What causes ED?
The most common causes of Erectile Dysfunction (ED) are physical and due to changes in the vasculature or nerves that supply the penis. This accounts for 90% of the cases of ED.
- Pelvic surgery
- Neurologic conditions
- Pelvic trauma
- Peyronie's Disease
- Hormone imbalances (including low testosterone)
The most common causes of ED are physical and due to changes in the vasculature or nerves that supply the penis. This accounts for 90% of the cases of ED.
Available Treatments for ED
Oral medications for ED are the most commonly used treatments. These drugs are all called phosphodiesterase type 5 inhibitors. They all work by the same mechanism to increase blood flow in the penis to improve erections. Most patients with ED will see improved erections with these medications. There are limitations for their use. People on nitrates for certain heart conditions cannot take this class of medication as it may cause an unsafe drop in blood pressure. You must also be healthy enough for sexual activity.
What if I have tried the pills and they did not help me?
With modern medical and surgical treatments there are few patients that we cannot restore erections adequate for a healthy sex life.
Treatments Beyond Pills
Vacuum Erection Device
The vacuum erection device is a pump that pulls blood into the penis using negative pressure to create an erection. With the penis erect a constriction ring can be placed that maintains the erection. The advantage of this device is that once it has been purchased there is no additional cost per use. The vacuum device can also be used after prostate surgery to exercise the penis maintaining penile length and girth.
Medicated Urethral Suppositories for Erection (MUSE)
MUSE is a small pill that is placed directly into the tip of the penis. This medication is absorbed through the urethra and induces an erection.
Penile Injection Therapy
There are several medications that can be injected directly into the penis to induce an erection. For many people that do not respond to any other treatments these medications provide a way to obtain natural erections. This therapy does require the patient or his partner to administer an injection, which for some people may be uncomfortable.
Some patients cannot tolerate medical treatments for ED or are dissatisfied with the results. There is another option. Surgical treatment for ED is with the placement of a penile prosthesis. Twenty to 30 thousand of these devices are implanted annually in the United States. These devices simulate a natural erection with the ability to inflate and deflate mimicking the penis's natural erect and flaccid states. Once in place the device is completely concealed and provides the ability to get an erection on demand that will last as long as you want it to.
Penile Prosthesis Benefits
- Erections obtained on demand
- No ongoing costs
- Natural feeling during intercourse
- Does not interfere with ejaculation or orgasm
Potential Risks of Prosthesis
- Mechanical failure: As with any mechanical device it may wear out.
- May get infected and need to be removed (< 1% of patients)
- May cause penile pain
- Perceived penile shortening