Erectile Dysfunction
Erectile dysfunction, or the inability to obtain an erection, is a condition that may be treated with medical injections, penile implant surgery, shockwave therapy, and vacuum therapy.
Having difficulty holding an erection from time to time isn’t necessarily a cause for concern. But if patients experience ongoing erectile dysfunction, the condition can cause stress, reduce self-confidence, and contribute to relationship problems. Difficulty getting or keeping an erection can also indicate an underlying health condition that requires treatment.
Causes of Erectile Dysfunction
Erectile dysfunction can result from a problem with the brain, hormones, emotions, nerves, muscles and blood vessels involved in male sexual arousal. Stress and mental health concerns may also cause or worsen erectile dysfunction.
Patients may have a combination of physical and psychological issues that lead to erectile dysfunction. For instance, a minor physical condition that slows a patient’s sexual response may cause anxiety about maintaining an erection. In turn, the anxiety can leado erectile dysfunction. For instance, a minor physical condition that slows a patient’s sexual response may cause anxiety about maintaining an erection. In turn, the anxiety can lead to or worsen erectile dysfunction.
Common physical causes of erectile dysfunction include:
- Heart disease
- Diabetes
- Clogged blood vessels (atherosclerosis)
- High cholesterol
- High blood pressure
- Parkinson’s disease
- Multiple sclerosis
- Sleep disorders
- Treatments for prostate cancer or enlarged prostate
- Low testosterone
- Obesity
- Metabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol
- Certain prescription medications
- Tobacco use
- Peyronie’s disease — formation of scar tissue inside the penis
- Alcoholism and other forms of substance abuse
- Surgeries or injuries that affect the pelvic area or spinal cord
Psychological causes of erectile dysfunction include:
- Stress
- Depression, anxiety, or other mental health conditions
- Relationship problems due to stress, poor communication, or other concerns
Medical Injection
Erectile dysfunction may be treated with three different types of medications, including papaverine, phentolamine, and prostaglandin E1 (PGE1) or alprostadil (Caverject, Edex, and MUSE). These medications help relax the smooth muscles and widen the blood vessels in the penis, to increase circulation and lead to an erection.
In some cases, patients may only receive one type of medication. But typically, a combination is used.
Penile Implant Surgery (Malleable & Inflatable)
A penile implant is designed to help men get an erection. Two types of malleable penile implants offered by Coloplast include:
- The Titan Touch® and Titan® OTR inflatable penile implant
- The Genesis™ flexible rod penile implant
Three types of inflatable penile prosthesis offered by Boston Scientific, in partnership with American Medical Systems (AMS), include:
- AMS 700™ Inflatable Penile Prosthesis
- AMS Ambicor™ Inflatable Penile Prosthesis
- Spectra™ Concealable Penile Prosthesis
There are advantages and drawbacks to each option, so patients should speak to their physician to identify the best option for them.
The inflatable penile prosthesis was invented in 1973 and has a long history of use. The prosthesis is a device placed through a small one-inch incision at the base of the penis where it joins the scrotum. The surgeon will then place two cylinders made of silicone and filled with water into the penis. A balloon of water will be placed on the abdomen and a small pump will be put between the testicles and scrotum. All of these components are entirely concealed in the body.
Inflatable penile prosthesis is a complex surgery that requires in-depth expertise and training. The results are closely tied to the surgeon’s experience. When surgery is successful, patients are able to achieve an erection at any time. But complications from poor technique can lead to infection, shortening of the penis, and even deformities.
At UCI, we perform three to four implants per week and know how to maximize the length of the implant. Using our techniques, we place appropriately sized cylinders that help decrease infection rates and complication rates. Our pain protocol allows the majority of our patients to not need narcotics after surgery and to go home the same day.
Shockwave Therapy
During treatment, the physician applies an ultrasound gel to the penis and moves the device head across the affected area to release acoustic shockwave pulses.
At UCI, we offer true, focused electrohydraulic shockwave therapy using the ViaSure™ device to improve vascular flow parameters and decrease connective tissue damage in the penis. This allows for improved erectile function.
Vacuum Therapy
Vacuum therapy is the use of a penis pump to obtain and sustain an erection. To use a penis pump, the patient will take the following steps:
- Place the plastic tube over the penis.
- Use a hand pump or electric pump to create a vacuum inside the tube and draw blood into the penis.
- Once the penis is erect, slip a rubber constriction ring around the base of the penis to help maintain the erection.
- Remove the vacuum device.
