Treatment for Erectile Dysfunction
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.
Visiting the Doctor
Treatment for ED usually begins with a discussion at an office visit with a health care professional. Specialists who deal with ED include:
- Primary care physicians
- Other interested health care professionals
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.
Tests for ED
In looking into potential causes of ED, some tests that may be run include:
- Testosterone level
- Thyroid hormone level
- Blood lipid profile looking for high cholesterol and triglycerides may also be obtained
- Blood sugar level may be obtained to look for diabetes
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:
- Less than three cardiac risk factors
- Stable angina
- Are at least 8 weeks post coronary bypass
- Are at least 8 weeks post coronary stenting
- Have class 1 heart failure
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:
- All 3 drugs are known as type 5 phosphodiesterase inhibitors. They are taken orally.
- These drugs help improve erectile function. They do not give a man an erection.
- These drugs work well in approximately 60-70% of cases, but they do not seem to be effective for all men with ED.
- These drugs may be used in men with all forms of ED.
- These drugs should NOT be used in men who take nitroglycerin, and should be used cautiously in men with any form of heart disease.
- These drugs can be used if men take drugs like alpha blockers, such as hytrin (terazosin), cardura (doxazosin), flomax (tamsulosin) or uroxatral (alfuzosin) , provided that you wait at least 4 hours between taking any of the 3 type 5 phosphodiesterase inhibitors (Viagra, Cialis or Levitra) and the alpha blockers.
- Viagra and Levitra are usually taken on an empty stomach approximately 1 hour prior to intercourse. Cialis can be taken with food.
- Cialis has a longer period of activity-24 to 36 hours. Viagra and Levitra both work over 4 to 8 hours.
- Recently, a lower daily dose of Cialis has been approved for use. This lower dose may have less side effects than the higher doses taken on an as needed basis. The efficacy of daily Cialis seems to be comparable to somewhere between the 10mg and 20 mg as needed Cialis dose.
- There have been rare reports of sudden blindness and also of hearing loss associated with the use of the 3 PDE5 inhibitors. Patients with a history of visual problems might wish to discuss their eye condition with their eye specialist before starting any pf the 3 PDE5i inhibitors. Anyone who develops hearing loss in conjunction with using any of the 3 PDE5 inhibitors should seek immediate medical attention.
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 (VED)
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:
- Stopping smoking
- Losing weight
- Eating a healthy diet
- Keeping their blood pressure, weight, and cholesterol under control.
- Controlling diabetes
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.
Testosterone Supplementation Therapy
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 , formerly of Case Western Reserve University, and published on NetWellness with permission.
More information about ED:
- Erectile Pain
- Debunking the Myths about Male Enhancement Drugs
- Premature Ejaculation
- ED – What it Is, What it Isn’t
For more information:
Go to the Erectile Dysfunction (ED) health topic.