Treatment Urology

Erectile Dysfunction

There are a variety of treatment options available for erectile dysfunction, which will be explained to you by your doctor. Your therapy will depend on the cause of ED, your age, your health and you and your doctor's preferences.

In most cases, an oral medication, such as Viagra, Levitra or Cialis, will be recommended first. Depending on its effectiveness and your tolerance to the medication, other approaches may be tried. In patients who have blood vessel blockage or leakage, microvascular surgery may be recommended. For those who do not respond to non-surgical treatments or are not candidates for surgery, penile prosthesis is an excellent alternative.

It is important to note that it is not necessary to have an erection to have an orgasm. A vibrator or creative and attentive partner can be helpful.

Oral Medications

Viagra, Levitra and Cialis are oral medications that have been approved by the Food and Drug Administration (FDA) for the treatment of ED. They are in pill form and must be taken by mouth.

Since its introduction in 1998, Viagra has become the drug of choice for treating ED. When a man is sexually stimulated, chemicals like nitric oxide are released into the nerve terminals, which cause the penile smooth muscles to relax, helping to foster an erection. A compound called cyclic guanine monophosphate (cGMP) is involved in this process. After an erection occurs, an enzyme called phosphodiesterase-5 (PDE-5) breaks down cGMP and returns the penis to a flaccid state. Viagra works to improve smooth muscle relaxation and erections by blocking the action of PDE-5, which causes an increase in the levels of cGMP in the penis.

Levitra and Cialis have a similar mechanism to Viagra. It is important to note that all oral medications for ED must be followed by sexual stimulation in order to achieve the desired erection.

For more information, please see Oral Medications for Erectile Dysfunction.

Urethral Suppository (MUSE)

Medicated urethral system for erection (MUSE) is often used when oral medications are not effective. This approach uses a small suppository of medication that is placed in the penile uretha without needles. The suppository is then absorbed and helps to produce an erection.

Large studies conducted in Europe and the United States reported that MUSE was effective in 43 percent of men with impotence of varying causes. The major advantage of the therapy is that is applied locally by patients or their partners, and has few side effects. However, the therapy has been shown to cause moderate penile pain and can have inconsistent response rates. Sometimes an adjustable rubber tension ring is applied at the base of the penis and improves results.

Patients using MUSE should have their first application performed in their doctor's office, to prevent complications such as urethral bleeding, decreased blood pressures, and sustained and prolonged erections. In addition, in rare instances, feelings of lightheadedness or decreased blood pressure may occur.

It also is important to note that after inserting the suppository into the penile uretha, sexual stimulation is required to increase blood flow to the penis. Medication should be refrigerated and maximum use is limited to one suppository per day.

Penile Injections

Penile injections are another treatment option for ED when oral medications are ineffective. Although the idea of inserting something into your penis is probably unappealing, thousands of men will testify to the effectiveness and ease of the injections.

In addition to two FDA approved medications called Caverject and Edex, urologists also use a combination of drugs, including papaverine, phentolamine and alprosdid. In most cases, a combination of two or three medications is used for injection. This combination, known as Trimix, allows for a synergistic effect of the three medications, while keeping the dose of each drug low enough to prevent side effects. In addition, the response rate of the Trimix solution is as high as 90 percent.

Men must receive appropriate training and education by their doctor before beginning home injection therapy. The goal of the injection medicine is to achieve an erection that is sustained for sexual intercourse, but not prolonged or painful. The injections must be given in proper amounts with the appropriate technique to minimize the risk of scarring the penis or developing priapism.

For more information on how to use penile injections, please see Patient Guide to Penile Injections.

Vacuum Device

In patients who only have partial erections, and do not respond to other treatments or prefer not to use them, a vacuum device may be helpful. The device consists of a plastic cylinder connected to a pump and a constriction ring. A vacuum pump uses either manual or battery power to create suction around the penis and bring blood into it. A constriction device is then released around the base of the penis to keep blood in the penis and maintain the erection.

A vacuum device can be used safely for up to 30 minutes, which is when the constriction device should be removed. The advantage of a vacuum device is it is relatively inexpensive, easy to use and avoids drug interactions and serious side effects. Potential side effects associated with the vacuum device are temporary and may include penile numbness, trapping the ejaculate and some bruising.

Penile Prosthesis

For men with erectile dysfunction who do not tolerate or respond to other treatments, a penile prosthesis offers an effective, yet more invasive alternative because it requires surgery. Prostheses come in either a semi-rigid form or as an inflatable device. Most men prefer the placement of the inflatable penile prosthesis, which consists of a pump that contains the inflation and deflation mechanism.

Although the placement of the penile prosthesis requires surgery, patient and partner satisfaction rates are as high as 85 percent. However, it is important to note that full penile length might not be restored to the patient's natural erect status.

Placing the prosthesis within the penis requires the use of an anesthetic. A skin incision is made either at the junction of the penis and scrotum, or just above the penis, depending on which prosthesis and technique is used. The spongy tissue of the penis is exposed and dilated; the prosthesis is then sized and the proper device is placed. The inflatable device is placed is the scrotum. The patient can control his erection at will by pushing a button under the skin.

Side effects associated with penile prosthesis include infection, pain and device malfunction or failure. As the nerves that control sensation are not injured, the penile sensation and the ability have an orgasm should be maintained.

Penile Vascular Reconstructive Surgery

Penile venous surgery is recommended only for young men who have ED as result of congenital or traumatic venous leakage of the penis. The procedure is performed to improve the trapping of blood in the penis, improving a man's ability to get and maintain an erection. Penile arterial surgery generally involves bypassing blocked arteries by transferring an artery from behind the abdominal muscle to a penile artery. This creates a path to the penis that bypasses the area of blockage, which is inhibiting blood flow to the penis.

UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.

Recommended reading

Erectile Dysfunction Causes

The greatest medical risk factors for erectile dysfunction include diabetes mellitus, heart disease, and hypertension. Learn more here.

Oral Medications for Erectile Dysfunction

Find a list of oral medications for Erectile Dysfunction (ED) including, viagra, levitra, and cialis and possible side effects and important things to remember.

Patient Guide to Penile Injections

Although you probably find the idea of injecting something into your penis unappealing, many men are highly satisfied with this therapy. Learn why here.

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