Erectile dysfunction (ED) is a medical term that describes the inability to achieve and/or maintain an erect penis adequate for sexual function.
This condition is one of the most common sexual problems for men and the change for a man to develop ED increases with age. It is estimated between 15 to 30 million American men suffer from ED.
Although it may be understandable to be embarrassed, Dr. Shaw and Dr. Law treat folks of all ages, from those in their 30s, to well in their 90s. His favorite quote to patients is that “if it’s important to you, it’s important to me.” Sexual function is personal, and we respect each person’s ability to preserve sexual health as a part of their relationship.
Dr. Shaw and Dr. Law are proud to offer comprehensive treatment of Erectile Dysfunction in Austin. Treatment involves a thorough examination and evaluation. This includes checking testosterone levels if needed. Many patients will simply do well with treatment such as Viagra®, Levitra or Cialis®. Others will need injectable treatment (what I refer to as “liquid Viagra®”) for more significant cases. Finally, others may need to consider vacuum erection devices, or surgery such as implanted inflatable penile prosthesis (IPP).
Use it or lose it! Dr. Shaw and Dr. Law believe in putting their patients through a program of “Erectile Recovery” to gradually improve erections.
Erectile Dysfunction Information
What happens under normal conditions?
What are the risk factors for ED?
- Age over 50
- Sleep apnea
- High blood pressure
- High cholesterol
- Cardiovascular disease
These risk factors can slowly destroy nerves and blood vessels in the penis over time. These
blood vessels and nerves are critical for erectile function. Abnormally low levels of testosterone may also cause ED, along with lack of exercise, poor diet, and a sedentary lifestyle (in which one is not physically active). Patients undergoing surgery or radiation therapy for cancer of the prostate, bladder, colon or rectum are at high risk for the development of ED.
Abnormally low levels of circulating testosterone may cause ED, although low testosterone is found in a minority of men who develop ED. Low levels of sexual desire, lack of energy, mood disturbances, loss of muscle strength and depression can all be symptoms of low testosterone. A simple blood test can determine if the testosterone level is abnormally low, and testosterone can be replaced using a number of different delivery systems (e.g., shots, skin patches, gels, subdermal implants).
The choices we make in life can lead to degeneration of the erectile tissue and the development of ED. Smoking, drug or alcohol abuse, particularly over a long period of time, will compromise the blood vessels of the penis. Lack of exercise and a sedentary lifestyle will contribute to the development of ED. Modifying these risk factors may contribute to overall health and may in some individuals correct mild ED.
Treatment of many medical conditions can interfere with normal erections. Drugs used to treat these risk factors listed above may also lead to or worsen ED. Another cause of ED is peripheral neuropathy in which the nerves leading to the penis fail to send coordinated signals to the penis. Peripheral neuropathy can be caused by diabetes, HIV infection, certain medications and other less common conditions.
How is ED diagnosed?
What are some non-surgical treatments?
- Increasing exercise – about 30 minute of cardio per day
- Diet – decreasing carbohydrates and fats, also reducing processed foods
- Visiting with primary care doctor to ensure that diabetes, blood pressure, and cholesterol are managed.
Oral PDE-5 Inhibitors (i.e., Viagra, Cialis, Levitra, Staxyn) work by increasing blood flow to the penis, and maintaining that blood flow long enough for intercourse. These medications are typically taken 30 minutes before intercourse. Common side effects include headache, muscle ache, and nasal congestion. The drugs boost the natural signals that are generated during sex, thereby improving and prolonging the erection itself. These medications are safe and often effective, with improvement in erection in nearly 80 percent of patients using these drugs.
There is also a low dose Cialis 5mg, which is taken daily or every other day. We often refer to this as the baby aspirin of the oral ED medications, since blood flow is increased to the penis little by little every day. This allows you to achieve an erection when you want to, instead of taking a pill 30 minutes before intercourse. Since the half-life of Cialis 5mg is 36 hours, it is still effective if you take it every other day.
