Treating Erectile Dysfunction

Today, there is a wide variety of mainstream treatment options available for erectile dysfunction. This list includes oral medications, penile injections, vacuum erection devices, urethral suppositories, and penile implants.  In today’s blog, I would like review these options and highlight the benefits and downsides of each, to empower my patients to navigate which option might be best for them.

Pills

I am sure everyone has heard about pills like Viagra and Cialis. They’ve been around for over 20 years, but contrary to popular belief, these treatments will not just give you a spontaneous erection.  They function by increasing the amount of blood flow into the penis during sexual stimulation, which can lead to a fuller erection that lasts longer. I would say about 75-80% of patients will get some positive response from these medications, but these meds do have a really long list of side effects, which often leads to discontinued use.   Yet they are convenient, and mostly generic so they do not cost anywhere near what they used to cost even a couple years ago.

Penile Injection Therapy

Another mainstream treatment in treating erectile dysfunction is penile injection therapy. Essentially, this is where the patient injects medication directly into the body or shaft of the penis, using a syringe. These medications are very potent vasodilators, which means they open the arteries to allow blood flow into those natural cavernous spaces that are supposed to fill with blood flow for an erection.  In contrast to pills, penile injections will generate an erection even if you are not sexually stimulated.  In fact, I will  often will use this in the office for diagnostic evaluation of patient’s erectile function or penile anatomy.  But a major downside to these injections is the possibility of an erection that is prolonged, or Priapism, which means an erection lasting longer that 4 hours, which becomes a medical emergency.  Also,  these injections are intimidating for patients to administer, because they have to inject directly into their penis at the moment they want to be sexually intimate.  And the injection is sometimes painful, but also the erect penis after an injection can be painful as a result of how the medications function.  Research has highlighted that only 10-15% of men will continue using this type of therapy beyond 6 months, likely to the above downsides, but also because it is not spontaneous.

Vacuum Erection Device

The next two categories of treatment are much less popular. The vacuum erection device is exactly as it sounds—you put your penis into a plastic tube, and it's connected to either a manual pump or a battery-operated motor that creates a vacuum, which then draws blood flow into the penis to achieve an erection. I have a lot of patients use this for penile exercise to prevent penile atrophy or shrinkage, particularly after prostate cancer treatment.   Similar to injections, VED’s are cumbersome and do not promote spontaneity.  They are also uncomfortable to use and can cause bruising, swelling, and even peyronie's disease.

Urethral Suppository

Lastly medication-wise, we have the urethral suppository. The suppopsitory is a medication that is inserted into the urethra where you normally pass your urine through. There is a small applicator that is placed into the urethra where the medication is delivered. The medication is similar to penile injections, in that it  it is absorbed through the urethra and will generate an erection without sexual stimulation.  For most patients, it is about 50/50 in terms of effectiveness and is often painful. The absorption is a little bit more difficult because it must go through a lot of tissue to get into the vascular area of the penis, and the medication itself can be irritating to the urethra so you can get pain with urination after using this medication as well.

Investigational Alternative Therapies

There are some investigational alternative therapies including extracorporeal shockwave therapy or penile shockwave therapy, intracavernous stem cell injection therapy or platelet-rich plasma or PRP therapy. Shockwave therapy is not FDA approved as of today and it's considered experimental, but we do offer it in our office because for the right patient, it can be effective. The other two are extremely experimental and we will not offer those therapies until research shows better results.

Penile Implant

Lastly, I want to talk about the Penile Implant.  The modern penile implant is a 3-piece device placed entirely within the body. Once implanted, no one can tell you have the device inside of you. The implant functions by the patient or their partner squeezing and releasing the pump, which sits in the scrotum, and moves fluid into a pair of cylinders or balloons inside the penis to fill the penis and create an erection. Once the erection is achieved, it will last until the patient and their partner are satisfied. To deflate the implant and end the erection, the release button near the pump is pushed and the implant is deflated. This gives the patient and their partner 100% control over when the erection happens and how long the erection lasts.

Its important to note that there is a procedure to place an implant, which comes with the usual risk of infection, which is low, and mechanical malfunction of the device, which typically occurs sometime beyond 10 years. The procedure takes about 45 minutes, and after about 4-6 weeks you can once again be independent and sexually active.

Overall, there is a wide variety of treatment options when it comes to erectile dysfunction. Each option has its drawbacks and its benefits and can be a great solution for the right patient. If you or a loved one are in search of a solution, you can visit https://www.edcure.org/treatment-options/ to learn more or visit my website, https://www.themensmd.com/, to make an appointment with me.