Erectile Dysfunction

Erectile dysfunction, otherwise known as ED or the inability to get or maintain an erection during sexual activity, is a common men’s health issue. Experts estimate that one out of every 10 men is likely to suffer from erectile dysfunction (ED) at some point during their life. While ED is often a symptom of other underlying problems, your urologist can typically help you get to the root of the issue and determine an effective treatment plan.  Over the years, treatments have improved significantly and the cost for many options has decreased — providing a wider range of options for many men.

Risk Factors & Causes of ED

Men who experience ED often have one of more of the following contributing factors:

• Vascular problems such as atherosclerosis (narrowing of the arteries), which can inhibit blood supply to the penis.
• Trauma/injury that can lead to ED symptoms.
• Neurological conditions can lead to problems sending impulses between the brain and the penis. Common causes include diabetes, stroke or multiple sclerosis.
• Other conditions such as Peyronie’s disease and certain cancers (particularly prostate, bladder and colon cancer).
• The use of certain medications such as diuretics, blood pressure medication, antihistamines, antidepressants, antiarrhythmics, muscle relaxers and tranquilizers — and even certain over-the-counter drugs such as nonsteroidal anti-inflammatory drugs, among others.
• Psychological factors such as depression, stress, performance anxiety and/or a lack of brain stimulus.
• Too much alcohol, nicotine and/or recreational drug use.

Regardless of the cause, the urologists with WakeMed Urology will work with you to ensure you get the treatment you need so you can get on with your life. Our team is trained in the latest medical therapies, devices and procedural options for men who want to overcome ED.

Common Treatments for ED

• Prescription medications are the most common, first-line treatment for ED.
• Sildenafil (Viagra)
• Tadalafil (Adcirca, Cialis)
• Vardenafil (Levitra, Staxyn)
• Avanafil (Stendra)

These medications enhance the natural chemicals in your body that relax muscles in the penis, thereby allowing for better blood flow. Working together, your urologist will make a recommendation about the best medication option(s) for you. It can take a few tries to find the right medication and dosage to relieve your symptoms. Side effects and complications for these medications range, so be sure to talk with your doctor and/or pharmacist to ensure you understand them.

Previously, some of these medications were too expensive for many patients. The good news is that many are now available in generic form, which can save a lot of money.

• Vacuum erection devices (VED), otherwise known as penis pumps, are sometimes used to treat ED. These small devices create a vacuum that’s designed to pull blood into your penis for long enough to have intercourse. There are numerous makes and models and the cost averages just over $100, but check with your urologist who can make a specific recommendation to ensure it’s a quality device. Side effects may include bruising, loss of spontaneity and/or discomfort.  Because these devices are nonpharmacologic, they can be used at any time without concern for side effects.
• Penile injections involve a medication or combination of medications that are injected directly into the penis to help patients obtain an erection. They are typically prescribed only if oral medications don’t work or aren’t well-tolerated due to side effects. The drugs help improve circulation and bloodflow, and generally take effect within 5 to 15 minutes following the injection. While this option may sound extreme, we find our patients typically have excellent results with minimal discomfort. The most common side effects include pain, penile scarring or priapism, which is a painful erection that lasts longer than two to three hours.
• Using a penile implant or prosthesic device is a permanent, surgical treatment option for patients to consider after exhausting all other therapy options. While it’s the most involved treatment option, patient satisfaction rates are very high at around 98-99%. There are two main categories of implants to consider.
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  • Inflatable implants are the most common penile prosthetic devices — and they are also the most life-like. Whether you choose a two-piece or three-piece inflatable, these devices are more natural and are flaccid when deflated. However, they have more parts to potentially malfunction than you find in the semi-rigid rods. The three-piece design creates the most rigid erection, but requires the most extensive surgery because it involves the placement of a fluid reservoir within the abdomen. Both models involve a pump that’s placed inside the scrotum.
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  • Semi-rigid rods can be implanted that will keep the penis firm all the time, but they are malleable for positioning.  They can be bent away from the body for sexual activity or against the body all other times. There are also models with springs that allow the device to maintain its positioning a bit better than those without springs. These simpler designs are less likely to malfunction than some of the more complex, inflatable types.

Based on a discussion and review of research, you and your urologist can decide together which model and procedure might be best for you. Surgery typically takes 1-2 hours and requires an overnight hospital stay followed by a one- to two-week recovery period.