Jun 3, 2003
Treatment Options:
There are essentially six ways I know to treat erectile dysfunction. I listed them here in order of how radical they are. Most men will be able to deal with this issue by using the first and second option.

Penile Exercise
Most men report better erections with general Penis Enlargement exercise. Jelqing aids in the increase of blood flow. PC exercises help strengthen the ability of the penis to maintain erections. PC exercise also helps to increase the density of the erection quality.

Oral Medications:
Viagra (Sildenafil)has truly revolutionized the treatment of erectile dysfunction. It is effective and safe in approximately 60% of men. It is taken one hour prior to intercourse and will work only if a man has significant stimulation. In most patients it will result in a very rigid erection that is well maintained and satisfactory.

Yohimbine is another oral medication that predated Viagra. Its efficacy is controversial, although it is generally believed to produce modest improvement in erectile dysfunction. It must be taken three times each day chronically, not only prior to intercourse.

Vacuum Erection Devices and Pumps
These devices are external and go over the penis. A seal is created between the device and the skin around the penis. The air in that space is removed and this creates a vacuum around the penis, which draws blood into the penis. A ring is then placed around the base of the penis, which holds the blood in, and the vacuum pump is removed. The patient will then maintain the erection while the ring is on and will have intercourse with the ring on. This method has proved effective. It is most commonly used by older men in long-standing relationships.
It is important to use only FDA approved devices as these have valves that limit the amount of vacuum pressure that can build up around the penis. If too much pressure is build up, the penis can be damaged.

Penile Injections
Penile injections are successful in 90-95% of patients (even in those cases where Viagra is not.) They result in a rapid onset of an erection and they are used immediately prior to intercourse. For most patients they produce an erection that is of increased rigidity and duration. Many patients who are not satisfied with results from Viagra use the injections with great success.
Injections are not painful. Most of the times they can be given with an auto-injector. Men describe this sensation as similar to that of a flick of a rubber band.
The three main medications used for injections are Alprostadil, Papaverine and Phentolamine. They can be used in various combinations. The Alprostadil is available in prescription form in kits. These include a vial of powdered medicine, a syringe with the fluid needed to dilute it and a self locking case for disposal of the used needles.

Intraurethral Delivery Systems
The Alprostadil may be made into a small pellet in high concentration. This is then placed, via an applicator, into the urethra, (the tube men from which men urinate and ejaculate). The medication then diffuses through the urethral tissue into the blood stream and then into the erectile tissue. It has worked in many men, although in general it is less effective than injecting the same medication into the penis. Side effects may include urethral burning and lowering of blood pressure.

There are two classifications of surgeries:

· The most common is the insertion of a penile prosthesis of which there are several types. The most sophisticated are very natural in appearance. They are inserted through a small incision, usually in the scrotum. Two cylinders are placed into the penis itself near the erectile tissue. A small pump is placed into the scrotum and a reservoir placed under the abdominal wall. When the man wants an erection, he transfers the fluid via the pump from the reservoir into the erection chambers, thus getting a rigid, well-maintained erection. When he is finished with intercourse, he can deflate the prosthesis. Penile sensation and orgasmic ability are basically unchanged with this procedure. This procedure, though invasive, does have a very high patient satisfaction rate.

· A very small percentage of patients are candidates for penile re-vascularization. In this situation, when there is a blockage or damage to the penile artery it can be bypassed giving a better blood supply to the penis.
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