Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection that is firm enough to have sexual intercourse.
How common is it?
In a study from John Hopkins Institute in 2007, the overall prevalence of ED in men aged
above 20 years was 18.4% suggesting that ED affects 18 million men in the USA. Among
men with diabetes, the prevalence of ED was 51.3%, so it’s a fairly common problem.
What causes ED?
Treatment options?
Penile Doppler scan with an injection may be required occasionally in special situations.
Whatever is causing ED, there is a treatment option that can provide a satisfying solution.
If you try one of the treatment options listed and it doesn’t work for you or you aren’t completely
satisfied, don’t be discouraged and give up hope.
These treatment options have varying degrees of success for each man depending on the cause of the
ED. Irreversible blood vessel or nerve damage may impact the success of some of these
treatments.
It is important to know all of your available options and discuss them with your doctor to determine
which will be appropriate for you and your lifestyle.
Lifestyle modifications: Exercise regularly (5 times a week), maintain a healthy weight, avoid
smoking, restrict alcohol intake to 2 drinks or less per day, adopt better sleep habits, take care
of your other health issues such as high blood sugar and heart, artery or kidney disease.
Non-Surgical options: Oral medications, Penile Injections, Vacuum erection device
Surgical options: Penile Implants
Oral medications:
These drugs are known as phosphodiesterase type 5 (PDE-5) inhibitors. They work to relax muscle
cells in the penis for better blood flow and to produce a rigid erection. These medicines work in
about 7 out of every 10 men with ED. They can be effective regardless of age or race. However, they
only work if a man is sexually stimulated. Their effects last for only a set amount of time. Men
should take these medications 30-60 minutes before sexual activity. These drugs do not treat a lack
of sexual desire. As with any drug, some men may experience side effects when taking PDE-5
inhibitors. The most common are headaches, flushing (redness) of the face, runny or stuffy nose,
upset stomach, dizziness and muscle aches. Those side effects are usually mild-moderate, but taking
these drugs with alcohol may make them worse. Be sure you tell your doctor about all drugs you are
taking, including prescriptions, over-the-counter medications or supplements or recreational drugs
before you take any PDE-5 inhibitors.
Penile self-injection:
Alprostadil (Prostaglandin) Injection therapy uses a needle to
inject medication directly into the base or side of the penis. These medications improve blood flow
into the penis to cause an erection. The recommended frequency of injection is no more than three
times weekly and should produce an erection in 5-20 minutes. Beyond a possible fear of needles, men
may experience pain, fibrosis and risk of a persistent erection with these injections. 60-65% of
men discontinue this mode of treatment after 1 year.
Vacuum erection devices (VED):
A mechanical ED pump used to pull blood into the penis can
cause an erection. The system includes a plastic cylinder, an external penile pump, and a
tension band to place at the base of the penis. When the penis is erect, the ring is placed at the
base to maintain an erection long enough to have sex (up to 30 minutes). This is a drug-free
non-invasive method of treatment, but the person will not be able to ejaculate soon after the orgasm
due to constrictive ring at the penile base.
Penile Implants:
In use since the year 1971, penile implants have helped many men return to
an active sex life. A penile implant is a medical implant that is implanted into the penis in the
operation theatre. The implant is entirely concealed within the body. Two basic types of implants
are available. With malleable or bendable implants, two silicon-type cylinders are inserted into the
penis. To have an erection, a man bends his penis upward into an erect position. The second type, an
inflatable implant has a pair of inflatable cylinders which is attached to a fluid reservoir and a
pump hidden inside the body. To have an erection, a man presses on the pump. This transfers fluid
into the cylinders, making the penis rigid. To return the penis to a natural flaccid state, the pump
is deflated.