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Impotence

How Is Erectile Dysfunction Treated?

Tuesday, April 10, 2012 - 16:45

Contributing Author: Guy Slowik FRCS

Men who experience erectile dysfunction have never had so many treatment options. Various therapies are available to successfully treat underlying physical causes and related emotional difficulties.

When the medication Viagra was recently introduced to the market, it was perceived by many to be a "cure-all" for erectile dysfunction. ButViagra is not for everyone. Here is why other therapies are important:

  • In some cases, simple lifestyle changes may be all that is necessary.
  • Some men, such as those with a heart condition, cannot takeViagra and need other options.
  • Erectile dysfunction may be linked to deeper emotional or relationship issues that would require counseling in order to address the underlying cause.

A doctor will decide on treatment based on what is causing the erectile dysfunction.

  • The first line of treatment for many men involves lifestyle changes.
  • Next, the doctor may prescribe Viagra or another medication and may also recommend counseling for the man and his partner.
  • If a man is unable to take medication, or if the medication is not effective, the doctor may suggest injections into the penis, or vacuum devices.
  • If a man has a severe blood vessel disorder, surgery may be considered.
  • Implants are generally the last line of treatment.

Treatment options include:

Lifestyle Changes

Cutting down on smoking, alcohol consumption, and drug abuse should be among the first lines of treatment, as they can affect potency. In addition, men can develop erectile problems as a side effect of medication they are taking for an unrelated condition. They may benefit from reducing the dose of the drug or changing to another drug that has the same result but not the same side effects.

Sex Therapy And Counseling

The focus of therapy is to educate a man and his partner, correct false beliefs, and improve the couple's communication skills. Sex therapy needs commitment and the involvement of a cooperative partner. It can take time.

The counseling sessions may involve therapeutic tools that include:

  • Various exercise to help couples explore each other's body, share their feelings, and experience pleasures they can enjoy together without erections, orgasms, or intercourse being the focus of attention. These exercises are designed to ease tension, relieve performance pressure, and break the circle of failure.
  • The "ladder concept," which focuses on men's and women's sexual response over seven different stages, with erection as only one of those stages. This serves to take the mind off erections and to concentrate on other aspects of sexual relations.
  • Redefinition of "success." Unrealistic or unreachable goals can only lead to failure. If success is redefined in terms of pleasure and fun rather than performance, the couple can recapture a successful relationship.

Viagra

Viagra has been hailed as a "wonder drug" in the treatment of erectile dysfunction, although it isn't for everyone. Viagra is the brand name of a drug called sildenafil and has been approved by the U.S. Food and Drug Administration (FDA). It works by increasing the activity of a chemical in the penis called nitric oxide, which increases blood flow and creates an erection. Viagra must be combined with sexual activity (foreplay) in order to work properly.

Viagra is available by prescription only and comes in three dosages (25 mg, 50 mg, and 100 mg). Your doctor may want you try several dosages in order to find the right one for you. The tablet is taken one hour before sexual activity.

Side effects of Viagra are generally mild and may include headaches, hot flashes, heartburn, diarrhea, and dizziness. It also can cause increased sensitivity to light or a minor change in your vision that may temporarily prevent you from distinguishing the color blue from green.

Need To Know:

Men who take nitroglycerin for a heart condition (as either tablets, spray, or patches) should NOT take Viagra. The two medicines, when combined, can cause a significant lowering of blood pressure. Some men have died from combining Viagra and nitroglycerin.

Other Medications

  • Uprima is a different drug for erectile dysfunction that has recently been approved by the FDA. It acts on the central nervous system and in the brain. It facilitates erections within 30 minutes.Uprima must be combined with sexual activity (foreplay) to work properly.

    Uprima is available by prescription only and comes in two doses (2 mg and 4 mg). It may require several different doses before the right dose is identified. Side effects of Uprima are mild and infrequent, and include nausea, headache, dizziness, and, rarely, fainting.

