Erectile Dysfunction

Erectile dysfunction (ED) is the inability of a man to achieve or maintain an erection sufficient for his sexual needs or the needs of his partner.

Erectile dysfunction is estimated to affect up to 30 million men in the United States, and over half of men between 40 and 70 years old. In many, erectile dysfunction can be an early sign of atherosclerosis, or “hardening of the arteries”. Erectile dysfunction may also signal other health concerns, including cardiovascular and/or neurological issues. Early diagnosis, intervention and behavioral and dietary changes can slow the progression and reduce the severity of erectile dysfunction, as well as improve overall cardiovascular health. Therefore, it is important to talk to your doctor if you have questions or concerns about erectile dysfunction.

At Urology of Indiana, we have experienced physicians who understand the impact erectile dysfunction can have on you and your partner. We have a specialized erectile dysfunction clinic that offers the full array of treatment options to improve sexual health and quality of life.

Symptoms

  • Relationship problems
  • Diminished self esteem

Risk Factors

  • Aging
  • Heart disease
  • High blood pressure
  • Diabetes
  • Depression
  • Benign prostate enlargement

Erectile dysfunction is a "goal-oriented" condition. Establishing the severity and circumstances of erectile dysfunction is often obtained with a thorough history by your physician. A physical examination may give clues regarding systemic problems. Careful attention must be paid to the circulatory and neurological systems (blood vessels and nerves). Depending on your history and exam your physician may determine that further diagnostic testing is necessary. Oftentimes, however, erectile dysfunction results from multiple factors and the focus becomes restoring sexual function.

Counseling

Counseling can help by working with couples to reducing tension, improve communications, and obtain realistic expectations. In some patients where psychologic causes are not the originating problem but have become a significant factor, counseling may be necessary during the difficult rehabilitation period. Lifestyle modifications may be beneficial, including changes in exercise, stress levels, diet, alcohol and smoking if these are considered major contributing factors.

Medications

There are several prescription drugs that may successfully treat erectile dysfunction. These drugs do not directly cause erections, but enhance erections caused by sexual stimulation. Ask your physician which drug might be best for you.

At this time, there is no evidence that nutritional supplements or vitamins have any significant bearing on sexual performance. The Food and Drug Administration has currently banned the sale or advertising of all nonprescription products for the treatment of erectile dysfunction due to the lack of scientific evidence.

Self-Injection Therapy

Self-injection therapy involves the patient or his partner giving an injection of medication directly into the side of the penis to create an erection. The erection is a natural one and usually begins five to 15 minutes after the injection. Not all patients respond to this type of treatment, but those who do should develop an erection that lasts anywhere from 30 to 120 minutes. About 70 percent of men find that their erections are satisfactory with self-injection therapy. The injections are given with a tiny needle and use very small amounts of medicine. The injections are relatively painless and are easily taught to the patient in one or two visits with the doctor. Self-injection therapy does not impede the development of an orgasm or ejaculation and is less costly than surgical implantation. Self-injection therapy can be used by the patient at his own discretion and at any time with a minimum of preparation. Treatment does not involve surgery and is minimally painful in most patients.

MUSE

MUSE is a drug treatment that represents a unique approach to treating erectile dysfunction. It is based on the discovery that the urethra can absorb certain medications into the surrounding erectile tissues, thereby creating an erection. The MUSE system uses prostaglandin E1, which is the same medication used in the self-injection therapy. An erection should begin within five to 10 minutes after administering MUSE. The duration of effect is approximately 30 to 60 minutes, but the actual duration will vary from patient to patient. Muse can be used in combination with oral therapy such as Viagra.

The most common side effects reported after using MUSE are aching in the penis, testicles, legs and in the area between the scrotum and the rectum; warmth or burning sensation in the urethra; redness of the penis due to increased blood flow; and minor urethral bleeding or spotting due to improper administration.

Vacuum Devices

The vacuum erection device is a simple mechanical tool that creates an erection by temporarily trapping blood in the penis. The more blood trapped in the penis, the firmer the erection. The penis is inserted into a hollow plastic tube, which is pressed against the body creating a seal. A vacuum is then created in the tube by use of a small hand pump. Blood is drawn into the penis, causing engorgement, enlargement and rigidity.

A vacuum device works best in patients who are able to achieve a partial erection on their own. After having adequate foreplay, which creates a mild erection, the partner can help in applying and using the vacuum device. In any type of sex therapy, the partner's full acceptance of whatever technique is used is always helpful.

Surgical Implantation Treatment

Implantation of a penile prosthesis is one of several options available for the treatment of erectile dysfunction. The penis consists of three hollow tubes running along the length of the shaft. One of these, the urethra, runs along the bottom of the penis and brings urine from the bladder out through the end of the penis. The other two matched tubes running side-by-side on the top of the penis are constructed much like an automobile tire with an outer tube and an inner tube. The erection is created by the two inner tubes filling and pushing against the outer tubes, much like a tire that is inflated with air.

One of the treatment options for erectile dysfunction is the placement of prosthetic inner tubes within the penis to mimic the inflation process and create an erection. Penile implants were first used in the 1950s, and since then further advances have occurred. Different types of prostheses have been developed, and hundreds of thousands of men throughout the world have been successfully treated with penile implants. Today there are three types of penile prostheses: the semi-rigid implant, the inflatable implant and a self-contained inflatable implant.

Implants are effective in treating almost every cause of erectile dysfunction. The success rate is more than 90 percent when both partners are informed of the nature and limitations of the prosthesis. Prostheses require no further treatment after implantation, and there is no external equipment, which might have negative connotations to the partner. No medicines or injections are needed, and once the prosthesis is placed and functioning there are no further costs. The newer prostheses are very reliable and the chance of mechanical failure is very low, in the range of 2 to 4 percent per year.