by J. François Eid, MD
Most men will, at some point in their sexual lives, have difficulty getting it up. But for approximately thirty million men in the United States, erectile dysfunction, or male impotence, is a chronic problem.
Men are often embarrassed by erectile dysfunction, and only one in twenty sufferers seeks treatment, even though there are treatments that can address each of the causes of erectile dysfunction. Below, some of the most effective treatments are described.
In 1998, Viagra was approved by the FDA, becoming a milestone in the field of treatment for erectile dysfunction. It works by increasing blood flow to the penis, as well as causing penile muscles to relax. It does not, however, initiate an erection, and this is a common misperception that has led to widespread disappointment. Viagra works by storing penile blood flow in an already-stimulated penis. So, for Viagra to be effective, one must be able to initiate a partial erection in response to sexual stimulation. In the absence of this partial erection, or without sexual, tactile stimulation, Viagra will not work.
Viagra works best when taken at a dosage of 100mg, one to one and a half hours before sex on an empty stomach. Studies show that it may take six to eight tries before it works optimally, as it may require time to overcome performance anxiety.
Side effects of Viagra include headaches, redness of the face, nasal stuffiness, and heartburn. Three percent of men may experience visual disturbance in the form of an increased sensitivity to light or seeing a bluish tint to everything. All side effects are very mild, well-tolerated, transient, and actually very few patients discontinue use because of them.
Viagra should not be taken by men taking medications that contain nitrates of any form or schedule.
Today, 250,000 men are the secret keepers of what is called the Internal Penile Pump-a manual device surgically implanted in the penis and scrotal sac, used to create erections. The IPP, one example of a penile implant or prosthesis, is a soft saline-filled device that can expand and contract without losing its elasticity. It consists of three small components: very thin tubes, a pump, and a reservoir. The reservoir contains the saline, which is transferred into the penis by a gentle squeeze of the scrotal sac where the pump is housed, causing the tubes in the penis to fill and become rigid.
The IPP has some excellent advantages over oral and injectable medications and its surgical predecessors. First, there are no drug side effects. Second, the entire IPP can be placed through a 2 to 3 centimeter opening in the scrotal skin in under an hour, unlike previous surgeries that required much larger openings and far more painful recoveries. Third, the IPP is entirely invisible in both the flaccid and hard penis. And last, but certainly not least, the IPP does not interfere with normal sensation or ejaculation. And a man is able to have a full erection at any time -- without planning ahead, as is necessary with other treatments.
The Internal Penile Pump is an excellent alternative for men who do not respond to Viagra. For most men, it represents a cure. Excellent candidates are men between the ages of 50 and 90 years old and are sexually motivated and active; men who have had prostate, bladder, or colon cancer treatment, and who have penile deformity and/or atrophy (shrinkage).
Prior to the FDA approval of Viagra, injection therapy was the most effective medical treatment available. Injection therapy works by injecting a medication through a very small hypodermic needle at the base of the penis, five minutes before intercourse. The medication injected dilates the blood vessels to produce an erection.
Prostaglandin E-1 (Alprostadil) (Caverject or Edex) has been the drug used for injections since 1995. Alprostadil is a naturally occurring substance in the penile tissue. It can be self-injected safely at home with few side effects. This is currently the only FDA approved medication for penile injection.