If erection returns with simple treatment like oral medication and the patient is satisfied, no further diagnosis and treatment are necessary. Sometimes patients may have to experiment with different treatment options. We do our best to advise you along the way, and help you choose the most effective treatment plan, which also fits your lifestyle.
Alprostadil Urethral Suppository – For men who do not respond to oral medications another drug, alprostadil, is approved for use in men with ED. This drug comes in two forms: injections that the patient places directly into the side of the penis and a intraurethral suppository. Success rates in achieving a firm erection useful for sexual intercourse with self-injection can reach 85 percent. Modifying alprostadil to allow intraurethral delivery avoids the need for a shot, but reduces the likelihood of successful treatment. The most common adverse effects of alprostadil use are a burning sensation in the penis and a prolonged erection lasting over four hours, requiring medical intervention to reverse the erection.
Injectable PDE-5 Inhibitor works similarly to the oral medications, however it goes directly into the penis. We often refer to this as “liquid Viagra.” Since it is a localized treatment, most people will have excellent results. The medication is administered 20-30 minutes before intercourse. Side effects may include skin reactions; for this reason we recommend alternating sites of injection.
We offer a demonstration and low dose trial of the injectable medication here in our clinic, and you will know whether or not the medication works well within about 15 minutes. The kit you will pick up from the pharmacy includes medication, syringes, needles, and alcohol pads. We understand that the thought of injecting the penis is unpleasant; however, most men actually leave our clinic saying that the injection is not as bad as they thought. Listed below are some tips to keep in mind when self-administering the medication:
- Inject about one inch away from the base of the penis
- Avoid any superficial blood vessels
- Alternate sides of injection each time
- Each syringe is 1.0cc, increase the dose by 0.10cc at a time
- Do not inject more than 1.0cc without talking to your doctor
- If an erection lasts for an hour, take a dose of Sudafed, this will help resolve the erection
- If an erection lasts for 2 hours or longer, go to the emergency room
Vacuum erection device (VED), also referred to as a Vacuum Pump. The device works by dilating blood vessels in the penis, similar to how the medications work, but through a manual pump. Once the desired erection is achieved, a rubber band is placed at the base of the penis, hold the erection in place. This not only helps with intercourse, but offers rehabilitation to patients who have lost some of their nerve function with removal of the prostate. The VED company representatives offer one-on-one information sessions monthly at our clinic. You are welcome to set up an appointment at your convenience.
What is the surgical treatment for ED?
There are some men who have severe degeneration in the tissues of the penis, which makes them unable to respond to any of the treatments listed above. While this is a small number of men, they usually have the most severe forms of ED. Patients most likely to fall into this group are men with advanced diabetes, men who suffered from ED before undergoing surgical or radiation treatment for prostate or bladder cancer and men with deformities of the penis called Peyronie’s disease. For these patients reconstructive prosthetic surgery (placement of a penile prosthesis or “implant”) will create an erection, with patient satisfaction rates approaching 90 percent. The implantation is done as a surgical procedure, under general anesthesia and patients usually stay one night in the hospital. Two long cylinders are placed in the two chambers of the penis, and a pump is placed in the scrotal sac. The IPP works by manually using the pump to fill the two empty chambers up with saline or fluid in the pump, which results in erection. The pump will also work to release the fluid, thereby eliminating the erection when needed. Neither the operation to implant a prosthesis nor the device itself will interfere with sensation, orgasm, ejaculation or urination.
Possible adverse effects include infection of the prosthesis or mechanical failure of the device.
What can be expected after treatment?
How do I know my ED is not in my head?
Can I combine treatment options?
I was fine until I began taking this new drug, what should I do?
Some men, who do not have improvement with the above treatments, may try Paxil. Paxil is an SSRI which is typically used for anxiety and depression; however the side effect of this medication is delayed ejaculation. Behavioral therapy or visiting with a counselor has also been beneficial in treating premature ejaculation.
Where can I get more information?
- Erectile Dysfunction
- Diagnosing Erectile Dysfunction
- Treating Erectile Dysfunction: Medical Options
- Treating Erectile Dysfunction: Surgical Treatment Options
- Preventing Erectile Dysfunction: What You Should Know
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