ERECTILE DYSFUNCTION 

ERECTILE DYSFUNCTION 

Erectile dysfunction or ED (also known as impotence) is when a man cannot achieve or sustain an erection for sexual intercourse. This can be:

• a total inability,

• inconsistent ability, or

• a tendency to sustain only brief erections.

At least 50% of men over the age of 50 experience some loss of function. Despite being a common male condition, it is not normal, no matter how old you are.

Only 10% of men seek treatment and many discontinue treatment once they start it because they are too embarrassed to discuss their sexual health issues with a doctor. There is no need to suffer in silence.

Our staff understands your sensitivities related to ED. We develop treatment plans customized for your needs to help you get your sexual function back.

CAUSES OF ED

An erection occurs when blood flows into the corpora cavernosa (erection bodies) and gets trapped there. If the blood has problems getting to or staying in those erection bodies, you may have erectile dysfunction.

There are many potential causes for erectile dysfunction, such as these conditions/circumstances:

-Vascular conditions:

• • High blood pressure

  • Elevated cholesterol

  • Cardiovascular disease

-Diabetes

-Trauma:

• • Spinal cord injury

  • Pelvis injury

-Neurologic disease:

• • Stroke

  • Parkinson’s disease

  • Alzheimer’s disease

-Radiation to the pelvis for cancer

-Endocrine:

• • Hypogonadism (low testosterone)

  • Hyperprolactinemia (high prolactin levels)

-Pelvis surgery:

• • Radical prostatectomy (a surgical procedure for the partial or complete removal of the prostate)

  • Surgeries for rectal cancer or bladder cancer

-Medication side effects:

• • Antidepressants

  • Antihypertensive (high blood pressure medicine)

  • Antiandrogens (testosterone blockers)

  • Antiarrhythmics (heart rhythm medicine)

-Alcohol

-Cigarette smoking

-Cocaine and marijuana

TREATMENT OF ERECTILE DYSFUNCTION 

There are many treatments for erectile dysfunction, such as:

• Pills

• Injections

• Vacuum Devices

• Shockwave Therapy

Surgery provides the only true cure, but men typically want to explore other, less invasive options first.

ED Pills

Currently, three pills (Viagra/sildenafil, Levitra/vardenafil, Cialis/tadalafil) are available and FDA-approved for erectile dysfunction. They are all called phosphodiesterase inhibitors, which means they act by blocking a chemical that stops erections.

Viagra was introduced in 1998 (the others in 2003) and revolutionized the way that men and their partners looked at ED.

Using ED Medications

Keep in mind that these medications are amplifiers, not magic pills; you must have sexual stimulation for them to work. These pills also typically do not work the first few times. Here are instructions for how to properly take Viagra, Levitra, or Cialis:

• Take your medication one hour before sexual activity.

• Take the pills prior to a meal or after a light snack, especially for Viagra. They do not absorb well if you have a full stomach.

You’ll need to take these pills at least four times before deciding if they work for you or not. 

ED Medications Side Effects

As with any medication, these medications do have side effects including:

• headache,

• facial flushing,

• upset stomach,

• back pain (Cialis),

• sensitivity to light, or

• blurry vision.

Do NOT take these medications if you are on nitroglycerin, taking medications with nitrates, or even have nitroglycerin at home. Ask your doctor if you have any questions about this.

These medications do NOT protect you against sexually transmitted diseases.

You must remember that these are prescription-only medications. Do NOT share these medications with your friends or family as they may have medical conditions that would prevent them from taking this medicine. 

ED Injections

You can also inject drugs directly by inserting a tiny needle into the penis. Several drugs and drug combinations are available, including alprostadil (Edex, Caverject), phentolamine, and papavarine (usually given in combination as Bimix or Trimix).

You can usually get an erection within five to 10 minutes of injecting this medicine. Your erection should last between 20 minutes to an hour.

Injections do require training and it may be tricky to get the right dose initially. We always do the first injection in the office to show you how to do it and to give us a good idea about the proper dose. Our patients are usually anxious about injecting their penis but are almost always surprised by how painless the process is.

Pros

• Very effective (85%)

• Mimics normal erection

• Discreet

Cons

• Risk of prolonged erection (Priapism)

• Risk of penile scarring

• Pain with injection (usually mild)

• Bruising or bleeding

• Hard to use if have tremor or poor vision or severe obesity

• Poor long-term satisfaction (less than 40%)

Although injections often work well, we don't recommend long-term use.