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Erectile Dysfunction

                                          

Erectile dysfunction is the inability to achieve or maintain erections for intercourse. Millions of men in America struggle with this problem. Although sometimes psychological, the majority of the time there is an underlying physical problem that can be addressed with medical or surgical treatment.

When to Seek Treatment

While sometimes temporary, there are times when erectile dysfunction (ED) can be a chronic problem. If ED occurs repeatedly and begins to cause significant anxiety or relationship problemsor if getting an erection causes physical painit might be time to consult a urologist. Whether the cause of erectile dysfunction is physical or psychological, a urologist can recommend any number of safe and effective treatments.

Treatments

Lifestyle Changes

Avoidance of excessive alcohol, smoking cessation, and control of other medical problems such as hypertension, heart disease, and diabetes can help improve sexual function.

Oral Medications

There are several oral medications that can help with sexual dysfunction such as Viagra, Levitra, and Cialis.
Oral medications should not be taken by everyone. Please consult your physician to discuss which treatment might be best for you.

Self Injection

This option involves using a short needle to inject medication (alprostadil, tri0mix, bi-mix, for example) into the side of the penis. This is a very effective treatment method, but usually reserved for individuals who did not experience good results from other forms of treatment. There is generally much less pain and discomfort than expected. Many men use this form of therapy successfully for many years.

Intraurethral Suppositories

As an alternative to injections, urethral suppository medication (alprostadil) can help treat sexual dysfunction. With this option, the patient inserts a pellet into the penis opening into the urethra. The medication (the same used in the self injection technique) is then absorbed into the erectile tissue. In general, it is not as effective as the injection technique, but it is usually well tolerated and may improve erections in some men.

Vacuum Devices

Vacuum devices manually create an erection. The patient places a plastic cylinder over the penis and an attached pump is used to create a vacuum that draws blood into the penis. After achieving the erection, a rubber O-ring is placed around the base of the penis to trap the blood and maintain the erection for longer duration.

Penile Prosthesis

Penile implants to treat sexual dysfunction problems are either semirigid (non-inflatable) or inflatable cylinders that replace the spongy tissue (Corpora Cavernosum) inside the penis that fill with blood during an erection. Implants come in a variety of diameters and lengths. They are safe and effective and completely concealed and discrete. Patient and partner satisfaction with use is often greater than 90%.

There are two kinds of inflatable implants. Both have cylinders in the shaft of the penis, a reservoir that holds water, and a pump to move the water from the reservoir to the cylinders. You create an erection by pumping water out of the reservoir and into the cylinders.

  • A three-chamber inflatable implant has the cylinders in the penis, the reservoir in the belly, and the pump and release valve in the scrotum. The reservoir in this type of implant is larger and separate from the cylinders.
  • A two-chamber inflatable implant has the reservoir at the beginning of the cylinders (at the base of the penis) and the pump and release valve in the scrotum. This type is a little less complex to place and can be helpful for patients where placement of a reservoir might be difficult.

Prosthetic implantation is done using regional or general anesthesia. The implants are inserted through a small incision made in the penis, lower abdomen, or scrotum.