What is ED?
Erectile dysfunction (ED) is the inability of a man to maintain an erection long enough to have sex. Although more common in older men, it can occur at any age. Having trouble maintaining an erection occasionally isn't always a cause for concern - but if the problem is ongoing, it can cause relationship stress and significant self-esteem problems in men.
Is ED a sign of a serious medical problem?
Sometimes ED is the first sign of a more serious condition - mainly cardiovascular disease or diabetes.
What testing should be done?
A brief physical exam, focusing on the male reproductive system and the cardiovascular system, should be done. Some blood tests (testosterone, PSA, lipids, glucose) are often performed. Sometimes an office injection of a vasoactive medication is done to help determine the cause and guide treatment of ED.
What are the treatment options?
Sometimes sexual therapy is helpful, especially for men having significant emotional/relationship problems or premature ejaculation. Occasionally, changing prescriptions (especially blood pressure medications) can be helpful. In general, the most beneficial treatments can be divided into the following two categories: medications and pumps.
Medications
For premature ejaculation, SSRI medications (Selective Serotonin Reuptake Inhibitors) taken prior to intercourse can be helpful. Downsides include nausea or headaches. If there is a documented low testosterone, then testosterone replacement (TR) can be given (injections, gels or patches). The advantage is that TR can increase libido (sexual desire) as well as enhance erectile ability. Side effects include prostate growth, which needs to be monitored. Phoshodiesterase 5 inhibitors (Viagra, Levitra, Cialis) increase blood flow when taken 30-60 minutes before sexual activity. They are convenient and safe with side effects including headaches or facial flushing. They should never be used with nitrate medications. Urethral suppositories (MUSE) are medicated pellets about the size of a grain of rice which are inserted into the urethra with a disposable plastic "eye dropped" prior to intercourse. The advantage is that no needle is required, with the downsides including urethral burning and lack of effectiveness. Injection therapy involves drugs injected by the patient directly into the side of the penis just before intercourse to try to establish a 30-60 minute errection. Side effects include needle discomfort, tissue scarring and prolonged painful erections (priapism).
Pumps
External pumps are essentially vacuum devices that can provide successful results. Advantages to the external pump are that it is a non-invasive reproducible method that does not involve medications. The main side effects include the appearance and pain that is progressive, usually after 20-30 minutes. Internal pumps are devices that are implanted underneath the skin during a one hour outpatient procedure. They are completely concealed and give a spontaneous, nonpainful "on demand" erection essentially for as long as a man wants. Rarely the internal pump may need to be replaced for infection or mechanical failure.
Dr. Stormont is a Board Certified Urologist with subspecialty interest and expertise in Mens Health, including the diagnosis and both medical and surgical treatments of male sexual problems. He is a member of the Sexual Medical Society of North America, an independent group interested in the science and treatment of human sexual dysfunction.
