Erectile Dysfunction

ED is one of the most common sexual problems men experience, affecting about 30 million men in the U.S. The condition is highly treatable.

Erectile dysfunction is the repeated inability to get or keep an erection firm enough for sexual intercourse. The percentage of men who typically experience erectile dysfunction relates with age. For example, 50% of 50-year-olds, 60% of 60-year-olds and so on will have problems with erections. But there are plenty of men in their 70s, 80s, and 90s with great sex lives. ED is typically treatable at any age.

An occasional inability to achieve an erection is normal. But the inability to reach or sustain an erection more than half of the time, at any age, indicates erectile dysfunction. Other symptoms may include decreased sexual desire and less rigid erections.

There are various physical and psychological issues that can result in poor erectile function. These include, but are not limited to:

• Increasing age
• Diabetes
• Diet that is unhealthy
• Heart disease
• High blood pressure
• Low testosterone
• Peyronie’s disease (penile curvature)
• Stress/mental health issues
• Certain medications
• Side effects from treatments for other diseases such as prostate cancer

During your visit, your doctor will ask about your medical history and may examine your abdominal and genital area. You’ll be asked about situations when you have difficulty obtaining erections, presence of morning/overnight erections, and any prior surgery or radiation.

It is essential to provide a detailed history of medication and drug use since nearly 25% of ED cases can be attributed to medications for other conditions.

Tests that may be performed during or after your visit:

• Blood tests to determine testosterone level
• Urinalysis: to determine the amount of protein and sugar in the urine. Abnormal measurements of these substances can indicate diabetes or kidney disease, which can contribute to ED.

NON-SURGICAL TREATMENTS

• Lifestyle changes: Maintaining a healthy lifestyle is the best way to prevent ED. This includes maintaining a healthy weight, controlling blood pressure and blood sugar, limiting alcohol, stopping smoking, and exercising regularly.
• Medications: Several drugs including Viagra, Levitra, Stendra, and Cialis can improve blood flow to the penis to enhance your erection in response to sexual stimulation. These cannot be taken if you also take nitrates for chest pain. These drugs require you to take them within a specific time before sex. Consult your pharmacist for specifics on these drugs.
• Low-intensity shockwave therapy: Using a hand-held wand that delivers gentle energy pulses, LiSWT stimulates penile tissue to increase the blood flow needed to improve erectile function and rigidity. This therapy is painless, requires no downtime, can be long-lasting, and involves just one 30-minute treatment each week for about six weeks.
• Injection therapy: Self-injection of a medication into the base of your penis with a very small needle can lead to satisfactory erections. Erections should start within 10 min and usually last about an hour. For erections lasting more than 4 hours, you must contact your physician immediately or go to the emergency room.
• Urethral suppository: This treatment involves placing a small suppository pellet into the tip of your penis to improve blood flow to the penis. Erections start within 10 minutes and typically last about an hour. The most common side effect can be penile discomfort.
• Penile pump: This hand-powered vacuum works by pulling blood into the penis. Once erect, a ring is placed over the base of the penis (do NOT keep ring on penis for more than 30 minutes). These erections tend not to be as firm, can result in bruising, may be cold to the touch, and ejaculation will be obstructed from the restriction band.

SURGICAL TREATMENTS

• Inflatable Penile Implant: The most common type of implant involves surgically implanting a cylinder into your penis, along with a pump in your scrotum and a reservoir of fluid in your abdomen. This provides you the ability to inflate the device to create an erection and deflate the device when you no longer want an erection (leaving the penis in a more natural state). The implant allows for a consistent erection and has a patient/partner satisfaction rate of more than 90%.
• Malleable Penile Implant: A different type of implant consists of surgically inserted rods, which keeps the penis erect. You can adjust the position of the penis and, therefore, the rods for intercourse, then position it downward afterwards. Adjustment does not affect the width or length of the penis.