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Treatment of Erectile Dysfunction

What is Erectile Dysfunction?

Erectile Dysfunction (ED) is a condition that affects men, defined as the inability to get and keep an erection firm enough for sexual intercourse. It may be due to a variety of factors, including physical and psychological causes.

Treatment of Erectile Dysfunction

There are three broad categories of Erectile Dysfunction treatment: non-invasive (a conservative procedure that does not enter the body), mildly-invasive (a procedure that enters the body by puncturing the skin or by inserting instruments) and invasive (a procedure that involves surgery). Generally, non-invasive treatments are often used to try to cure the disease first. Then, if non-invasive treatments are not effective enough, mildly-invasive treatments and invasive treatments will be carried out.

Drug and Mechanical Treatments

A. Oral Drugs or Pills

Prescribed drugs or pills, such as Viagra ®, Levitra ®, Cialis ® and Stendra ® can increase penile blood flow. For best results, men with Erectile Dysfunction should take these pills about an hour or two before having sex.

However, oral drugs or pills can result in mild side effects that last just a short time, including headaches, stuffy nose, facial flushing, muscle aches and indigestion. This is because the oral drugs or pills are working to increase blood flow to your penis, and at the same time, are also impacting the blood flow to other vascular tissues in your body.

B. Vacuum Erection Device

A vacuum erection device is an external plastic tube which can help a man get and maintain an erection. It works when the pump is placed over the penis, and air in the cylinder is pumped out to create a vacuum which draws blood into the shaft of the penis by suction and causes it to swell and become erect. An elastic ring is then slipped on to hold the blood in the penis, and keeps it hard for approximately 30 minutes.

C. Lifestyle changes

An unhealthy and sedentary lifestyle, alcoholism and drug abuse, as well as stress and anxiety, can cause problems with sexual function. By making positive changes to your lifestyle choices, it may be possible to cure erectile dysfunction effectively without the use of any treatment.

D. Alprostadil Therapy

Similar to oral drugs or pills, the drug Alprostadil works by increasing penile blood flow. Hence, if oral drugs do not work successfully, Alprostadil can be injected via penile injections (Intracavernosal Injection ("ICI")) or placed in the urethra ("IU Therapy"):

Penile Injections/ Intracavernosal Injection ("ICI")

– Using a fine needle, Alprostadil is injected into the side of penis, directly into the erectile chamber.

Intraurethral medication ("IU Therapy")

– A small pellet of Alprostadil is placed in the urethra (the tube that carries urine out of your body), where it is absorbed into the tissue.

E. Testosterone Therapy

When a man has low levels of testosterone (a male sex hormone), he also experiences a loss of libido, also known as sex drive. This may result in erectile dysfunction. Hence, for cases where low levels of testosterone is detected during blood testing and is suspected to be the main cause of erectile dysfunction, Testosterone Therapy may be able to cure the condition. It can be administered in various ways: by injection into the muscle, or patch, gel, pill or pellet which works by absorption.

New Minimally Invasive Treatment

These new methods involve using endovascular techniques to treat the root cause of erectile dysfunction without the need for open invasive surgery. Most cases are done as day surgery procedures with patients being discharged home on the same day. The majority of ED cases are caused by increased venous blood leaks away from the penis. A smaller number are due to narrowed arteries affecting Blood flow into the penis. Both these causes can be addressed using new minimally invasive techniques to either plug the venous leak (embolization) or widen the narrowed inflow arteries ( angioplasty and stenting).

Invasive Treatments

A. Penile Implants

A diagram of penile implants in a penis

The main surgical treatment of Erectile Dysfunction involves the insertion of a penile implant, which is a device that is placed fully inside your body while under anesthesia. During the surgery, one small surgical cut is made either above or under the penis. No tissue is removed, and blood loss is typically small. There is also limited downtime for the surgery, meaning that the patient can go home on the same day of the surgery or spend one night in the hospital after the surgery.

Just like other normal surgeries, you may feel pain around the site of surgery for one to two weeks, but will feel better with a narcotic pain-relief drug. After the first week, the narcotic pain-relief drugs can be replaced by over-the-counter pain drugs as the pain subsides. However, some discomfort, bruising and swelling after the surgery may last for a few weeks. As such, for the first month after the surgery, you should limit your physical activity as much as possible. By eight weeks after surgery, as long as there is no persisting swelling or pain, you can start having sex with your penile implants.

There are two types of penile implants:

  • Semi-Rigid Implant

– Semi-Rigid Implants are often made from two easy-to-bend rods made of silicone. These rods can be bent downward for peeing or upward for sex, and give the man's penis the firmness needed for sexual penetration.

  • Inflatable Implant

– With an inflatable implant, fluid-filled cylinders are placed lengthwise in the penis, connected to a pump placed inside the scrotum (between the testicles). When the pump is engaged, pressure in the cylinders inflate the penis and makes it stiff. Inflatable implants make a normal looking erection and give natural feeling for your partner.

B. Penile Vascular Surgery

Sometimes, penile blood flow is reduced due to a blockage or leakage in blood flow to the penis. In these cases, Penile Vascular Surgery attempts to restore penile blood flow by repairing leaking veins, rerouting blood past blocked arteries and blocking off veins that allow blood to leave penile tissue, in order to improve a man's ability to get and maintain a natural erection.

This procedure is recommended for men who have experienced a penile vessel injury caused by events such as trauma, pelvic fracture or surgery. People who undergo Penile Vascular Surgery should not have other vascular risk factors such as diabetes or hypertension, as these conditions can lead to complications and may cause the surgery to be extremely high-risk.

In summary, most men with Erectile Dysfunction are recommended with non-invasive treatments, such as Viagra, Cialis and Alprostadil. They are also given advice on changes in their lifestyle. Only when these non-invasive treatments do not work, minimally-invasive and invasive treatments are recommended.

For more information or if you require a medical consultation, please contact My Healthcare Collective here.