Over recent years a greater understanding has evolved about ED and its possible association with other underlying disease processes, such as diabetes and vascular disease. Once a thorough evaluation has been completed, the next step in deciding on a treatment plan that best suits you.
I view the treatment of ED as having 3 layers. The first and simplest is attempting oral medications. We have a number now available, such as Viagra, Levitra, Cialis, Staxyn, and Stendra. It is important to understand that these medications can help facilitate but do not cause erections.
The second layer of treatment options can directly cause erections.
- One is the vacuum erection device (VED). This is a cylindrical tube that is placed onto the penis. A pump (handheld or electronic) is activated to create a vacuum which engorges the penis and results in an erection. Constricting bands (thick rubber bands) are placed at the base of the penis to prevent an outflow of blood. Side effects can include bruising of the penis, pain, and a sense of numbness.
- Medicated urethral system for erections (MUSE) requires implantation of a pellet of alprostadil into the urethra (pee channel). Intracavernosal injections (ICI) are direct penile injections of medications that cause dilation of blood vessels resulting in an erection. Among the side effects is priapism, a prolonged and painful erection that requires immediate medical attention. Pain, bruising, and scar tissue formation can also occur.
Lastly, we have the option of an inflatable penile prosthesis (IPP). This option is typically met with a healthy degree of skepticism when first discussed. However, most men who have an IPP placed are very happy that they did so. In fact, patient and partner satisfaction surveys exceed 85 to 90%. It is important to understand that this is a surgical procedure and once placed natural erections will no longer occur. Instead, a pump, which is placed in the scrotum, is used to inflate the penis whenever sexual activity is desired. Sensation, orgasm, and ejaculation all occur in an un-altered fashion. When the device is no longer needed, the pump is used to deflate the device until the next time. The implantation is done as a same day surgery but it is not activated until after 4 to 6 weeks of recovery. Key risks include bleeding and infection. Your Urologist can review the procedure in more detail so you can decide if such a surgery is right for you.
The take home message should be that there are many treatment options available to men who suffer from ED. The first step is to discuss this problem with your healthcare provider so he or she knows about it and can get you started on your road to recovery.