What doctors treat erectile dysfunction?
The type of medical specialist who treats ED will depend on the cause of the problem. Based on your family's medical history, as well as your own medical history and current health, your doctor may treat you with oral medications (Viagra®, Levitra®, Cialis®).
If these options fail, you may be referred to a urologist who can assist with other non-surgical options such as vacuum device or injections or surgical treatment options. If needed, your doctor may also refer you to a psychologist specializing in sexual dysfunction.
How is erectile dysfunction treated?
ED can be treated in many ways, including:
- Oral medications
- Sex therapy
- Penile injections
- Vacuum devices
- Intraurethral medication
- Surgery (penile implant)
Each type has its own pros and cons. Discuss your options with your doctor to determine the best treatment for you.
The first step to treating ED is to find the underlying cause. Then the appropriate treatment can begin. There are a number of non-surgical and surgical options that can help a man regain normal sexual function.
What non-surgical treatments are there for erectile dysfunction (ED)?
Education and communication
Education about sex, sexual behaviors, and sexual responses may help a man overcome his anxieties about sexual dysfunction.
Talking honestly with your partner about your needs and concerns may also help to overcome many barriers to a healthy sex life.
Medications such as sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis) may help improve sexual function in men by increasing blood flow to the penis. Men who are on medicines that contain nitrates such as nitroglycerine should not take oral ED medications. The combination of nitrates and these specific medications can cause low blood pressure (hypotension).
The most common side effects of these medications are indigestion, nasal congestion, flushing, headaches, and a temporary visual disturbance.
Aids such as vacuum devices and penile constriction rings serve as erectile aids for some men.
A vacuum constriction device (left) is a cylinder that is placed over the penis. The air is pumped out of the cylinder, which draws blood into the penis and causes an erection. The erection is maintained by slipping a band off of the base of the cylinder and onto the base of the penis. The band can stay in place for up to 30 minutes. The vacuum device can be safely used to treat most causes of erectile failure. Lack of spontaneity, discomfort, and cumbersomeness of the device seem to be the biggest concerns of patients.
Penile injection therapy (intracavernosal injection therapy)
Men are taught how to inject medications directly into the erection chambers of the penis to create an erection. Injection therapy is effective in treating a wide variety of erection issues caused by blood vessel, nerve, and psychological conditions.
Using a tiny needle and syringe, the man injects a small amount of medicine into the side of his penis. The medicine relaxes the blood vessels, allowing blood to flow into the penis. This treatment has been widely used and accepted since the early 1980s. The three most common medicines are prostaglandin E1 (alprostadil), papaverine (Papacon®), and phentolamine (Regitine®).
The most common side effects are pain and penile scarring (fibrosis). In extremely rare cases, patients with cerebral and vascular disease or severe cardiovascular diseases might not be able to tolerate the dizziness and high blood pressure occasionally caused by injection therapy.
A painful erection that lasts longer than two to three hours is called priapism and may occur with injection therapy. This can be lessened with proper dosing and by following the treatment guidelines.
Psychology and sex therapies
Psychological causes may contribute to erectile failure even when there is a clear organic cause.
Therapy with a trained counselor can help a person address feelings of anxiety, fear, or guilt that may have an impact on sexual dysfunction.
Sex therapy can be beneficial to most men when counseling is provided by a skilled sex therapist. Sex therapy also helps a man's partner accept and cope with the problems.
A patient whose ED has a clear psychological cause should receive sex therapy counseling before any invasive treatments are pursued.
Low hormone levels may play a role in ED. Hormone replacement in the form of topical gels, creams, patches, injections, and pellets are only used after physician evaluation.
What are surgical treatment options for erectile dysfunction (ED)?
Penile prosthesis surgery
Inflatable penile prostheses are implanted during outpatient surgery. Once they are part of a man's body, they enable him to have an erection whenever he desires. The use of a prosthesis preserves penile sensation, orgasm, and ejaculation for most men.
The most commonly used penile implant consists of a pair of inflatable cylinders that are surgically implanted in the erection chambers of the penis. The cylinders are connected through tubing to a reservoir of fluid under the lower abdominal muscles, and to a pump inside the scrotal sac.
To inflate the penile prosthesis, the man compresses the pump a number of times to transfer fluid from the reservoir to the cylinders. This causes the penis to become erect. When inflated, the prosthesis makes the penis stiff and thick, which is very similar to a natural erection.
A penile prosthesis does not change the sensation on the skin of the penis or a man's ability to achieve orgasm or ejaculate. Pressing on a deflation valve attached to the pump returns the fluid to the reservoir, which returns the penis to a flaccid state.
The surgical procedure is performed through one or two small incisions that are generally well hidden. Other people will be unable to tell that a man has an inflatable penile prosthesis — most men would not be embarrassed in a locker room or public restroom. Complications following surgery are not common, but primarily include infection and mechanical device failure.
Approximately 95% of penile implant surgeries are successful in producing erections that enable men to have sexual intercourse. Moreover, patient satisfaction questionnaires show that up to 90% of men who have undergone penile implants say they would choose the surgery again, and overall satisfaction ratings are higher than those reported by men using oral medication or penile injection therapy.