Erectile Dysfunction or ED, can be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections. It is treatable at any age, and awareness of this fact has been growing. More men have been seeking help and returning to normal sexual activity because of improved, successful treatments for ED.
Conservative Treatment for Erectile Dysfunction
Conservative treatment measures to treat erectile dysfunction are always considered first before invasive measures such as surgery. Some conservative treatment measures include the following:
Lifestyle Changes
For some men, making a few healthy lifestyle changes may solve the problem. Quitting smoking, losing excess weight, and increasing physical activity may help some men regain sexual function.
Medication Changes
Cutting back on any drugs with harmful side effects is considered next. For example, drugs for high blood pressure work in different ways. If you think a particular drug is causing problems with erection, tell your doctor and ask whether you can try a different class of blood pressure medicine.
Psychotherapy
Experts often treat psychologically based ED using techniques that decrease the anxiety associated with intercourse. The patient’s partner can help with the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when ED from physical causes is being treated.
Drug Therapy
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 March 1998, the Food and Drug Administration (FDA) approved Viagra, the first pill to treat ED. Since that time, vardenafil hydrochloride (Levitra) and tadalafil (Cialis) have also been approved. Additional oral medicines are being tested forsafety and effectiveness.
Viagra, Levitra, and Cialis all belong to a class of drugs called phosphodiesterase (PDE) inhibitors. Taken an hour before sexual activity, these drugs work by enhancing the effects ofnitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulationand allows increased blood flow.
Many men achieve stronger erections by injecting drugs into the penis, causing it to become engorged with blood. These drugs may create unwanted side effects, however, including persistent erection (known as priapism) and scarring.
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.
Research on drugs for treating ED is expanding rapidly. Patients should ask their doctor about the latest advances and what would be the most appropriate choice for their particular situation.
Vacuum Devices
Mechanical vacuum devices cause erection by creating a partial vacuum, which draws blood into the penis, engorging and expanding it.
The devices have three components: a plastic cylinder, into which the penis is placed; a pump, which draws air out of the cylinder; and an elastic band, which is placed around the base of the penis to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back into the body.
One variation of the vacuum device involves a semi rigid rubber sheath that is placed on the penis and remains there after erection is attained and during intercourse.
Surgical Treatment for ED:
Surgery usually has one of three goals:
- To implant a device that can cause the penis to become erect
- To reconstruct arteries to increase flow of blood to the penis
- To block off veins that allow blood to leak from the penile tissues
The most common surgery performed for ED is Penile Implant surgery. Implanted devices, known as prostheses, can restore erection in many men with ED. There are two main types of implants:
Malleable implants:
Malleable implants usually consist of paired rods, which are inserted surgically into the corpora cavernosa. The user manually adjusts the position of the penis and, therefore, the rods.
Adjustment does not affect the width or length of the penis.
Inflatable implants:
Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid.
Tubes connect the cylinders to a fluid reservoir and a pump, which are also surgically implanted.
The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis somewhat. They also leave the penis in a more natural state when not inflated.
Surgery to repair arteries can reduce ED caused by obstructions that block the flow of blood. The best candidates for such surgery are young men with discrete blockage of an artery because of an injury to the crotch or fracture of the pelvis. The procedure is almost never successful in older men with widespread blockage.
Surgery to veins that allow blood to leave the penis usually involves an opposite procedure intentional blockage. Blocking off veins (ligation) can reduce the leakage of blood that diminishes the rigidity of the penis during erection. However, experts have raised questions about the long-term effectiveness of this procedure, and it is rarely done.
Procedure for Penile Implant Surgery
Penile Implant surgery is performed under sterile conditions in the operating room with the patient under general or spinal anaesthesia. The operation usually takes between 1 and 2 hours and is performed as outpatient day surgery with no overnight stay required in the hospital.
Your surgeon will perform the following:
- An incision is made across the top of the scrotum at the base of the penis.
- Special instruments are inserted through the incision to stretch the spongy tissues inside the hollow chambers of the penis (corpora cavernosa).
- Your surgeon then flushes the chambers with antibiotic fluid to reduce the risk of infection post operatively.
- The implant rods or cylinders are then inserted into position inside the penis. If an inflatable prosthesis is used, a pump and valve is inserted into the scrotum and a fluid reservoir is implanted under the abdominal wall through an incision your surgeon will make internally.
- When the prosthesis is in place and functioning, your surgeon will suture the incisions closed.
Postoperative Guidelines
- You will be sent home with pain medications to keep you comfortable.
- You will have a urinary catheter in place that will be removed the next day at your surgeon’s office.
- If an inflatable implant is inserted it will be left inflated until your appointment with your surgeon the next day.
- You should apply an ice pack to the groin area to minimize pain and swelling. Apply ice over a towel, never directly on the skin, for 20 minutes every hour.
- You will be given oral antibiotics to decrease the risk of postoperative infection.
- Your surgeon will instruct you on how to use your new implant once the pain and swelling has subsided.
- Most patients can resume sexual activity in 6-8 weeks.
Risks & Complications
As with any surgery there are potential risks involved. It is important that you are informed of these risks before the surgery takes place.
Most patients do not have complications after Penile Implant surgery; however complications can occur and depend on which type of surgery your doctor performs as well as the patient’s health status. (Obese, diabetic, smoker, etc.)
Complications can be medical (general) or specific to Penile Implant surgery.
Medical complications include those of the anaesthesia and your general well-being. Almost any medical condition can occur so this list is not complete. Complications include:
- Allergic reaction to medications
- Blood loss requiring transfusion with its low risk of disease transmission
- Heart attack, strokes, kidney failure, pneumonia, bladder infections
- Complications from nerve blocks such as infection or nerve damage
- Serious medical problems can lead to ongoing health concerns, prolonged hospitalisation, or rarely death.
Specific complications for Penile Implant surgery include:
Infection:
Infection can occur with any operation. Infection rates vary but are generally low for healthy men. Infection can occur weeks or longer after penile implant surgery and may present as pain, swelling of the scrotum, fever, or drainage.
If infection occurs it can usually be treated with antibiotics but may require further surgery to remove the implant until the infection can be resolved. In rare cases, the prosthesis has eroded through the skin requiring surgical intervention.
Mechanical Breakdown:
Although rare, mechanical breakdown can occur and requires surgery to repair or replace the broken prosthesis. Mechanical problems with implants have diminished in recent years due to technological advances.
Injury to the Urethra:
Damage to the urethra is rare but can occur during surgery requiring repair.