In the majority of the partnerships, sexuality remains the most important bonding factor.  Erectile dysfunction is the most common male sexual disorder with studies showing rates of 9-39% of men < 50 years of age and 40-80% of men > 70 years of age.  Risks of erectile dysfunction include: heart disease, diabetes, high blood pressure, high cholesterol and low testosterone.  Erectile dysfunction can be a marker for future heart disease and usually precedes by 2-4 years.  We recommended all patients with erectile dysfunction to discuss cardiology workup with their primary care physician. 

 

At Men’s Health Utah we are staffed by urologic surgeons specifically licensed and  trained to lead men to erectile restoration.

 

Treatment Options

 

Medical Therapy: PDE5 inhibitors “The blue pill”  The pills should be taken about 30 min prior to sexual activity.  Sexual stimulation will be necessary to initiate an erection.  May titrate dose such that an erection is achieved that lasts no more than one hour. Patients are advised not to take more than one dose/day.  Patient must not take these medication with nitrates.  Side effects include headache, flushing, decreased blood pressure, vision loss/changes, nausea, dyspepsia, gastroesophageal reflux, nasal congestion, hearing loss, muscle aches, flushing and dizziness.

 

Penile Self Injection Therapy:  A small amount of medication prescribed is self injected into the penis to elicit an erection.  The first dose must be administered under the supervision of a health care provider.  Most men barely feel the injection and have excellent results with high satisfactory scores.  Side effects include: priapism (must seek medical help if an erection lasts longer than 2 hours, permanent damage if erection lasts longer than 4 hours, scar tissue formation (patients should alter injection sites), bleeding, penile pain/burning, hypotension and headache. 

 

Vacuum Erection Device:  A cylindrical vacuum pump is placed over the penis.  Air is drawn from the cylinder, causing blood to flow into the penis.  When erection is achieved, an occlusive ring is placed around the penile base to maintain the erection.  Vacuum erection devices should only be used in they have a vacuum limiter.  Side effects include: buckling or pivoting the penis at the ring site, retarded undulation, cold penis, numb penis, bleeding, pain. Maximum duration of use is 20-30 minutes.

 

Penile Implant:  A penile implant is a medical device that is custom-fit and surgically placed into a penis to produce a natural-looking and natural-feeling erection.  A pump placed in the scrotum is used to inflate the penis on demand.  Patient and partner satisfaction rates have shown to be >90% in some studies.  Risk factors include: Infection (1-3%), injury to adjacent structures requiring to abandon the procedure and return at later date, bleeding,  device malfunction (Durability: 95% at 5 years, 85% at 10 years and 70%at 15 years), erosion, perforation, loss of natural erectile function, need for removal, loss of penile length perception, decreased glanular engorgement, not perfectly straight outcome, altered erectile and ejaculatory sensation, peri-operative and possibly chronic pain, inability to conceal the device, difficulty mastering device operation and partner dissatisfaction.  Placement of prosthesis will destroy any latent natural erection and make other interventional treatment options impossible.  The prosthesis will not increase the size of his penis on inflation.