As a urologist with a general practice I see a lot of men with erectile dysfunction, and somewhere around fifty percent of men in their fifties may have some difficulty with erectile dysfunction, and that will increase with age, a particularly in middle-aged or older men. If a man presents with erectile dysfunction, there is increased risk that they have cardiovascular disease and so would be prudent for them to be evaluated by their primary physician or cardiologist.
Contributing factors to ED
The major contributing factors to erectile dysfunction include poor blood flow and impairment of the nerve signals. So it’s common particularly in patients that have diabetes or high blood pressure.
Often there is not extensive testing that’s needed before a man can be offered treatment. Most commonly men will be offered treatment with one of the pills that are available now. Viagra, Cialis, Levitra has been the medications most widely-known. They are a similar category of medication that dilates the blood vessels in the penis, which allows the inflow of the blood. 75% of the patients that try those will get an improvement in the quality of erection on the medication.
A man can try what we call a vacuum device that involves a plastic tube, that’s put over the penis and suction either with an automatic device or hand pump will pull in the blood, and that will allow for the rigidity of the penis. And then an elastic ring that is soft will be slipped down off the base of the device onto the base of the penis, and that keeps the blood in. It’s not only effective, but it’s actually relatively inexpensive compared to some of the other treatments. It is non-invasive and then not requiring medication in the system, so that’s very popular.
Also very effective is a technique we call injection therapy. A patient can actually be taught to use a very small needle and inject into the side of the penis medication that also dilates the blood vessels. And that medication is pretty successful as well. 75-80% of men that try that will be able to handle the injection technique and get a positive response.
There are two additional options. There’s a medication called MUSE. And there’s a little plastic dispenser that allows a little pellet of medication to be placed into the urethra, into the opening of the penis. A lower chance of being successful but still is substantial and is an option for patients. Again, the mechanism is that the medication is absorbed into the bloodstream and that turns on blood flow to the penis.
For patients who have failed other treatments or who don’t have other options, we do have the surgical option of implanting a prosthetic device. They are very sophisticated now; they can be very effective.
Most men have an excellent chance of having satisfactory treatment of ED with these treatment options, but it depends on what they are comfortable within and the medical concerns that were trying to match up.