Erectile Dysfunction (ED)
What causes ED?
Erectile dysfunction, also known as impotence, has many different causes. Many common medical diseases such as diabetes, high blood pressure, and elevated cholesterol can cause damage to the tiny blood vessels and nerves that are involved in achieving an erection. ED can also be caused by nerve damage secondary to surgery or radiation to treat prostate cancer. Psychological factors can also play a large role in the development of ED as can low levels of testosterone, and ED can also be a side effect of many types of medications.
How is ED treated?
There are several different options for the treatment of ED. If a specific cause such as low testosterone or a new medication can be identified, removal or correction of the cause should reverse the ED.
In cases of ED caused by other factors that may not be able to be corrected such as diabetes, the initial treatment is often a trial of one of the oral medications such as sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis). These medications help to prevent the breakdown of a substance called nitric oxide which is involved in getting an erection. These medications do not have significant side effects for the majority of patients and are an excellent first line treatment.
If the oral medications do not work, other medication options include intra-urethral alprostadil or MUSE which is a small pellet placed into the tip of the urethra and vasoactive injections of medications directly into the side of the penis with a tiny needle.
The vacuum erection device can also be very effective but can be somewhat cumbersome so often works best for motivated patients in a stable relationship. Last but not least are penile prostheses.
A prosthesis can be either semi-rigid which is a non-mechanical implant with flexible cylinders that are rigid enough for intercourse when straightened, or the prosthesis can be inflatable which utilizes to cylinders and a fluid reservoir. When an erection is desired, a pump placed in the scrotum is pressed and the fluid fills the cylinders to achieve an erection.