Erectile dysfunction treatments
More than two decades after its introduction, Viagra® remains among the most common treatments for erectile dysfunction, but doctors have numerous other tools for treating an issue that affects many men at some point in their lives.
The first step is determining the cause of erectile dysfunction (ED), says Dr. Craig Stauffer, a urologist with Montage Medical Group in Monterey and vice chair of the urology division of Community Hospital’s medical staff.
"ED can be the first sign of metabolic changes in the body and should be taken seriously," Stauffer says. "Finding and treating the cause or causes of your ED
can improve your overall health and your sex life."
ED happens when blood doesn’t flow well into the penis, or when the nerves in the penis are injured. It can be caused by other health issues, including an injury, surgery, diabetes, heart disease, and high blood pressure, or the medications taken for a health issue. It can also be due to lifestyle choices, such as drinking too much alcohol, using drugs, or smoking. Stress, depression, and anxiety can cause or worsen ED.
"I do a very systematic approach to help determine the priorities of the patient and his partner, and identify the therapy that will sustain them," Stauffer says. "A lot of people know about some of the therapies but not all of them."
Non-invasive treatments are often tried first, most commonly prescription medications such as sildenafil (Viagra®), tadalafil (Cialis®), vardenafil (Levitra®), and avanafil (Stendra®). Each of these has a different profile in terms of speed of onset, duration of action, adverse reactions, etc., and should be discussed with a
healthcare professional.
"ED can be the first sign of metabolic changes in the body and should be taken seriously. Finding and treating the cause or causes of your ED can improve your overall health and your sex life."
— Dr. Craig Stauffer, urologist, Montage Medical Group
These work by increasing blood flow to the penis and require that the user have normal nerve function. They should not be taken by men who take nitrates to improve blood flow to the heart. The Urology Care Foundation reports that about 70 percent of men who take them report good results; rates are lower for people with diabetes or cancer.
Those who don’t have success with oral medication should talk further with their doctor, Stauffer says, because studies indicate that up to 50 percent of
failures can be remedied with proper education.
If medication isn’t the solution, there are other options
to consider.
- Penile injections with vasoactive drugs — these work by increasing blood flow through a variety of mechanisms. Self-injections can be done after instructions from a doctor or other medical professional. Success rates of up to 85 percent have been reported, but most men discontinue use after a short period. "This takes a patient who’s willing to push a needle into a very sensitive area, but they are very effective," Stauffer says
- Intraurethral medication — this involves placing a tiny pellet of alprostadil in the urethra, the tube that carries urine from the body. The pellet dissolves to increase blood flow. Success rates of up to 65 percent have been reported, but most men discontinue use in less than a year because of discomfort
- Vacuum devices — these use a plastic tube with a low-pressure vacuum. The device creates a negative pressure, which increases blood flow. Most devices are coupled with some form of constriction device at the base of the penis to maintain the erection. With proper training, according to the Urology Care Foundation, about 75 percent of users find it successful
- Non-inflatable penile implant — this implant is malleable and, when bent, stays in that form
- Inflatable penile implant — this uses a pump implanted in the patient’s scrotum, which shifts water from a reservoir to cylinders within the penis, mechanically creating an erection. "Patients and partners alike tend to be very satisfied with the outcomes of this procedure," Stauffer says
In addition to addressing ED from a physical standpoint, Stauffer also focuses on mental well-being. By collaborating with a mental health professional who helps with issues such as adherence to treatment, performance anxiety, stress, and depression, he approaches the patient in a holistic manner.
"I explain to my patients that stress is a very potent anti-erection agent," he says. "It turns on the sympathetic nervous system, which can prevent erections. This can be a very real response to the psychologic stress
of erectile function"
