Treating Erectile Dysfunction
Today, there are a wide variety of mainstream treatment options available for erectile dysfunction. This list includes oral medications, penile injections, vacuum erection devices, urethral suppositories, and penile implants. In today's blog, I would like to review these options and highlight the benefits and downsides of each to empower my patients to navigate which option might be best for them. You can learn more about the available treatment options at this website.
I am sure everyone has heard about pills like Viagra™ and Cialis™. They've been around for over 20 years, but contrary to popular belief, these treatments will not just give you a spontaneous erection.1,2 Instead, they function by increasing the amount of blood flow into the penis during sexual stimulation, which can lead to a fuller erection that lasts longer.1-3 I would say about 75-80% of patients will get some positive response from these medications, but these meds do have side effects, which can lead to discontinued use.1-3 Yet they are convenient and mostly available in a generic form, so they do not cost anywhere near what they used to even a couple of years ago.
Penile Injection Therapy
Another mainstream treatment in treating erectile dysfunction is penile injection therapy. Essentially, this is where the patient injects medication directly into the body or shaft of the penis using a syringe.4 These medications are very potent vasodilators, which means they open the arteries to allow blood flow into those natural cavernous spaces that are supposed to fill with blood flow for an erection.4 In contrast to pills, penile injections will generate an erection even if you are not sexually stimulated. In fact, I will often use this in the office for diagnostic evaluation of a patient's erectile function or penile anatomy. But a downside to these injections is the possibility of an erection that is prolonged, or Priapism, which means an erection lasting longer than 4 hours, which becomes a medical emergency.4,5 Also, these injections are intimidating for patients to administer because they have to inject the medication directly into their penis at the moment they want to be sexually intimate. The injection is sometimes painful initially, but it can also be painful in the erect penis after the injection as a result of how the medications function.4,5 In a study of 294 men, only 59 continued with penile injections after 18 months – that’s only 20% of patients.5 The most common reasons for discontinuing injections were poor response to therapy and inconvenience.5
Vacuum Erection Device
The next two categories of treatment are much less popular. The vacuum erection device (VED) is exactly as it sounds—you put your penis into a plastic tube, and it's connected to either a manual pump or a battery-operated motor that creates a vacuum, which then draws blood flow into the penis to achieve an erection.6 I have a lot of patients who use this for penile exercise to prevent penile atrophy or shrinkage, particularly after prostate cancer treatment.7 Similar to injections, VEDs are cumbersome and do not promote spontaneity.8,9 They are also uncomfortable to use and can cause bruising, swelling, and even Peyronie's disease.6,9,10
Lastly, medication-wise, we have the urethral suppository. The suppository is a medication inserted into the urethra where you normally pass your urine through. There is a small applicator that is placed into the urethra where the medication is delivered.11 The medication is similar to penile injections in that it is absorbed through the urethra and will generate an erection without sexual stimulation.12 For most of my patients, it is about 50/50 in terms of effectiveness and is often painful.12,13 The absorption is a little bit more difficult because it must go through a lot of tissue to get into the vascular area of the penis, and the medication itself can irritate the urethra, so you can get pain with urination after using this medication as well.11,14
Investigational Alternative Therapies
There are some investigational alternative therapies, including extracorporeal shockwave therapy or penile shockwave therapy, intracavernous stem cell injection therapy, or platelet-rich plasma or PRP therapy. Shockwave therapy is not FDA approved as of today and is considered experimental, but we offer it in our office because it can be effective for the right patient. The other two are extremely experimental, and we will not offer those therapies until research shows better results.
Lastly, I want to talk about a Penile Implant. A modern penile implant, the AMS 700™ Penile Implant, is a 3-piece device placed entirely within the body.15 Once implanted, no one can tell you have the device inside of you.15 To use the implant, the patient or their partner squeezes and releases the pump, which sits in the scrotum and moves fluid into a pair of cylinders or balloons inside the penis shaft that fill up to create an erection. Once the erection is achieved, it will last until the patient, and their partner are satisfied.15 To deflate the implant and end the erection, the release button near the pump in the scrotum is pushed, and the implant is deflated. This design gives the patient and their partner 100% control over when the erection happens and how long the erection lasts.16 You can see an animated patient demonstration video of the penile implant’s function here.