  • If your testosterone level is low, testosterone medication is available to restore the testosterone to adequate levels which may be helpful in improving erections. An adequate level of testosterone in the blood is normally needed to get an erection. These medicines are available in pill form or as an adhesive patch that you wear on your skin. Some patches are designed to be worn on your scrotum (testosterone absorption is greater through scrotal skin), while others can be worn elsewhere on your body.

    A new gel is available that can be applied daily to increase testosterone levels. This gel works like the testosterone patch, in which the medication is absorbed through the skin into the body.

  • Yohimbine is a drug that has been used as an aphrodisiac for many years. Given at the right dose, it can enhance erections and increase sexual interest. It must be given under close medical supervision, however, as it could interact with other drugs and cause severe side effects.
  • A new gel is available that can be applied to the penis to help impotent men have an erection. The gel contains a hormone-like substance called alprostadil and an agent known as SEPA that helps deliver the alprostadil through the skin of the penis. However, many users experience an uncomfortable sensation, and the potential effects of the gel on female partners are unknown.
  • MUSE is a system to insert alprostadil as a suppository into the urethra of the penis with a plastic applicator. The alprostadil is absorbed into the penis and can cause an erection.

Intracavernous Injections (Injections Into The Penis)

Intracavernous injections are a fast and effective means of restoring an erection. Medications such as alprostadil are injected into the spongy tissue inside the penis. These medications act by releasing chemicals in the penis that cause increased blood flow and accumulation at a high pressure, which makes the penis larger and rigid.

The hardness and duration of the erection produced by these drugs depends on the choice of the drug and the dose. After a few chemically induced erections, many men find they can achieve erection again without the medication. Others may find they only are able to function with the injections, but are pleased to have something that will always work.

The doctor gives the first few injections, but men are taught later how to inject themselves at home. Most describe the discomfort from the injection as mild.

The only significant side effect, which is rare, is an erection that lasts for too long (the medical term for this is priapism). This is a serious condition that requires immediate medical attention. Immediate treatment is to apply ice for about 10 minutes to the inner thighs to help reduce the blood flow. Otherwise it can be successfully treated at the hospital with medication and by draining excess blood from the penis.

Nice To Know:

Injections work best for men with erectile dysfunction due to:

  • Psychological factors, such as the vicious circle of failure
  • Neurological problems, such as diabetes or multiple sclerosis
  • Vascular problems, such as high blood pressure
  • Surgery, such as prostate surgery or colostomy

Vacuum Devices

Mechanical devices are available to stimulate the natural mechanism of erection by creating a vacuum to suck the blood inside the penis, then putting a rubber constriction band around the base of the penis to stop blood from leaking out. Vacuum devices appeal to men who do not want to take oral or injected medicine. However, the erection produced by these devices can be of poor quality and flaccid at the base. In addition, the sensation felt by the man during intercourse and ejaculation can be reduced.

Surgery

In men with narrowing of the arteries to the legs, the blood supply to the penis may also be affected. Surgery may help. The choice of procedure depends on various factors. A bypass operation, similar to that used in heart surgery, can provide extra blood supply to the penis and restore potency.

Implants

In men who are not helped by other treatment options, implants can be placed in the penis. Implants are surgically placed inside the spongy cylinders of the penis. There are two main types:

  • A semi-rigid implant is made of two silicone rubber rods, with a firm shaft and a flexible base. It gives a permanent erection, but the flexible part makes it possible to bend it between the legs when an erection is not needed.
  • An inflatable implant is a more complicated device. Fluid is pumped from a reservoir into two inflatable cylinders that have been surgically inserted in the erectile bodies of the penis. This implant produces an erection similar to a naturally occurring erection with normal sensation and normal appearance. The penis can be made flaccid again by releasing the fluid back to the reservoir. These devices are very reliable, and satisfaction rates exceed 90 percent.

With the advent of newer medications for ED, implants are not as widely used today. But they remain a viable option for men whose erectile dysfunction is a long-term condition (for example, as a complication of prostate surgery).

As with any surgical procedure, infection can be a problem. Sometimes, a low grade infection persists, which causes discomfort, but may respond to antibiotics. Otherwise the implant needs to be replaced, which is quite a complicated procedure, but does have a high success rate.

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