Treatment Options for Erectile Dysfunction

Erectile Dysfunction Treatment

What is Erectile Dysfunction?

Erectile dysfunction is defined as the inability to attain and/or maintain an erection suitable for intercourse.

What are the causes of erectile dysfunction?

Erectile dysfunction can be caused by a number of factors, including the following:

• Vascular disease--Blood supply to the penis can become blocked or reduced as a result of vascular diseases such as atherosclerosis (hardening of the arteries).
• Nerve disorders--Nerves that send impulse to the penis can become damaged from stroke, diabetes or other causes.
• Psychological states--Such as stress, depression, and performance anxiety.
• Trauma--Such as from injury.

Chronic illness, medications and Peyronie's Disease (scar tissue in the penis) can also cause erectile dysfunction.

How is erectile dysfunction treated?

The first step to treating erectile dysfunction is finding the underlying cause, then the appropriate treatment can be given. If the problem continues after treatment, there are a number of nonsurgical treatments that can help you gain and maintain erections.

Nonsurgical Treatments

Oral Corporeal Pharmacotherapy

Viagra (sildenafil) is the first oral medication for erectile dysfunction ever approved by the Food and Drug Administration. It was approved in March 1998 and should be available in pharmacies soon. The medication is taken about one hour before sexual activity. It will be available in three dose sizes: 25 milligrams (mg), 50 mg and 100 mg. Most men will start on 50 mg. Men who are on medications that contain nitrates such as nitroglycerine, should not take Viagra. The combination of Viagra and nitrates can cause low blood pressure (hypotension). The most common side effects of Viagra are dyspepsia (indigestion), nasal congestion, flushing, headaches and a transient visual disturbance. There have been no reports of priapism (prolonged, painful erection) with Viagra therapy.

Vacuum Constriction Device

The vacuum constriction device is a cylinder that is placed over the penis. The air is pumped out of the cylinder, which draws blood into the penis and causes an erection. The erection is maintained by slipping a band off the base of the cylinder and onto the base of the penis. The band can stay in place up to 20 minutes. The vacuum device can be safely used to treat most causes of erectile failure. Lack of spontaneity and cumbersomeness of the device seem to be the biggest concerns of patients.

Intracavernosal Injection Therapy

This type of treatment is more commonly known as penile self-injection. Using a tiny needle and syringe, you inject a small amount of medication into the side of the penis. The medication relaxes the blood vessels, allowing blood to flow into the penis. This treatment has been widely used and accepted since the early 1980s. The three most commonly used medications are prostaglandin E1 (alprostadil) and papaverine and phentolamine (Resitine).

Injection therapy is effective in treating a wide variety of erection problems caused by blood vessel, nerve, and psychological conditions. The most common adverse side effects are pain and penile scarring (fibrosis). Patients with cerebral vascular disease or severe cardiovascular disease may not be able to tolerate the dizziness and high blood pressure occasionally encountered with injection therapy. A painful erection that lasts longer than 2 to 3 hours (priapism) can occur but can be lessened with proper dosing and by following the treatment guidelines.

Transurethral Pharmacotherapy

For this treatment, which became available a little over a year ago, you place a suppository into the urinary tube (urethra) using a plastic applicator. The suppository contains the medication alprostadil (MUSE), which is absorbed into the blood stream. MUSE relaxes the blood vessels, allowing blood to flow into the penis. MUSE is available in four dose sizes: 125 micrograms (mcg), 250 mcg, 500 mcg, and 1000 mcg.

MUSE appears to be less effective than either injection or vacuum therapy. MUSE can be used to treat erectile dysfunction due to a wide variety of causes. Patients with urethral problems must use special care when using this treatment, since the suppository is placed directly into the urethra.

Sex Therapy

Sex therapy can be very beneficial to most men when counseling is provided by a skilled sex therapist. Psychological causes may contribute to erectile failure even when there is a clear organic cause. Sex therapy also helps a man's partner accept and cope with the problem. A patient whose erectile failure has a clear psychological cause should receive sex counseling before any invasive treatments are pursued.

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