Erectile Dysfunction (ED)

Erectile dysfunction (ED) is an ailment that traditionally has been thought of as a condition that impacted men who are older. However, that stereotype has faded away with the advent of the “little blue pill” and the ED dialogue is now openly discussed among men young and old.

Medically ED is defined as the inability to achieve and/or maintain an erection adequate for sexual intercourse.

According to the Cleveland Clinic, as many as 52 percent of men experience erectile dysfunction, with it affecting 40 percent of men age 40, and 70 percent of men age 70. Men who have heart disease, diabetes and are taking certain medications have higher risks of experiencing erectile dysfunction.

• Coronary artery disease
• Peripheral vascular disease
• Tobacco use
• Alcohol and substance abuse
• Medications such as anti-psychotics, anti-hypertensive
• Fatigue
• Stress
• Obesity
• Depression
• Thyroid disease
• Diabetes
• Elevated cholesterol
• Neurological disease such as Parkinson’s disease, multiple sclerosis, spinal cord injury
• Peyronie’s disease – development of plaque/scar tissue along the shaft of the penis
• Nerve damage due to pelvic surgery or radiation therapy

When a patient comes to our clinic concerned about ED, we do a detailed history and physical examination. Other tests that may be performed are:

• Laboratory studies may include a check for low testosterone, thyroid disease, and diabetic screening (if suspected)
• Penile doppler study to assess blood flow and screen for venous leakage. This study may be accompanied by the injection of a medication to induce an erection occasionally
• Nocturnal penile tumescence test (Snap-Gauge band) screening for erection when the individual is asleep

Typically, the underlying medical condition will need to be treated, such as poorly controlled diabetes or undiagnosed thyroid disease, if present.

Oral Medications for ED:

• If an individual continues to experience erectile dysfunction, then the use of oral medications is usually preferable.
• This class of medication is called phosphodiesterase inhibitors (PDEs) and is designed to reduce the breakdown of nitric oxide in the blood stream leading to greater relaxation of the musculature found in arterial blood vessels.
• Examples of these medications include: Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra/Staxyn), Avanafil (Stendra)

Other (Non-Oral Therapies) for ED:

Patients who fail oral therapy can also consider the following:

• Penile injection of vasodilating agents (single agent/Trimix/Quadmix) directly into the corpus cavernosum
• Insertion of an intraurethral vasodilation agent called MUSE
• Use of a constriction band in conjunction with medication.
• Use of a vacuum erection device

Shockwave Therapy for ED:

Officially called low-intensity extracorporeal shockwave therapy (Li-ESWT), the procedure is more commonly known as shockwave therapy. The treatment involves noninvasive low-intensity sound waves that trigger a process called neovascularization in the targeted area of the body to help improve blood flow to the region.  

When used for ED, the soundwaves pass through the erectile tissue. The goal is to restore natural erectile function by clearing plaque out of blood vessels as well as to encourage the growth of new blood vessels and blood flow. Shockwave therapy has been effectively used to treat kidney stones and in orthopedics, sports medicine and podiatry to treat joint and musculoskeletal issues.  

Compared with conventional treatment for ED, shockwave therapy for ED offers some distinct advantages:  

• Research shows high rate of effectiveness 
• Minimum procedural time 
• Low risk 
• Non-invasive 
• Efficient, a typical session is around 15 minutes

As blood flow is critical to a man’s ability to achieve an erection, scientists are more recently studying shockwave therapy’s effects on erectile dysfunction. Shockwave therapy is anticipated to be FDA-approved, with early and ongoing research being promising.  

Early clinical trials of shockwave therapy for ED have shown promising results. The treatment has been well tolerated by patients. Many men have found that their erections have improved and they can have intercourse. However, without more robust data, which will take time to accumulate and such research is underway, shockwave therapy is currently considered an experimental treatment. More robust studies will help confirm early promising findings.  

Surgical Correction for ED:

• Surgical correction of erectile dysfunction is certainly another option for men who have failed to respond to more conservative therapies.

The two types of penile prosthesis currently available are semi-rigid penile prosthesis and inflatable penile prosthesis.

• A semi-rigid penile prosthesis is usually a self-contained pair of malleable rods that are placed in the corpus cavernosum. When the individual is not engaged in sexual activity, the penis can be flexed against the pubic symphysis or along the thigh. However, when engaged in sexual activity the individual can bend the penis into an erect position to allow for sexual intercourse.
• An inflatable penile prosthesis, on the other hand, is a much more dynamic device. The basic component of any penile prosthesis involves a reservoir to hold the fluid that provides the erection when moved into the penile cylinders as well as a control pump which directs the fluid between the reservoir and cylinders. When the patient is not in an erect state most of fluid is in the reservoir. When the patient is engaged in sexual activity, he will press on the control pump several times to move fluid from the reservoir toward the cylinders that are implanted into the corpus cavernosum.

The risks associated with any implant are mechanical failure and erection. Patients receiving an implant should be counseled carefully on expectation. Quite often despite a successful implantation, most recipients may complain of a loss of length.

If an individual receiving an implant also suffers from Peyronie’s disease, we will often perform a procedure to correct the curvature during the same procedure.

Procedures include:

• Penile mottling
• Nesbitt plication
• Excision of plaque and placement of tissue graft

If you are experiencing ED, there may be an underlying condition that is causing it. There are many treatment options available for ED.