Erectile dysfunction (commonly mis-spelled as erectile disfunction) is the repeated inability to achieve or maintain an erection long enough for sexual intercourse. Erectile dysfunction is also sometimes called impotence. Impotence may be used to describe other problems that interfere with sexual intercourse, for example lack of sexual desire, problems with ejaculation or problems achieving an orgasm.

Erectile dysfunction is a symptom of Impotence, see more on this at a previous post here.

Common Erectile Dysfunction Treatments

Erectile Dysfunction treatment usually falls under two categories, non-surgical or surgical. Non-surgical treatment may include oral (pills), injectible & penile devices such as vacuum pumps. Surgical options may include injectible therapy: penile implants & vascular reconstructive surgery.

NON-SURGICAL ERECTILE DYSFUNCTION TREATMENT

Oral treatment: Please note that the treatment discussed here cannot be used by men taking nitrates or those with any cardiovascular disease(s).

PDE5 Inhibitors

There are currently three Phosphodiesterase 5 (PDE5) inhibitors available to treat erectile dysfunction: Sildenafil (Viagra), Tadalafil (Cialis) and Vardenafil (Levitra). PDE5 inhibitors (sildenafil, tadalafil and vardenafil) are the gold standards of oral therapies. They act by promoting penile cavernous and vascular smooth muscle relaxation inducing an erection in response to sexual stimulation. Benefit from these medications is dependent on adequate sexual stimulation. Once tissue expansion is sufficient, the veins that exit the trabecular tissue through the tough fibrous capsule are compressed, which prevents further escape of blood. Thus, in the penis, the high flow of the developing erection is converted to the low flow of a fully erect penis. Vardenafil (Levitra) is significantly superior to sildenafil (viagra) in terms of erectile function, intercourse satisfaction and overall satisfaction. There are also a significant higher percentage of positive responses for vardenafil with regards to erection hardness for penetration, maintenance of erection, maintenance until completion, and erection confidence.

Side effects of PDE5 Inhibitors

Hypotension is a common side effects of pde5 inhibitors. Hypotension, not to be confused with hypertension refers to abnormally low blood pressure. Hypertension refers to abnormally high blood pressure. Hypotension can in some instances be life threatening - because reduced blood flow to vital organs such as the brain, heart and kidneys can cause organ failure and ultimately lead to death.

Other side effects of all three medications include:

• facial flushing
• nasal congestion
• headache
• upset stomach
• heartburn
• dizziness
• changes in vision (color, glare)
• dyspepsia

Sildenafil and vardenafil may cause visual side effects. A limited number a patients taking tadalafil report back pain. Many men being treated for erectile dysfunction are also taking medication for treatment of hypertension or lower urinary tract symptoms. PDE5 inhibitors interact with beta blockers, a class of drugs commonly used to treat hypertension and lower urinary tract symptoms. Vardenafil should not be used by any patient taking any other medication with alpha blocker activity.

Natural / Herbal Supplements

Natural / Herbal supplements are mainly favored over drugs because drugs are mainly used to eradicate the disease being treated, and usually tend to interfere with specific biological pathways by trying to modify or amend them. Sometimes this interference could be very dominant or unnatural, leading to a long list of side effects which accompany the treatment. Nutritional supplements are natural and augmentative; they enhance and support existing body functions to overcome the ailment. Supplements work towards overall health and wellness of the body.

Traditional natural healing products for the treatment of erectile dysfunction were not always readily available in the western world. Now you can chose a natural rather than a man-made solution for erectile dysfunction as a safe alternative. With a natural healing product, you retain the power to control your erection as opposed to oral and man-made drugs which induce an erection for a longer period of time but do not give you the control. A natural healing product will help boost your self esteem and confidence by allowing you to get an erection and to maintain it for as long as desired.

Side effects of Natural / Herbal Supplements

The ingredients in natural supplements have a long history of use in humans and are not known to interact in any adverse way at the suggested dose with any foods. However, as a general rule of precaution, it is recommended that anyone with any medical conditions including but not limited to anyone on prescription medications, or with a history of cancer, heart disease, stroke, migraine headaches, renal failure, liver failure, severe allergies, or other conditions, should consult their physician before starting with natural supplements. Also, if you are using other supplements, please check with the ingredient list to make sure that you are not going to ingest an unadvisable dose for any of the individual ingredients. It is best to discontinue the usage of that particular herb.

Natural supplements are cheap, effective and non-prescription methods of erectile dysfunction treatment and should be seriously considered in the first step towards treatment. If desired results are not achieved, one may then advance to the next level of non-surgical therapy.

Injectible therapy

Intracavernous vasoactive drug injection therapy is invasive, but it is one of the most effective non-surgical treatments for erectile dysfunction. The most widely used drugs for this therapy are alprostadil, papaverine (Pavabid), and phentolamine. The initial dose of all intracavernous injection medications should be administered in the presence of a physician to instruct the patient on proper technique, determine the most effective dose, and monitor the patient for side effects.

Side effects of Intracavernous vasoactive drug injection therapy

• Priapism (painful prolonged erections lasting four hours or more)
• Corporal tissue damage
• penile pain
• scarring

Alprostadil injections

A successful erection requires an increased flow of blood into the penis. Alprostadil (also known as prostaglandin E1) is a potent vasodilator; it widens arteries, allowing them to carry more blood. But its potency is a drawback as well as an asset. It is very effective inproducing erections, but to be safe it must be administered directly to the penis by injections or pellets.

The most effective way to take alprostadil is to inject it directly into the corpus cavernosa, the shaft of the spongy tissue that brings blood to the penis. It sounds like torture, but most men can master the technique with brief instruction from a urologist. The needle is very small and the injection is generally well tolerated. The usual dose is 5-20 micrograms (mcg) per injection; some men respond to as little as 2.5 mcg, while others require up to 60 mcg.

