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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. Tsai 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. Tsai 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. Tsai believe in putting their patients through a program of “Erectile Recovery” to gradually improve erections.
Achieving a normal erection is a complex process involving psychological impulses from the brain, adequate levels of the male sex hormone testosterone, a functioning nervous system, and adequate and healthy vascular tissue in the penis. The simplest way to describe the process of erection is to think of a washing machine. The “on-off” switch (the brain) initiates the process; the wires in the washing machine (the nerves) carry the electrical signal to the pipes (the blood vessels), when an appropriate signal arrives a valve opens to allow water to flow in (the arteries carry blood into the penis) and the drain shuts (the penile veins close). Water flows in and fills the tank (the penis fills with blood and becomes erect) and the wash cycle begins (enjoys sexual activity). At the end of the wash cycle this process reverses, the switch goes to the off position (the brain terminates erection), the valve closes (the arteries markedly decrease blood inflow) and the drain opens draining the wash tank of water (the veins open, blood leaves the penis and erection subsides).
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.
For most patients, the diagnosis will require a simple medical history, physical examination and a few routine blood tests. Most patients do not require extensive testing before beginning treatment. The choice of testing and treatment depends on the goals of the individual. If erection returns with simple treatment like oral medication and the patient is satisfied, no further diagnosis and treatment are necessary. If the initial treatment response is inadequate or the patient is not satisfied, then further steps may be taken. In general, as more invasive treatment options are chosen, testing may be more complex.
Modifying risk factors such as diabetes, high blood pressure, high cholesterol, and smoking may help improve the underlying disease that could possibly be contributing to ED.
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:
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.
Implanted Inflatable Penile Prosthesis (IPP)
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.
All of the treatments above, with the exception of prosthetic reconstructive surgery, are temporary and meant for use on demand. The treatments compensate for but do not correct the underlying problem in the penis. So it is important to follow-up with your doctor and report on the success of the therapy. If your goals are not reached, if your erection is not of sufficient quality or duration and you are still distressed, you should explore the alternatives with your doctor. Because the medications used are not correcting the problems leading to ED, your response over time may not be what it once was. If such should occur again, have a repeat discussion with your physician about the remaining treatment options.
We now realize that most men have an underlying physical cause and that the cause of ED is often a combination of physical and psychological factors. Nothing happens in the body without the brain, and worrying about your ability to get an erection can itself interfere with the process. This condition is called performance anxiety and can be overcome with education and treatment.
This is often done but because of the risk of prolonged erections with drug therapy it should only be performed under physician supervision. Ask your doctor for proper instructions.
Many drugs can cause ED, but some cannot be changed because the benefits outweigh the adverse effects. If you are fairly certain that a specific drug has caused the problem, discuss the possibility of a medication change with your doctor. If you must remain on the specific medication causing the problem, the treatment options outlined above can still be used in most cases.
As with erectile dysfunction, premature ejaculation is a disorder where the bodily functions are beyond the control of the man experiencing the symptoms. Treatment typically begins with using a medication for erectile dysfunction (usually Cialis 5mg daily). This helps by keeping the penis erect longer and thereby delaying ejaculation. Other techniques that delay ejaculation include condom use and lidocaine sprays or creams. The lidocaine can decrease sensation though and may be irritating to your partner.
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.