Erectile dysfunction is the inability to get or maintain an erection that’s satisfactory for sexual function. It is one of the more common health problems men will encounter during their lives, with about 40 percent of men 40 or older and close to 70 percent of men over age 70 having erection issues.
While age is a common factor, 80 percent of cases are traced to a physical problem or disorder.
ED also may be an early indicator of heart disease. In fact, for some men, it can predate serious cardiac complications by a decade. That’s because the arteries in the penis are smaller than those in the heart. So, the impact of coronary artery disease may be quicker to show up in that region. Your doctor may send you for a cardiac evaluation to ensure there are no issues with your heart as they evaluate and treat your ED.
Doctors have a wide range of tools available to treat ED, with safe, noninvasive options leading the way. Ask your doctor about potential side effects from each treatment. Most of the treatments are used along with suggested lifestyle changes, such as losing weight or quitting smoking, to improve sexual function.
The first option to treat ED is trying medications called PDE5 inhibitors, which include Sildenafil (Viagra) and Tadalafil (Cialis). Generic versions of these medications are available, which substantially lowers the cost. Oral medications work by keeping blood in the penis when erect. Medications are effective in about 70 percent of cases. These medications can lower your blood pressure, so you may not be a candidate to take them if you are on certain heart medications.
This can help if you have low sex drive and low testosterone levels. Testosterone itself cannot lead to stronger erections, but testosterone replacement can increase your sexual drive, which then may help boost your ability to get an erection.
For men who don’t respond to oral medications, direct injection into the penis may be an option. There is risk of a prolonged erection, and the injections require training to self-administer. Injection therapy involves a combination of medications, which include TRIMIX and BIMIX in different doses to help boost erections. Your doctor may use a doppler ultrasound on your penis to test the effectiveness of the injections and evaluate for restricted blood flow or leaky veins.
The medicine is inserted as a suppository into the urethra. Burning in the urethra is a common side effect. The medication can be expensive, making it prohibitive for some patients.
These devices, also known as penis or vacuum pumps, are a drug-free, noninvasive and cost-effective option to get a rigid erection. The pumps can be manual or battery operated. Some men who have trouble maintaining erections may skip the pump and only use a ring at the base of their penis to keep an erection.
A penile implant is a self-contained system made up of three pieces that are placed surgically through a small incision in your scrotum or pubic area. The three pieces include cylinders placed inside the penis, a reservoir that holds fluid within the abdomen and a small pump hidden inside the scrotum. The pump is used to bring fluid from the reservoir into the penile cylinders to get a rigid erection. Once sexual activity is complete, a button on the pump is used to automatically deflate the pump and make the penis flaccid again. This option, which should not affect your ability to climax, is designed to more closely resemble a natural erection. It is manufactured by companies such as Boston Scientific and Coloplast. Implants can also come in two pieces where there is no reservoir.
This is one of two surgical implant options. With the malleable version, the erection is essentially permanent, using flexible metal or plastic rods placed in the penis shaft. When it’s time for sex, the penis is straightened by hand into position – and then bent back down afterward to conceal it. Your ability to reach climax should not be affected. This option is available but rarely needed with the advancements made with the inflatable three-piece implants.
This procedure typically is performed at a surgery center or hospital, using spinal or general anesthesia. You may go home the same day or be admitted for overnight observation. A small incision is made in the scrotum or pubic area to place all the parts of the implant. The implants come in different lengths and girths, which allows for customization to your anatomy. The surgery takes about an hour, and you can have sex after about six weeks.
Surgery cannot add additional length or girth to the penis. Your surgeon may ask you to start stretching your penis manually or use a vacuum device a few weeks before surgery to help regain length that may have been lost due to long periods of having no erections. Your doctor may have you get control of your diabetes or other medical conditions before the surgery.
Medication is used to manage pain after surgery, with limited physical activity during the first 48 hours. Antibiotics are given for five to seven days after surgery to prevent infection. Mild discomfort and swelling under the incision may persist for several weeks. Most men can resume strenuous exercise within four weeks. Your urologist will see you six to eight weeks after surgery to go over use of the implant. At this point, you can start using the implant for sexual activity.
About 90 percent to 95 percent of surgeries result in erections adequate for sexual intercourse. They mimic the look of a natural erections. Satisfaction rates are high, with 80 percent to 90 percent of men saying they’d have the surgery again.
There are risks associated with any surgery, including infection and formation of scar tissue. Rarely, mechanical failure, implant erosion or pump displacement may require additional procedures to repair. Once you get an implant you will not be able to get an erection on your own again.