A wide variety of options exist for treating erectile dysfunction. Treatment options include everything from medications, simple mechanical devices, surgery, and psychological counseling. The cause and severity for each Individual’s condition are important factors in determining the best treatment, or combination of treatments available. It is wise to consider with your doctor how much money you’re willing to spend, and the personal preferences of you and your partner. Should erectile dysfunction be a result of a medical condition, the cost of treatment may be covered by insurance.
Sildenafil (Viagra)
Sildenafil (Viagra) was approved by the Food and Drug Administration (FDA) in 1998, becoming the first oral medication for erectile dysfunction on the market. Since then, doctors have written millions of prescriptions for the blue, diamond-shaped tablets. Drugs for treating ED can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis. In August 2003, the FDA gave approval to a second oral medicine, vardenafil hydrochloride (Levitra). Presently, additional oral medicines are being tested for safety and effectiveness.
Taken an hour before sexual activity, Viagra and Levitra work by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow.
While oral medicines improve the response to sexual stimulation, they do not trigger an automatic erection as injections do. The recommended dose for Viagra is 50 mg, a physician may adjust this dose to 100 mg or 25 mg, depending on the patient. The recommended dose for Levitra is 10 mg, a physician may adjust this dose to 20 mg if 10 mg is insufficient. Lower doses of 5 mg and 2.5 mg are available for patients who take other medicines or have conditions that may decrease the body’s ability to use Levitra.
Neither Viagra nor Levitra should be used more than once a day. Men who take nitrate-based drugs such as nitroglycerin for heart problems should not use either drug, as the combination can cause a sudden drop in blood pressure. Levitra should not be taken with any of the drugs called alpha-blockers, which are used to treat prostate enlargement or high blood pressure.
Oral testosterone can reduce ED in some men with low levels of natural testosterone, but it is often ineffective and may cause liver damage. Patients also have claimed other oral drugs–including yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone–are effective. The results of scientific studies to substantiate these claims have been inconsistent. Improvements observed by the use of the drugs may be examples of the placebo effect; a change that results simply from the patient’s believing that an improvement will occur.
Many men achieve stronger erections by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine, and alprostadil (marketed as Caverject) widen blood vessels. These drugs may create unwanted side effects such as a persistent erection (known as priapism) and/ or scarring. Nitroglycerin, a muscle relaxant, can sometimes enhance erection when rubbed on the penis.
A system for inserting a pellet of alprostadil into the urethra is marketed as Muse. The system uses a prefilled applicator to deliver the pellet about an inch deep into the urethra. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes. The most common side effects are aching in the penis, testicles, and area between the penis and rectum, warmth or burning sensation in the urethra, redness from increased blood flow to the penis, and minor urethral bleeding or spotting.
Research on drugs for treating ED is expanding rapidly. Patients should ask their doctor about the latest advances.
Prostaglandin E (alprostadil)
Alternatives to sildenafil exist. Two treatments involve the use of a drug called alprostadil (al-PROS-tuh-dil). Alprostadil is a synthetic version of the hormone prostaglandin E. The hormone helps relax the smooth muscle tissue in the penis, which enhances the blood flow needed for an erection. There are two ways to use alprostadil:
Needle-injection therapy.With this method, a fine needle is used to inject alprostadil (Caverject, Edex) into the base or side of the penis. This generally produces an erection within 5 to 20 minutes, which lasts about an hour. As the injection goes directly into the spongy cylinders that fill with blood, alprostadil is an effective treatment for many men. The needle used for injection is generally small, and pain from the injection site is usually minor. Other side effects may include bleeding from the injection, prolonged erection, and formation of fibrous tissue at the injection site. The cost per injection can be expensive. Injecting a mixture of alprostadil and other prescribed drugs may be a less expensive and more effective option. These other drugs may include papaverine and phentolamine (Regitine).
Self-administered intraurethral therapy. This method’s trade name is Medicated Urethral System for Erection (Muse). It involves using a disposable applicator to insert a tiny suppository, about half the size of a grain of rice, into the tip of your penis. The suppository, placed about 2 inches into your urethra, and is absorbed by erectile tissue in your penis, increasing the blood flow that causes an erection. Although needles aren’t involved, you may still find this method painful or uncomfortable. Side effects may include pain, minor bleeding in the urethra, dizziness and formation of fibrous tissue.
Hormone replacement therapy
For the small number of men who have a testosterone deficiency, testosterone replacement therapy may be recommended.
Vacuum devices
This treatment involves the use of an external vacuum and one, or more, rubber bands (tension rings). To begin, a hollow plastic tube is placed, (available by prescription), over the penis. A hand pump is then used to create a vacuum in the tube, pulling blood into the penis. Once an adequate erection achieved, a tension ring is placed around the base of the penis to maintain the erection. The vacuum device is then removed. Erection achieved by this method typically lasts long enough for a couple to have adequate sexual relations.
Vascular surgery
This treatment is usually reserved for men whose blood flow has been blocked by an injury to the penis or pelvic area. Surgery may also be used to correct erectile dysfunction caused by vascular blockages. The goal of this treatment is to correct a blockage of blood flow to the penis, allowing erections to occur naturally. It is important to note, the long-term success of this surgery is unclear.
Penile implants
This treatment involves surgically placing a device into the two sides of the penis, allowing an erection to occur as often, and for as long as desired. These implants consist of an inflatable device or semirigid rods made from silicone or polyurethane. Surgical implants are often expensive and is usually not recommended until other methods have been considered or have been unsuccessful. As with any surgery, there is a small risk of complications such as infection.
Psychological counseling
Should stress, anxiety or depression be the cause of your erectile dysfunction, your doctor may suggest that you, or you and your partner, visit a psychologist or psychiatrist with experience in treating sexual problems.