It is important to note that a procedure is required to place an implant, which comes with the usual risk of surgical infection, which is low,15 and mechanical malfunction of the device, which typically occurs some time beyond 10 years.16,17 The procedure takes about 45 minutes, and after about 4-6 weeks of healing, you can once again be independent and sexually active.
Overall, there is a wide variety of treatment options for erectile dysfunction. Each option has its drawbacks and benefits and can be a great solution for the right patient. If you or a loved one are in search of a solution, you can visit EDCure.org/treatemnt-options to learn more or visit my website, TheMensMD.com, to make an appointment with me.
- Viagra Prescribing Information, Revised August 2017.
- Cialis Prescribing Information, Revised October 2018.
- Levitra Prescribing Information, Revised November 2014.
- Caverject® Prescribing Information, Revised March 2017.
- Sung HH, Ahn JS, Kim JJ, et al. The role of intracavernosal injection therapy and the reasons of withdrawal from therapy in patients with erectile dysfunction in the era of PDE5 inhibitors. Andrology. 2014 Jan;2(1):45-50.
- Osbon ErecAid® Esteem® Vacuum Therapy System User Guide. Timm Medical Technologies, 2011.
- Defade BP, Carson CC 3rd, Kennelly MJ. Postprostatectomy erectile dysfunction: the role of penile rehabilitation. Rev Urol. 2011;13(1):6-13.
- Phé V, Rouprêt M. Erectile dysfunction and diabetes: A review of the current evidence-based medicine and a synthesis of the main available therapies. Diabetes Metab. 2012 Feb;38(1):1-13.
- Hellstrom WJ, Montague DK, Moncada I, et al. Implants, mechanical devices, and vascular surgery for erectile dysfunction. J Sex Med. 2010 Jan;7(1 Pt 2):501-23
- Sidi AA, Becher EF, Zhang G, et al. Patient acceptance of and satisfaction with an external negative pressure device for impotence. J Urol. 1990 Nov;144(5):1154-6.
- MUSE® Prescribing Information. Revised February 2018.
- Padma-Nathan H, Hellstrom WJ, Kaiser FE, et al. Treatment of men with erectile dysfunction with transurethral alprostadil. Medicated Urethral System for Erection (MUSE) Study Group. N Engl J Med. 1997 Jan 2;336(1):1-7.
- Costabile RA, Spevak M, Fishman IJ, et al. Efficacy and safety of transurethral alprostadil in patients with erectile dysfunction following radical prostatectomy. J Urol. 1998 Oct;160(4):1325-8.
- Mydlo JH, Volpe MA, MacChia RJ. Results from different patient populations using combined therapy with alprostadil and sildenafil: predictors of satisfaction. BJU Int. 2000 Sep;86(4):469-73.
- Burnett AL, Nehra A, Breau RH, et al. Erectile dysfunction: AUA Guideline (2018). https://www.auanet.org/guidelines-and-quality/guidelines/erectile-dysfunction-(ed)-guideline.
Accessed January 8, 2020.
- Data on file with Boston Scientific.
- Dhar NB, Angermeier KW, Montague DK. Long-term mechanical reliability of AMS 700 CX/CXM inflatable penile prosthesis. J Urol. 2006 Dec;176(6 Pt 1):2599-601.
EDCure.org is a website sponsored by Boston Scientific.
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J. Abram McBride, MD is a paid consultant of Boston Scientific.
This material is for informational Purposes only and not meant for medical diagnosis. This information does not constitute medical or legal advice, and Boston Scientific makes no representation regarding the medical benefits included in this information. Boston Scientific strongly recommends that you consult with your physician on all matters pertaining to your health.
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