Guest blog post by Doron S. Stember, MD, Urologist at Beth Israel Medical Center.
A major medical study published several years ago showed that 50% of all men between the ages of 40 and 70 experience erectile dysfunction (ED) on at least some occasions. The first line of treatment is oral therapy (pills), including Viagra, Levitra and Cialis. For most men with ED, these pills provide a satisfactory solution. Some men, however, do not respond to pills, and for others, including those with certain heart conditions, the pills are unsafe. What are their options?
Treatment Alternatives to Pills
1. Vacuum Erection Device
To achieve an erection with the vacuum device, the man places a ring over the base of the penis, followed by a vacuum tube over the penile shaft. Once it’s activated, negative pressure in the tube draws blood into the penis. He then removes the tube, and the ring keeps blood in the penis, thereby providing rigidity.
In my professional experience, most of the men who are happy with this treatment have minimal ED to begin with. Those with more serious ED need to use a very tight ring to keep blood in the penis, which becomes uncomfortable and can cause numbness, tingling and, eventually, pain.
2. Penile Injections
Penile injections can be a good option for some patients with ED. Each time the man wants an erection, he gives himself a penile injection of medicine, which can be thought of as “liquid Viagra.” Although it initially sounds terrible, this treatment can be extremely effective. The needle is actually very small and injections are given at the base of the penis, which is much less sensitive than the head.
The major downside of penile injections is the risk of priapism, a prolonged, painful erection that lasts 4 or more hours and can only be treated at the hospital. When patients are properly trained to give themselves injections, the likelihood of priapism is extremely low.
3. Internal Penile Prosthesis
Finally, the internal penile prosthesis can be an excellent option for the right patient. The prosthesis is a soft, sterile plastic device that is inserted through a small opening just above the penis during a procedure under general anesthesia. There is no actual cut on the penis or scrotum. The procedure takes less than an hour, and patients go home either the same day or next morning. The stitches are internal and get absorbed by the body, so never have to be removed.
In use, the device becomes inflated with sterile water—providing penile rigidity—when the patient squeezes a pump located in his scrotum. The penis becomes flaccid again when he pushes another button on the pump. The prosthesis can provide an erection for virtually any man, regardless of whether or not he responds to any of the other treatments for ED.
Sensation is unchanged, as is the ability to have an orgasm and ejaculate—and the man has complete control over his erection. Even after having an orgasm, he can continue to have sex if he wants to. The device is entirely internal, so no one can see it, and it does not interfere with the urine channel or affect urination in any way.
As with any surgical procedure, the downside of getting a penile implant is the risk of pain and infection. Pain or discomfort is usually worst in the first week after the device is placed, although it is manageable with prescription pain pills for most men. Infection occurs in about 2% of cases; however, there are many specific methods that can minimize risk of infection.
Good News
The main message, and good news, is that almost every man—even those who don’t respond to Viagra—can achieve an erection strong enough for intercourse.
To find an excellent urologist who is right for you, please call our Physician Referral Service at 866.804.1007.