There are a variety of approaches that may be taken when treating erectile dysfunction. We will be looking at the following options:
- Traditional treatment with medication
- Treatment using external mechanical devices
- Surgical procedure for erectile dysfunction
- Alternative methods of treating ED
Treatment with medication
There are a number of drugs that can be used to treat ED. Whilst they all work in a slightly different way, ultimately they are designed to improve the sexual activity by stimulating and increasing blood flow into the penis.
The first and most common group of drugs belong to a group known as phosphodiesterase type 5 inhibitors (PDE5). Their action is to block the enzyme activity attributable to the ED. If an ED sufferer has heart disease it may not be safe to take these types of drugs and so it is necessary that they are used under medical supervision, either that of a doctor or in the case of over the counter versions, the pharmacist.
PED5 inhibitors should not be taken if you are taking nitrates to treat heart disease; this can cause severely low blood pressure and can even be fatal
- Avanafil (Stendra) - is an oral PDE5 inhibitor. It should be taken approximately fifteen minutes prior to having sex and should only be taken once per day. Common side effects to this drug include headache, flushing, stuffed or runny nose, back pain and sore throat
- Sildenafil (Viagra) - is also a PDE5 inhibitor. It is only available as a tablet to take orally and should only be used once per day. It is best taken approximately 30 minutes prior to sexual intercourse. The more common side effects to this drug include headache, flushing, stuffed or runny nose, back pain, upset stomach, muscle aches and vision changes such as blurred vision and changes in colours
- Tadalafil (Cialis) - this oral drug will increase blood flow throughout the body and should be taken about 30 minutes before sex and only once per day; it may work for up to 26 hours. The common side effects of this drug are headache, flushing, stuffed or runny nose, back pain, upset stomach and pain in the limbs
- Vardenafil (Levitra) - another PDE5 inhibitor, this pill should be taken around 60 minutes before sex no more than once per day. Common side effects are headache, flushing, stuffed or runny nose, back pain, upset stomach and dizziness
There are other drugs which may be used to treat ED but are not PDE5 inhibitors
- Alprostadil (Caverject, Edex, MUSE, Vitaros) - this is found in three different forms, an injectable solution, a penile suppository and as a topical cream. The solution can be injected directly into the penis 5 - 20 minutes prior to sex and can be used up to three times a week; there should be a lapse of a minimum of 24 hours between injections. The suppository form of the medication is put in place 5 - 10 minutes prior to sex and should be used no more than twice in a 24 hour period. Vitaros topical cream is applied to the head of the penis via dropper 5 - 30 minutes prior to sex. It should be used no more than once in a 24 hour period and also used no more than three times per week
- Testosterone - as the main sex hormone present in the male body, it has many roles. Testosterone levels will naturally drop with age and this may lead to problems with ED, fatigue, reduced libido, reduced sperm count and weight gain.
Testosterone may be prescribed to treat ED and in actual fact, PDE5 inhibitors are more effective if used in conjunction with testosterone therapy in patients who are deficient in testosterone.
Testosterone, however, does come with its own risks and increases the chance of having a heart attack or stroke. It is for this reason that ONLY men who are deficient in the hormone are advised to have testosterone replacement therapy. During treatment, levels of testosterone in the body will be closely monitored. Side effects of taking testosterone include skin breakouts (acne), male breasts, prostate growth, swelling, moodiness and interrupted breathing during sleep
Erectile dysfunction as a result of psychological/emotional issues
There are a number of psychological issues which may affect erectile function. These include:
- Stress
- Depression
- Anxiety
- Relationship problems History of sexual abuse
Many emotional problems can be successfully treated with counselling. Your GP will be able to advise which form of counselling would be best suited to your individual case.
