Dr. Piper discusses treatment options for ED

    In 15th and 16th century Europe, a woman could divorce her husband if he was unable to perform, but only after a community inquiry and embarrassing trial to prove the complaint.  Fast forward to 1998 and the introduction of the little blue pill, Viagra. Suddenly Erectile Dysfunction became a hot-button medical issue and the stigma associated with male performance issues diminished. Today, there are a host of options available to men suffering from ED ranging from medication to the surgical implantation of prosthetic devices.      Erectile Dysfunction may be caused by damage to one of three systems; arteries, veins or nerves. To obtain an erection all three systems must work in harmony. Upon sexual arousal, nerves affecting the penis trigger a chemical reaction that causes two slender areas of spongy tissue within the penis to relax and fill with blood. These engorged tissues press against nearby veins and prevent them from emptying, thereby producing an erection.
    In most instances the cause of a man’s ED may be difficult to identify and is often a combination of factors. Atherosclerosis, the most common cause, clogs arteries with a plaque-like material preventing adequate blood flow into the penis. Diabetes, which often damages nerve and vascular tissue, can cause decreased sensation to the pelvic area and arterial damage. Tobacco use creates defects (holes) in arteries.  These holes are repaired by platelets that in turn can block blood flow. Surgeries and trauma to the pelvic area can also injure the components of erectile activity. Illicit drug use can produce prolonged erections (Priapism) that damage the penile tissue. Hypogonadism, or low levels of testosterone, may also impact a man’s interest in intercourse and his ability to obtain an erection. Medications that are used to treat other medical conditions, such as high blood pressure, can also affect erectile function. Finally, the cause may be psychological or due to stress or chronic pain.
    Your doctor will diagnose ED by first obtaining a medical history. This will include a list of your current medications, health problems and previous surgeries. This will be followed by a physical exam to evaluate potential causes of the dysfunction. Laboratory testing may be required and a cardiac evaluation may be indicated to ensure a man’s fitness to engage in sexual activity and to rule out the onset cardiovascular disease. Interestingly, one of the first signs of heart disease may be erectile dysfunction, especially in younger men.
    Today treatment is not only widely available for ED, but generally very effective. Sometimes hormone replacement may be all that’s needed to produce erections. In other cases, simple changes in medication and psychological counseling may be the answer. For many men, medication may be the best option. This consists of administering chemicals in a variety of ways. Most often utilized are the oral medications, Viagra, Levitra and Cialis.  These medications are very similar, differ only in their length of activity, have a success rate of about 70 percent and an average cost of $10 per tablet.   
    Suppositories may also be useful. In this formulation a small soft pellet is placed within the urethra allowing absorption of the drug as it melts. A functional erection may be obtained in about 30 minutes, with success rates around 40 percent. Injectable medications are also available. Using a very small needle, medication can be injected directly into the penis creating an erection in 5 to 10 minutes. Although this sounds unpleasant, for most men the injection is nearly painless and the results are very good.
    Another, though more invasive option, involves implanting of a permanent prosthetic device. A marvel of modern medicine, these devices succeed where others fail. Implanted into the spongy tissues of the penis, the prosthesis is activated with a pump and provides an instant erection. Patient satisfaction is very high with the implant, however, most insurance companies will not cover the cost which may approach $20,000.
    A less expensive alternative may be a vacuum pump. These devices have been used for decades and are effective in about 40 percent of men. The pump pulls blood into the penis and a band is then placed at the base of the penis to ensure the penis remains engorged. Some men complain of pain at the band site, bruising and inconvenience. These devices cost around $250 to $500 and are widely available. Again, most insurance companies will not reimburse for these devices.
    The ability to engage in sexual activity is an important part of a healthy relationship. As physicians, we are fortunate to have so many treatment options to offer men suffering with ED. As with any medical problem, I encourage you to have a discussion with your health care provider about your individual situation.