Updated 07/20/2022
OK, readers, there are many causes of erectile dysfunction (ED) or impotence, the inability to achieve or maintain an erection satisfactory for penetration. Erections are a critical part of a man’s sexual function. From the pleasant sensations first experienced in adolescence with self exploration and masturbation, to the first sexual encounters, to the sexual intimacy of a long term relationship, erections are an integral part of a man’s identity. If erections become difficult to obtain, maintain, or disappear altogether, it is a significant physical and psychological blow to the one affected and to his partner. Erection and penetration is such a part of man’s sexual interaction that anything less can cause the male to withdraw completely from any kind of sexual contact with his partner. I know from experience, I was one of those men. In my case, impotence was secondary to prostatectomy and later radiation for treatment of prostatic cancer.
In men, there are many conditions that can lead to ED. High on the long list are cardiovascular disease, hypertension, hyperlipidemias, diabetes, depression, alcoholism, prostatectomy, pelvic radiation therapy, neurological diseases, obesity, Peyronie’s disease, and prescription drug use.
Lifestyle conditions including smoking, recreational drug use, absence of a spouse or partner, and the quality of the partnered relationship, can also cause ED.
Your physician and you have to review your health status, medications, substance use and lifestyle choices before beginning therapy. Therapy is step-wise, requires patience from you and your partner, and good communication with your health care provider.
First line treatment is the well advertised ED medications, like Viagra and Cialis. These drugs are effective in a high percentage of men. The main contraindication is heart disease that requires nitrate treatment.
If the “blue pill” is not satisfactory or safe the next option is intra-urethral suppositories. These contain the same type of medication as Viagra and Cialis, but the route of delivery is different. You insert a small medication containing suppository into the urethra and it is absorbed directly into the penis blood supply. You might be squeamish with this route of administration at first, but it is not difficult nor uncomfortable with practice.
Another effective option is penile injection therapy. While injecting your penis with a needle might make one squeamish, with practice it is well tolerated. The medication is injected in the midpoint of the penis. It usually takes effect within 15-30 minutes, self stimulation or foreplay helps the erection develop. The erection lasts 30 minutes to an hour.
If still not satisfied with the quality of your erection or the method of treatment, the next step is to try vacuum constriction devices, pumps. These combine a negative pressure pump to create the erection, with a penile ring to maintain the erection. Make sure the device has a vacuum limiter, to avoid damage to the penis by overfilling. The penile ring can be used alone if the problem is not being able to maintain an already achieved erection. Some men go directly to the pump, rather than try the urethral suppositories or penile injections.
Finally, surgery, the most invasive alternative, but worth considering when nothing else has worked well. The most commonly used implant is inflatable, using saline stored in a reservoir, and a pump. The inflatable part is inserted in the shaft of the penis, the reservoir is placed in the pelvic space behind the pubic bone, and the pump is placed in the scrotum. All of this is done through a small incision on the under side of the scrotum. It sounds complicated, but the results are excellent with high patient satisfaction.
So what was my journey? After prostatectomy for prostate cancer, I began with Viagra, I did not have a good response. Next, I tried the penile injections, again without a good result. I next moved the pump with the ring, and that worked. However, it was not spontaneous nor romantic. Three years into the journey I decided to have implant surgery, I am only sorry I waited so long. The result has been the return of spontaneous lovemaking without pills, injections, or pumps.
The take home message? There are many safe, successful options for ED treatment. The biggest obstacle to overcome is that first call to your doctor to make an appointment to discuss the problem, to put yourself on the road to successful treatment.
