What is it?
Erectile dysfunction is the inability to maintain an adequate erection to complete sexual intercourse/activity. It may occur at any age but the incidence of erectile problems does increase with age. It may be difficult for many men to discuss this topic with their physician but our urologists at Advanced Urology Centers White Plains – Maple Avenue can provide a comfortable open environment for patients to discuss these issues.
Why does it occur?
Erectile dysfunction may be a combination of multiples factors at play: psychological, medical, lifestyle.
Causes of erectile dysfunction:
- Medical disease: kidney failure, diabetes, liver failure, substance abuse, neurologic disease (stroke, spinal cord injury), thyroid disorders, atherosclerosis, weight gain, sleep disorders
- Surgery: prostate surgery, bladder surgery, rectal surgery, vascular surgery/aortic repair, pituitary surgery, penile surgery
- Psychiatric conditions: anxiety, depression, alcohol and drug abuse
- Trauma: penile trauma, pelvic fracture, pelvic radiation, bicycle riding
- Blood pressure medications
- Medications affecting hormonal (testosterone levels)
- Low Testosterone
In addition, men may experience problems with sexual performance in the setting of relationship difficulties, low sexual drive, low interest in sexual activity. It is important to let your doctor know if you are experiencing any of these symptoms.
How is it evaluated?
You and your physician will have a comprehensive discussion covering your medical, surgical, social and sexual health history. Your discussion is completely confidential and your urologist is accustomed to discussing these issues to help patients return to satisfactory sexual health.
Your urologist may perform a physical examination including genitalia and prostate exams. They may also perform blood work or more sophisticated evaluating of erectile function with sonograms.
There are several treatment options that can be tailored to your needs and other medical conditions. Your physician will help decide which is the best option for you.
- Smoking cessation
- Weight loss
- Regular exercise
- Moderate your alcohol intake
- Medication: if possible change any medications that may be contributing to your ED. This may require careful consultation with your other health care providers
- Management of your other medical conditions: e.g. heart disease, elevated cholesterol, high blood pressure, diabetes
These include Viagra, Levitra, Cialis, Stendra and all acts by increasing blood flow to the penis and thereby make the erection stronger. Most of them can be taken shortly (30-60 minutes) before sexual activity however some are designed for daily use.
- Nasal congestion
- Back pain
- Stomach upset
- Vision Changes
You may not be able to take this class of medication if you have significant heart disease or other medical conditions or are taking nitrates. Your urologist can instruct you which medication is right for you.
Vacuum Erection Device:
A cylindrical vacuum pump is placed over the penis. Air is manually drawn in to the device which causes blood to flow into the erectile tissues. An occlusive elastic ring is then placed around the base of the penis to maintain a rigid erection.
Patients may complain of numbness, tingling or bruising of the penis for a short time after using the pump.
Intrapenile and Intraurethral Injections:
Some men may not respond to or may not be a candidate for oral medications. Your urologist may discuss injection therapy with you which involves injecting medication with a small needle directly into the penis or urethra. While many men are apprehensive about this form of therapy, your urologist will discuss the benefits and side effects with you. It is typical that your urologist will demonstrate/administer the first dose under careful supervision in the office.
With all therapy for erectile dysfunction, it is important to notify your physician if you have a painful or prolonged erection lasting more than four hours after using any of the above therapies
This is a surgical procedure that requires implantation of an prosthetic device in the penis which provides a rigid erection. There are several options and considerations when choosing this therapy and your urologist will help your decide which is right for you.