Treatment
Reduce stress or anxiety as much as possible. Mental or emotional states such as stress or anxiety may cause erectile dysfunction. Yoga or meditation may help to decrease stress.
Eat a low-fat diet. A high-fat diet is a risk factor for hardening and/or blockage of the blood vessels (atherosclerosis). Just as in the heart, the blood vessels supplying the penis may also be affected.
A low-fat diet improves blood flow to all parts of the body. Reducing cholesterol levels heightens sexual potency. Reduce alcohol intake, as it may increase sexual desire while decreasing sexual performance.
Avoid smoking. Smoking affects the blood vessels that are involved in having and maintaining an erection.
Your doctor is the best source of information on the drug treatment choices available to you.
Men who are experiencing mental or emotional issues may benefit from psychotherapy. Psychotherapy may address the mental or emotional issues underlying the physical causes of erectile dysfunction. The techniques involved in psychotherapy are aimed at decreasing the anxiety associated with intercourse. Patients and their partners focus on developing intimacy.
Certain medical devices, such as a vacuum pump, help some men to get and maintain an erection. If used properly, vacuum erection devices can be effective in 70% of couples who use them. Figure 02 Vacuum devices mechanically help you get and maintain an erection by producing a partial vacuum around the penis. This vacuum draws blood into the penis, engorging it, and causing it to expand and become erect. The three parts to the vacuum are: 1) the plastic cylinder into which the penis is placed; 2) a pump that draws air out of the cylinder; and 3) an elastic band which is placed around the base of the penis to maintain the erection and prevent the blood from flowing back into the body. One variation of this vacuum pump uses a semi-rigid rubber sheath that remains on the erect penis during intercourse.
Figure 02. Vacuum pump device
If you are a young man with a single blockage in a blood vessel, surgery may correct your ED. Blockages in blood vessels due to an injury in the groin area or fractured pelvis are best addressed by surgery in younger men. This type of surgery is less successful in older men because their blockage may be more extensive.
You may opt to have surgery to correct your erectile dysfunction. Figure 03Table 02 Surgical techniques are used to treat erectile dysfunction for three reasons:
- to implant a device that allows the penis to become erect
- to repair damaged blood vessels and increase the blood flow to the penis
- to block blood vessels that allow blood to leak from the tissues in the penis.
Success rates for repairing blood vessels and restoring blood flow to the penis range from 50% to 75%. Success rate for blocking blood vessels is 40% to 50% initially, but eventually drops to 15%.
Figure 03. Inflatable penile implant
Table 2. Surgical Procedures Used to Treat Erectile Dysfunction
Implants Description Prosthesis Restore erection; side effects include mechanical breakdown and infection Malleable Paired rods inserted into the two chambers of the penis to be adjusted by the user for penis position; does not affect width or length of penis Inflatable Paired cylinders inserted into the penis and expanded using pressurized fluid; user inflates the cylinders by pressing a small pump located under the skin in the scrotum; expands length and width of penis to an extent; penis is in more natural state when not inflated Some men try alternative therapies that claim to increase bloodflow to the penis. However, these treatments are unproven, and may cause serious side effects. Table 03
Table 3. Unproven Alternative Therapies for Erectile Dysfunction
Therapy Description Side effects Aphrodisiacs (e.g., spanish fly and foods like chilis, chocolate, licorice, lard, scallops, oysters, and anchovies) Increase sexual drive Some foods (e.g., licorice and lard) may be harmful in large doses; spanish fly causes urinary and genital tract irritation as well as infection, scarring, and burning of the mouth and throat, and can be life-threatening Ginkgo Improves blood flow to the brain Headache, fever, tremors, irritability, loss of breath Ginseng Stimulates sexual function Increased blood pressure, headache, sleeplessness, skin rash, nervousness, upset stomach Erectile dysfunction is usually correctable. Table 04 There is a variety of effective treatments for ED. Sildenafil citrate (Viagra, Cialis, and Levitra) has been shown to have a high success rate when combined with erotic stimulation. Other drugs such as alprostadil help men to maintain their erections for 30 to 60 minutes. Vacuum pumps produce erections that last for up to an estimated 30 minutes. Penile implants allow men to get and maintain erections at any time and for as long as they want.
Table 4. Prognosis for Erectile Dysfunction Treatments
Treatment Percentage of men who achieve erection Viagra 70% Alprostadil (penile injection) 95% Alprostadil (MUSE) 25% to 65% Alprostadil (topical) 75% Vacuum devices 56% to 67% Surgery 40% to 75% Depending on the cause of the blockage and nature of the surgery
Contact your physician if erectile dysfunction does not resolve with treatment. Usually, doctors start by limiting or replacing drugs that cause erectile dysfunction. If those treatments do not work, they may try more extensive therapies such as medications or surgical procedures. In certain circumstances, psychotherapy may be recommended.
Report any drug side effects or complications to your doctor promptly. Some side effects are associated with drug and other therapies prescribed for erectile dysfunction. To avoid any complications, report any symptoms of side effects to your physician.
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I'm Kristen Dore, PharmD. Welcome to PDR Health!
