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Saturday, May 25, 2013
Erectile Dysfunction (ED) is the inability to get and/or keep an erection for satisfactory sexual functions. Most people translate these terms to mean that a man cannot either get an erection or keep an erection for satisfactory sexual functioning.
Treatment for ED usually begins with a discussion at an office visit with a health care professional. Specialists who deal with ED include:
Usually, there is a 20 minute interview to review the problem and all medical/vascular risk factors.
After a history there is a physical examination which usually involves the abdomen and male genitalia.
It is prudent for your physician to check the conditions that are associated with ED: high blood pressure, diabetes, depression, high cholesterol, smoking, sedentary lifestyle, and obesity.
In looking into potential causes of ED, some tests that may be run include:
A physician may ask a patient to undergo vascular testing to further evaluate the cause of the ED. Vascular testing may also be required prior to starting therapy and the resumption of sexual activity. There are guidelines, known as the Princeton Guidelines, that help direct the physician. Men with certain characteristics should be able to resume sexual activity without the need for further testing including:
Depending on the cause of ED most physicians and patients opt for the oral medication, Sildenafil (Viagra). Another drug, vardenafil (Levitra), which acts in a similar fashion, has been approved for use as well. Tadalafil (Cialis), a third drug, which also acts in a similar fashion, should be approved for use in the very near future.
Some important facts about these drugs include the following:
Because oral medication may not be the best option for every man with ED, there are other reasonable options listed below that have time-honored success in previous patients.
Penile intracavernosal injections (penile shots) is where a man is taught to inject himself with a drug into the penis to get himself an erection. The injection usually occurs 5-10 minutes prior to planned sexual intercourse.
MUSE, the medicated urethral system of erections, is a small pellet inserted into the urethra prior to intercourse.
Vacuum erection device therapy is a plastic tube that fits over the penis. The device uses suction to fill the penis with blood, giving the man an erection. The blood is then trapped in the penis with a constriction ring, (although it should not be left on longer than 30 minutes).
Another therapeutic option is the surgical insertion of a penile prosthesis (implant).
Patients are also asked to consider changing lifestyles. This includes:
Further, if there are marital issues, then psychological or marital counseling, or other forms of appropriate counseling are suggested. It is our practice for men who present with ED to be screened for depression. ED related to depression or psychological issues can be successfully treated with short-term oral medication therapy combined with counseling.
For young men with trauma to the pelvis from either chronic bike riding or perhaps a motor vehicle accident or other forms of crush injury, revascularization surgery is an option. In these cases, an artery is obtained from the abdomen down into the penis to bypass the blockage that is due to the trauma.
In selected cases, which are uncommon, there is venous ligation surgery in which vein tissues can be tied off in hopes of restoring erectile function.
A low serum testosterone may need to be replaced, but testosterone supplementation should be viewed with caution and requires a planned program of monitoring Also, testosterone may affect sperm count or motility, thus, testosterone should be used with caution in men who wish to have children. The goal of testosterone supplementation should be to restore the testosterone to therapeutic levels. Testosterone cannot be given to men with prostate or breast cancer.
With all of these treatment options, a male's sexual partner is encouraged to participate in the ED evaluation and treatment process because this enhances the overall outcome. Inclusion of the partner can be challenging but can also be quite rewarding if successful.
This article was originally authored by Allen Seftel, MD, formerly of Case Western Reserve University, and published on NetWellness with permission.
This article is a NetWellness exclusive.
Last Reviewed: Jul 03, 2010
Ahmad Hamidinia, MD
Professor of Clinical Surgery
College of Medicine
University of Cincinnati