This simple and highly effective method produces an erection within 5 to 20 minutes after a man injects the medication into the base of the penis, causing the smooth muscle tissue of the penis to relax and allowing blood to flow into the corpora cavernosa.

Alprostadil works rapidly. Since it bypasses the nervous system and produces an erection by acting directly on arteries, it does not require sexual stimulation to do its work. Without sufficient erotic stimulation, however, some men may fail to achieve orgasm despite having good erections. Some men have reported a return of spontaneous erections after long-term alprostadil use, possibly because the drug has improved the penile circulation.

Alprostadil injections are highly effective, producing an erection in up to 80% of patients. Still, many men abandon the treatment, usually because they find it unpleasant or, in 15%-20%, painful.

Side effects of Alprostadil injection therapy

• pain
• prolonged erections
• priapism
• Minor bleeding may occur

Alprostadil should not be used more than once a day or three times a week. Nearly every man who has a choice between alprostadil injections and oral medication prefers an erectile dysfunction pill. But alprostadil is effective in many men who fail to respond to pills and, unlike the pills, it is safe for men taking nitrate medications. Some men who do not respond to an erectile dysfunction pill or to alprostadil may respond to a combination of the two, but since low blood pressure is a serious risk, a trial of combination therapy requires careful medical supervision. About a third of patients who try combination therapy experience significant adverse effects.
Alprostadil is most effective when taken by injection, but men who find the procedure daunting or unpleasant can consider using the drug in pellet form.

Penile Devices

Vacuum Pumps: Vacuum tumescence devices (VTDs) consist of a plastic cylinder, a vacuum pump to produce an erection and a constriction ring to maintain it. The advantages of VTDs is that they are non-invasive and very effective. However, they are cumbersome, need good manual dexterity, and can lead to coldness, bruising and cyanosis of the penis and ejaculatory block. Vacuum constriction devices are a low-cost treatment appropriate for some patients with erectile dysfunction. To avoid injury to the penis, only devices that contain a vacuum limiter should be used. Vacuum constriction devices are available with or without a prescription.

Most men with ED can use a vacuum constriction device to achieve erections without medication. The penis is placed in an airtight plastic cylinder attached to a hand pump. Air is pumped out of the cylinder to create a vacuum, which increases penile blood flow. When the penis is erect, a special band is secured around its base to retain the blood after the cylinder is removed. When intercourse is complete, the band is removed and the penis becomes flaccid. Vacuum devices are up to 90% effective in producing satisfactory erections within 5 minutes. About 10% of men experience adverse effects, including penile bruising, numbness, pain, and impaired ejaculation. The side effects are almost always mild; and the device does not produce excessive bleeding in men taking anticoagulants (blood thinners). Vacuum devices cost between $150 and $450 and are available without a prescription.

Side effects of Vacuum pumps

• penile bruising
• numbness
• penile pain
• impaired ejaculation

Counseling and sex therapy

About 90% of men with erectile dysfunction of no identifiable organic cause respond well to erectile dysfunction pills, and most of the others can benefit from alprostadil or the pump. Still, if the cause of impotence is psychological, psychotherapy is the only way to correct the basic problem. Therapists who specialize in sexual dysfunction can also help a man and his partner cope with a broad range of sexual problems that even a good erection won’t resolve. One can also try common Sense measures / Lifestyle changes such as:

• Quitting smoking
• Regular Exercise
• Reducing Stress
• Reducing alcohol consumption
• Eating an improved diet low in saturated fats

SURGICAL ERECTILE DYSFUNCTION TREATMENT

Penile Implants

Surgical penile implants should be the last resort when all other treatments have failed. Two approaches are available; one implants silicone rods that produce a permanent erection - because the rods can be bent up and down, the erect penis can be concealed under clothing. The alternative is an inflatable device that produces an erection when it is filled with fluid pumped from a reservoir placed in the abdomen. Inflatable implants function more naturally, but they have a higher rate of complications and failure than rigid implants. More than 200,000 American men have had penile implants, but fewer men are choosing this method now that less invasive treatments are available.

Vascular reconstructive surgery

Vascular reconstructive surgery is performed to improve the blood supply of the penis in attempts to improve a man’s ability to get and maintain an erection. Because the procedure is technically difficult, costly and not always effective, it is very rarely performed. Vascular reconstructive surgery of the penis generally involves bypassing blocked arteries by transferring an artery from an abdominal muscle to a penile artery so that it creates a path to the penis that bypasses the area of blockage that is inhibiting blood flow to the penis.

Only a small percentage of men may be candidates for this surgery, in particular young men suffering from erectile dysfunction as a result of trauma to the penis and surrounding areas. If you fall into this category, talk to your doctor to see if vascular reconstructive surgery is right for you.

Unfortunately, the long-term results from this type of surgery have been disappointing with even the best of results showing only 1 out of 20 men improved. However, for younger men with a single damaged blood vessel that occurred as a result of a pelvic or genital injury, the success rate for this treatment is higher (typically 50%-75%).

Vascular surgery may be able to correct problems in penile circulation, restoring erectile function to some men. It’s a logical approach, but the results have been very poor in typical erectile dysfunction patients and in older men. Still, some young men with hereditary or traumatic causes of impotence may wish to consult a specially trained urologist to discuss this possibility.

Conclusion

For someone considering erectile dysfunction treatment, it may be more economical and advantageous to take a multi-level approach. Start with non-surgical treatments, specifically natural supplements, then pde5 inhibitors before considering surgical treatments such as penile implants etc. Always ensure to combine whatever treatment you undergo with a healthy lifestyle by maintaining a proper diet and exercising regularly to improve your overall blood circulation.