Erectile dysfunction caused by underlying conditions
There are some underlying conditions that can cause erectile dysfunction if left untreated. These include diabetes and high blood pressure. These can be dangerous underlying conditions which need to be treated and in doing that, the erectile dysfunction may improve
Erectile dysfunction caused by medication
There are some medications which may contribute to or cause erectile dysfunction. These include:
- Medication for hypertension (high blood pressure)
- Heart disease
- Depression
- Seizures
- Cancer
If you are taking medication and an unwelcome side effect is erectile dysfunction, your doctor may be able to prescribe an alternative and your erectile function will return to normal
Erectile dysfunction caused by lifestyle
In general, an unhealthy lifestyle can result in erectile dysfunction in that cardiovascular health is likely to be suffering and you are more likely to be at risk of becoming diabetic. The following steps are recommended to reduce these risks:
- Follow a good diet
- Take regular exercise
- Lose weight (if required)
- Give up smoking
- Ensure alcohol intake is within safe levels
Devices for erectile dysfunction
Erectile function medication does not suit everyone as there are some very unpleasant headaches associated with the drugs. If medication does not help your erectile dysfunction it may be that a penile device may be helpful:
- Vacuum erection device - this is a cylinder which is placed around the penis; it can involve a hand pump or the pump may run on batteries. The air is then pumped out of the cylinder to create a vacuum within the cylinder. The presence of a vacuum causes blood to flow into the penis and once it is erect, with the aid of lubricating gel, slide the retaining band down the penis and remove the pump. After intercourse the retaining band id removed. While these devices are not a cure for ED they enable the sufferer to have sexual intercourse; they may cause slight bruising on the penis and should not be used too often or for too long as this may cause tissue damage
- Erectile dysfunction rings - these rings are placed around the base of the penis; they are designed to slow the flow of blood from the penis back into the body. In general, they are made from a flexible material such as rubber or silicone. They work best when a man can achieve a partial or full erection but is unable to sustain it. There are some precautions which must be observed when using a penile ring. The ring is not suitable for use by men who have blood clotting disorders or are on blood clotting medication; neither is it suitable for men with sickle cell anaemia
Surgery for erectile dysfunction
There are several surgical procedures which a man may consider to help with erectile dysfunction
Penile prosthesis
Vacuum pumps and medication can mean that spontaneity in a sexual relationship cannot happen in which case a specialist may advise that you have a penile prosthesis fitted. This device is implanted into the penis and it creates an ‘erection like’ state. If ED is related to diabetes, spinal cord injury or vascular disease these implants may be of most use. Implants do not change the sensation felt on the skin of the penis or interfere with a man’s ability to ejaculate or orgasm and they come in two types:
- Malleable implants - these are mechanical devices which are implanted into the penis to create permanent firmness. An incision is made at the base of the penis which creates an entry into both cavities within the penis; one semi-rigid rod is placed in each opening. Any sexual activity should be avoided for the following six weeks.
- Inflatable implants - these implants can be inflated to create an erection like state and then are deflated following intercourse. The device consists of two inflatable cylinders, a reservoir and a pump unit. When ‘erection’ is required, the area of the scrotum where the pump has been located can be pressed and this will allow the inflatable chambers to be filled with fluid from the reservoir which in turn creates an erection.
Microsurgical penile revascularization
This procedure involves microsurgery to repair and divert blood vessels following an injury to the pelvis. This is done in order to restore blood flow to the penis, without which it is not possible to achieve an erection.
As a general rule, this procedure is recommended for men under 40 years old who have sustained a traumatic pelvic injury which in turn has resulted in erectile dysfunction. The procedure is not recommended for men who have atherosclerosis (hardening of the arteries)
Alternative treatments for erectile dysfunction
Vitamins and supplements for erectile dysfunction
There are some natural options that can be considered for the treatment of ED. It is important to ensure that supplements are safe in advance of trying them out and be aware that they may interact with some prescription medication. In addition, it is advisable to find out what studies, if any, have been done and what were the results as to their efficacy.
- Panax ginseng - this is also known as the herbal viagra. There are some studies which may suggest that there is some evidence of efficacy in the treatment of ED.
- Rhodiola Rosea - there is one small study suggested that this herb may be useful in treating ED. It has been shown to increase energy and reduce fatigue.
- DHEA - dehydroepiandrosterone is a natural adrenal gland hormone. A study carried out in Massachusetts USA showed that men with ED were more likely to have low levels of DHEA in their system. A further study in 2009 indicated that supplements of DHEA appeared to make men more likely to achieve and maintain erections
- L-arginine - this is an amino acid which occurs naturally in the body. It is a precursor of nitric acid which is essential to the body to enable a successful erection to be achieved. There are a number of small studies which may suggest that the supplement of L-arginine may be helpful to ED sufferers.
- Yohimbe - This is an extract from the African Yohimbe tree and some studies have exhibited that it has positive effects on sexual performance. There is little evidence however as to how it works and it may also have harmful side effects
- Other possible helpful supplements include Ginkgo Biloba and zinc but these require further studies to be performed
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