A
PATIENT'S GUIDE
WHAT IS ERECTILE
DYSFUNCTION?
Erectile
dysfunction is the inability to achieve or maintain a hard, erect penis
sufficient for sexual intercourse. Traditionally, this inability has
been called "impotence". The term "erectile dysfunction" is more
precise, because it refers only to erection problems. Men with erection
problems often retain other sexual functions such as the ability to
ejaculate and have an orgasm.
WHAT CAUSES ERECTILE
DYSFUNCTION?
Psychological causes of erectile dysfunction include stress and anxiety
due to marital, financial, or other external problems. It is possible
for a man's stress and anxiety to interfere with nerve impulses from his
brain when he attempts sexual intercourse. Physical causes of erectile
dysfunction are frequently related to vascular diseases. Hardening of
the arteries and other diseases affecting the vascular system can impede
the flow of blood to the penis and affect a man's ability to maintain an
erection. Diseases that affect the nervous system, such as multiple
sclerosis and alcoholism, can also cause erectile dysfunction. Accident
victims who receive injuries to their spines or pelvic regions are also
at risk for erectile dysfunction.
HOW ARE CAUSES DIAGNOSED?
Medical History - The patient will be asked questions covering a
wide range of risk factors in order to determine whether or not his
medical history is in any way related to his erectile dysfunction
problems.
Sexual
History - Questions like "When was the last time you had an
erection" and "Do you ever wake up in the morning with an erection" are
both typical questions patients are asked about their sexual histories.
Physical Examination - The doctor will pay particular attention to
the genitalia and will test nervous and vascular function as well as
check for Peyronie's disease.
Lab
Tests - Testosterone level tests and tests for diabetes and vascular
problems such as elevated cholesterol or fat in the blood are routine.
TREATMENT OPTIONS
For the
majority of men whose erectile dysfunction has mainly physical causes,
there are three generally accepted treatment options:
Vacuum constriction devices consist of a plastic cylinder, a vacuum pump
and an elastic constriction band. Using the pump, the patient creates a
vacuum around the penis inside the cylinder, forcing blood into the
penis. The constriction band maintains the erection.
In penile
injection therapy, vasoactive drugs are injection into the erection
chambers. These drugs work by expanding arteries and relaxing penile
tissue. Blood flow increased into the two erection chambers, helping to
cause an erection.
A penile
prosthesis is a plastic device surgically implanted into the penis so it
can be made rigid. A prosthesis does not change the ability to urinate,
ejaculate, or have an orgasm. There are two kinds of penile prostheses:
inflatable and semirigid.
ADVANTAGES AND DISADVANTAGES
Vacuum
constriction devices are reliable and safe, with no serious side effects
when reputable prescription devices are used properly by patients who
have been instructed by trained professionals. Interruption of
lovemaking is the most common complaints. Some men report coldness or
numbness of the penis and/or discomfort when ejaculating.
Penile
injection therapy tends to produce a firm erection, which may last an
hour or more. A man can inject himself before activity begins; erection
occurs five to fifteen minutes later. The procedure is easy and usually
painless, though some men report discomfort following injection.
Possible side effects include prolonged erections. If an erection lasts
too long, the penis can be injured. The chances of a prolonged erection
with this type of therapy range from one to eight percent, but it rarely
occurs once a patient has been properly trained. Another possible side
effect is the eventual formation of scar tissue in the penis.
Penile
prostheses enjoy a high satisfaction rate among those electing this
course of treatment. With a prosthesis, a man can create an erection
whenever he wishes. Although the erection may be slightly shorter than a
natural one would be, it is rigid enough for sexual intercourse. There
is no change in either skin sensation or the ability to have an orgasm.
Once a prosthesis is implanted, however, it is difficult for a man to
change his mind and choose a different treatment option. Also, as is the
case with any mechanical device, failure of the prosthesis is possible.
For the more complex inflatable prostheses, the chances of failure are
one out of ten. For the simpler semirigid malleable prosthesis, chances
of failure are one out of twenty. Possible complications from surgery,
such as infection, may require removal of the device.
COST AND TIME CONSIDERATIONS
If cost
is a consideration, vacuum constriction devices have a decided
advantage. They are far less expensive than the operation necessary to
implant a prosthesis and less expensive over time than the drugs needed
for injection therapy. Vacuum constriction devices also require the
smallest investment of time. Only one training session is required in
addition to follow-up as scheduled with your doctor. For injection
therapy, several visits to the doctor are necessary to learn
self-injection, adjust the dosage of necessary, and check for any
complications. Implanting a prosthesis usually means one or two days in
the hospital, 10 to 21 days before resuming usual activities after
surgery and one to two follow-up visits.
