Men with erectile dysfunction often don’t seek treatment. But they should. It can be a sign of serious health problems, including diabetes, heart disease and low testosterone. Your doctor may order blood or urine tests to check for these. They might also ask about your medical history, sex life and attitudes towards sex.
Medications
Medications, including the popular Viagra pill, can improve blood flow to the penis and help you achieve an erection. Other FDA-approved drugs for erectile dysfunction include avanafil (Stendra), tadalafil (Cialis) and vardenafil (Levitra). These medications work best when you are sexually aroused.
Other medications, including antidepressants, 5-reductase inhibitors (5-ARIs) and neuropsychiatric medications, can cause or worsen ED. You should let your doctor know if you’re experiencing erectile dysfunction while taking one of these drugs.
You can also take steps to improve your sex life by adjusting the timing of your medications, limiting alcohol, smoking and illicit drugs, exercising regularly, maintaining a healthy weight and managing stress. Involving your sexual partner in therapy can also help you build confidence and trust. Many people who experience ED as a result of medication will find it improves with time. Medications do not improve sex drive or make erections last longer, but they can help you enjoy a satisfying sex life.
Penile Implants
Penile implants provide an immediate, lasting solution for men who don’t get good results from medications or other less invasive treatments. However, they don’t restore libido, sensation or orgasm.
Before giving you a penile implant, your doctor will review your health history and do a physical exam, including a urologic examination. He will ask about your expectations and goals for treatment, as well as whether you have any concerns about surgery or recovery.
Your doctor will help you decide which type of implant to choose. One-piece implants use flexible or semirigid cylinders that can be bent for sexual intercourse, but they remain flaccid when not in use (see picture). You can also conceal these types of prostheses under clothing.
Two-piece implants use a fluid-filled reservoir in your abdomen and a pump with a release valve in the scrotum. Pressing the pump transfers fluid from the cylinders in your penis to the pump bulb, creating an erection. Bending the cylinders causes them to deflate, and squeezing the pump drains the fluid back into the reservoir.
Microsurgical Penile Revascularization
Penile revascularization surgery can improve erections in men who have a vascular blockage to the penis. This surgery is similar to a coronary bypass for the heart and is most appropriate in young healthy men who sustain pelvic or perineal trauma and have a resulting vascular injury of the common penile artery that results in erectile dysfunction. It is a highly specialized procedure requiring specialized preoperative duplex Doppler ultrasound testing (dynamic cavernosometry) and selective inferior epigastric arteriography. It is also very difficult to perform and rarely performed by urologists due to its complexity, the need for specialized microvascular training, and it is generally not reimbursed by insurance.
To perform this operation, the inferior epigastric artery is identified from the abdominal perspective and is dissected using blunt finger dissection to preserve its transfer route to the penis. The inferior epigastric artery is then anastomosed to the dorsal penile artery through a penoscrotal incision. A Penrose drain is placed to protect this transfer route.
Lifestyle Changes
Many men pay little attention to their bodies until something goes wrong, like a heart attack or pulled hamstring. But good body awareness is key to healthy sexual function and overall wellness.
Studies have shown that lifestyle changes can reduce or eliminate erectile dysfunction symptoms. These include regular cardiovascular exercise, which can help blood flow to the penis during an erection; eating a balanced diet that is low in saturated fat, sugar and trans-fats; limiting alcohol consumption; and managing stress.
Most men experience occasional difficulties getting or keeping an erection, especially after heavy drinking or as a side effect of certain medicines. If these problems persist, it is important to see a doctor so that the underlying cause can be addressed. For most men, a few simple lifestyle changes can improve their erectile function and lead to better health in general. They are also good habits to promote in the family. Most of these are also good for the environment, which can be an additional motivation to make these changes.
