DEFINING ERECTILE DYSFUNCTION
Erectile dysfunction (ED) is defined as the inability to have an erection satisfactory for penetration. It is a very common complaint in men and fortunately, one that can be restored in most situations.
The causes are often psychogenic (anxiety, fear of not satisfying one’s partner, depression, etc.) or physical (trauma to the external genitalia , radiation injury, pelvic surgery, etc.). Rarely, the cause may be hormonal, i.e., secondary to a low serum testosterone (male sex hormone) level. Regardless of the cause, treatment is often effective in a single office session.
Erectile dysfunction can occur transiently as a result of the above causes which can be treated by reducing the psychogenic cause or if physical, have the ED treated by medical, injectable or surgical therapy. For example, erectile dysfunction (ED) in men who are anxious or who are afraid of “under-performing” can often be discerned on history and treated by reassurance and by reducing one’s fear of failure. If this approach is not successful, a small dose of medication used to increase blood flow to the penis is often enough to convince the patient that he does not have an ailment which can’t be corrected.
Medical therapy to improve penile blood flow has been the major advance in men’s health over the past several decades. There are a host of Food and Drug Administration approved medications around which can be utilized but the dosage and timing of these medications must be coordinated by a physician so that the incidence of negative side effects is kept to a minimum.
Hormonal therapy (testosterone supplementation) can often restore potency in men who have “low” serum testosterone levels. Testosterone is not absorbed orally so there is no testosterone medication a man can take by mouth. Testosterone therapy is provided in the form of a gel, drug patches or by deep tissue (muscle) injection. For those patients that do not respond to oral medical therapy, a vacuum pump device will often be satisfactory. The pump is a bit cumbersome but many couples find it to be acceptable.
Direct injection into the penile tissue of medications used to increase penile flow is another approach particularly in men who find the oral medications ineffective and/or who do not wish to use a vacuum pump. Men have to be taught by a physician how and where to inject the medication which one does prior to each sexual encounter. The erection provide by this technique is often very firm and can last for several hours. The downside to injection therapy is that it does cause a small amount of pain (particularly following the first few injections) and may stimulate the formation of some penile scar tissue. For those patients who do not respond to any of the above treatments, implantation of a surgical prosthesis (silicone rods) is the remaining option. This is a surgical procedure which is performed under an anesthetic in a hospital or ambulatory surgical care setting. The advantages are that no medication is involved and “one is always ready”. The downside is that this is a surgical procedure and there is a slight risk of infection since the rods are foreign bodies. If this does occur, the prosthesis may have to be removed.
Most cases of ED can be treated successfully. Usually one or a few physician visits can remedy the situation to everyone’s satisfaction.