Treatment for Erectile dysfunction

Treatment options are based on the cause of ED. Discussing treatment options with your healthcare provider after the diagnosis and cause of ED is the first step. You healthcare provider may ask you to make lifestyle changes including exercising, particularly aerobic exercise, which can have an effective impact in preventing ED. Cessation of smoking, using drugs, and alcohol can result in significant improvement in symptoms. Counseling for depression, performance anxiety, emotional and relationship issues can be helpful as well.

Some of the options that your healthcare provider may discuss with you may include the following. Always discuss risk and benefits of each treatment option which is right for you with your healthcare provider:

  • Vacuum erection device
  • Oral drugs
  • Drugs in the penis
  • Surgery

Oral pharmacotherapy and vacuum erection devices are considered first-line treatment followed by injections and penile implants.

Oral Drugs

Drugs known as PDE-5 inhibitors relax muscle cells in the penis and increase blood flow.

  • Viagra® (sildenafil citrate)
  • Levitra® (vardenafil HCl)
  • Cialis® (tadalafil)
  • Stendra® (avanafil)

Oral drugs are typically taken 15 minutes to 60 minutes before having sex. These drugs stop the degradation of cGMP, which allows for increasing blood flow to the penis during sexual stimulation. The drugs boost the natural signals that are generated during arousal to help you have a firmer erection that lasts longer. These drugs often work well, and considered a first line agent for almost all men, unless contraindicated.

The side effects of PDE-5 inhibitors are mild and often last just a short time. The side effects also get weaker the longer you use the drug. The most common side effects are:

  • Headache
  • Stuffy nose
  • Flushing
  • Muscle aches

In rare cases, sildenafil can cause blue-green shading of vision that lasts for a short time. There is no long-term risk and the problem goes away as the amount of the drug in the body lowers. It is important to follow the instructions for taking this drug to get the best results.

If you are taking nitrates for your heart, you should speak with your health care provider before using a PDE-5 inhibitor to learn how it might affect your health.

Vacuum Erection Device

A vacuum erection device creates an erection by drawing blood into the penis by creating negative pressure in cylinder. These devices are used just prior to having sexual intercourse. A compression ring or band is used at the base of the penis to lock the blood to maintain an erection for up to 30 minutes. Vacuum erection device treatment option is over 90 percent effective in creating and maintaining an erection based on clinical trials.

Testosterone Replacement Therapy

Testosterone replacement therapy (TRT) could be an option your healthcare provider may consider for you if a blood test shows low testosterone levels (low T). However, adding TRT will not help your erection problems if you have normal testosterone levels. TRT are associated with potential increase in cardiovascular events.

Other Treatments :

Drugs in the Penis

If oral drugs don’t work, another drug, alprostadil, is approved for use in men with ED. This drug comes in two forms, depending on how it is to be used:

Self-Injection Therapy :

The drug injected into the side of penis with a very fine needle. The success rate for getting an erection firm enough to have sex is as high as 85%.

Intraurethral Therapy :

A tiny medicated pellet of the drug is placed in the urethra (the tube that carries urine out of your body). Using the drug this way avoids having to give yourself a shot, but makes it less likely to work.

The most common side effects of alprostadil are a burning or pain feeling in the penis, and an erection that can last for over four hours and need medical attention to make it go down.

Surgical Treatment

When other treatments do not improve ED, your health care provider may offer you surgery. Surgeries that help treat ED are penile implant surgery and surgeries to fix problems with blood vessels in the penis. Fixing blood vessels only helps in very specific cases.

Penile Prostheses :

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Penile implants (also called penile prostheses) is a permanent option for a man suffering with ED and offers concealed support for an erection whenever and wherever desired. Patients report 97% satisfaction rates with a penile implant. Penile implants are devices that are placed completely inside your body in an outpatient procedure. They produce a stiff penis that lets you have normal sex. Penile implants are a good treatment choice for some men. There are two types of penile implants.

Bendable Implant :

The simplest kind of implant consists of 2 easy-to-bend rods that are most often made of silicone. These silicone rods give the man’s penis the firmness needed to have sex. The implant can be bent downward for peeing or upward for sex.

Inflatable Implant :

With an inflatable implant, fluid-filled cylinders are placed lengthwise in the penis. Tubing connects these rods to a pump that is placed inside the scrotum (the sac that holds the testicles). When the pump pushes fluid into the cylinders, they make the penis hard. Inflatable implants are the most natural feeling of the penile implants, as they let you control firmness and size.

In the simplest inflatable implants, the pump moves a small amount of fluid into the cylinders for erection then out again when erection is no longer needed. These devices are often called 2-part (or 2-component) penile implants. One part is the paired cylinders and the second part is the scrotal pump.

A 3-part inflatable penile implant has paired cylinders, a scrotal pump, and a fluid reservoir in the belly. With these three-part devices, a larger volume of fluid is pumped into the cylinders for erection and out of the cylinders when erection is no longer needed.

What is the Surgery Like?

Penile implants are usually placed under anesthesia, during a 1-hour surgery. Usually 1 small surgical cut is made either above the penis where it joins the abdomen or under the penis where it joins the scrotum. No tissue is removed, blood loss is small and blood transfusion is almost never needed. A patient will usually spend 1 night in the hospital for observation.

Most men have pain after the surgery for about 4 weeks. During this time, oral pain medicine is needed and you are not allowed to drive. If men limit their physical activity while pain is present, the pain usually ends sooner. Men can often be taught how to use the prosthesis for sex 1 month after surgery, but if there is still pain and soreness this may be delayed for another month.

If there is an infection, or the implant fails to work, it will usually have to be removed. On rare occasions, the device can cause pain or reduced feeling. It is important to know that after an implant is placed, other non-surgical treatments will no longer work if that prosthesis is removed. Fortunately, most men with penile implants and their partners say that they’re satisfied with the results.

Other Possible Therapies:

  • Penile Arterial Revascularization
  • Venous Ligation Surgery

Vascular surgeries are still thought of as experimental by some, and may not be covered by your health plan.

Neither the penile arterial revascularization or venous ligation surgeries are recommended if you use tobacco or have:

  • insulin-dependent high blood sugar
  • widespread hardened arteries
  • high blood serum cholesterol levels
  • injured nerves
  • diseased and/or wide-spread damaged blood vessels