.
Once that pellet dissolves, it will travel across the urethra, dilate the blood vessels and your penis will become engorged with blood.
The good thing is it’s easy and simple to use. The bad thing is it doesn’t work for everybody. About 45 percent or so of men will get an erection hard enough for sex.
It can also have some side effects like achy pain in the penis or achy feeling within the penis. It happens in about a third of the men who use the drug.
You can scratch yourself and get a little bleeding, but that probably won’t happen if you’re careful.
Lastly, you could get a drop in blood pressure, dizziness, lightheadedness.
We like to try the first dose of MUSE in the clinic to make sure your blood pressure is normal, and you don’t have any adverse side effects. And we can see how well it’s going to work for you in particular.
Penile Injections
Injections are a little bit more invasive. That is why you want to be very careful when injecting. You can do penile injection once in 24 hours max or three times a week maximum.
When you inject, you want to inject on the side of the penis along the shaft on either side at 10 o’clock or two o’clock.
You want to avoid visible veins and inject them directly into the tissue. The needle is thin and short, about a half-inch long. Most men do not find the procedure very painful at all. But you do have to give yourself an injection each time.
You want to follow the instructions very carefully with injections. You want to clean the skin carefully and give it exactly where we described above.
If you haven’t tried injections yet, you can have about an hour visit with one of our providers. We’re going to go through, step by step, the entire process with you carefully. You’ll do your first injection in the office because we want to see how well it works and if you have any side effects.
Sometimes side effects can occur, with pain being the most common. Bleeding is the second most common adverse reaction.
You want to press over the injection site tightly for about three to five minutes after the injection, even if you don’t see blood to help prevent bruising or trauma.
You can also get more severe side effects that aren’t very common but can happen. One is scarring on the penis. Scarring on the penis can cause curvature. You can have a slight curve or you can have a more significant curve of the penis. This doesn’t happen commonly. It probably happens in about one out of ten men. However, if it happens to you, it can be something that can be very problematic for sexual relations, and it can be permanent.
Another uncommon side effect that’s more serious is priapism. A priapism is an erection that will not go away. It is an unbendable erection for several hours. That blood trapped in your penis can cause damage. We need blood and nutrients to move in and out of the penis for the tissue to remain healthy. If the blood’s trapped in there for too long from an erection that won’t go away, it can cause permanent tissue damage. This situation is considered a medical emergency. You have to seek medical help or go to the emergency room to have that situation.
The most common FDA version you get at a regular pharmacy near your home is Caverject or Edex. These manufacturers have made these penile injections FDA approved and available at your pharmacy through a prescription.
The good thing about that is if your insurance were going to cover one of the medications, it’s more likely to cover this FDA approved version.
Surgery
If patients don’t like to inject themselves or put a suppository into the urethra, surgical treatments are available. Using inflatable penile prosthesis or semi-rigid prosthesis gives the patient the sensation and the ability to penetrate. It will not necessarily increase orgasm or increase feeling, but it’s a purely mechanical device that allows adequate penetration for the couple’s satisfaction. Some patients are curious about the surgical procedures that we can do for erectile dysfunction.
Inflatable penile prosthesis
It is an example of an inflatable penile prosthesis. You have two tubes that go into the shaft of the penis that fills up with water. They get that water from the reservoir, which is placed inside the body next to the bladder. The pump stays in the scrotum, which controls the inflation-deflation.
When you’re ready to inflate, you squeeze the pump’s bottom, and water is transferred. That makes the core properties get rigid. When you finish the act, you press another part of the pump to make it go off again.
Semi-rigid prosthesis
If patients cannot handle the inflatable prostheses, they can use a semi-rigid prosthesis. This device is much more like a gooseneck lamp, which goes inside the tubes of the penis. When you’re not using it, it’s bent down, and nobody knows that you have this.
You wear it in your penis under the underwear or clothes. And when you’re ready to have an erection, you just bend it up, and it stays rigid.
Both this and the semi-rigid will not make your penis any bigger or increase your sex drive, or increase sensation. It’s purely mechanical to maintain sufficient erection for penetration.
It would be best if you talk with your primary health care provider any time you use any medication like an oral pill, injectable agent, or even a vacuum pump. He evaluates the risks and benefits of each of these devices and drugs. That’s extremely important.
ED Treatment Summary
When a patient comes to our office, we think about what medications we can offer and what he can do to help the medication work better. When that doesn’t work, we go to stage two: injection therapy, vacuum pump therapy, or using suppositories in the urethra.
Lastly, when that doesn’t work, we talk about the surgery with either the inflatable penile prosthesis or the semirural prosthesis. You can discuss the benefits with our practitioner. You may feel and play with these devices to see what is best for you and your partner.
Viagra, Cialis, Levitra can save your marriage or make you a better husband. However, only using them in conjunction with good communication and a good, responsible way with your partner can lead to a better sexual outcome.
In summary, seek out your options with your health care provider, have realistic expectations. There is erectile dysfunction treatment out there, and we here to help.