Treatment of Erectile Dysfunction

⚠ Important Note:
This content is based on clinical guidelines (AUA/EAU) for educational use. It does not replace a professional medical consultation. Please consult a specialized doctor before starting any treatment mentioned.

Treating underlying conditions

Any underlying conditions, such as diabetes mellitus and hypertension, must be treated first. The doctor often stops any medications that may cause erectile dysfunction or replaces them with other medications. The patient should not stop using any medication before consulting the doctor.

Being overweight is a risk factor for erectile dysfunction, and therefore, losing excess weight may help improve erectile function. Smoking is also a risk factor for atherosclerosis, and therefore, smoking cessation may also help improve erectile function. If the patient drinks excessively, stopping or limiting alcoholic beverages may improve erectile dysfunction.

Education and counseling

Even erectile dysfunction caused by a physical problem may have a psychological aspect, so the doctor can provide educational materials to help the patient and his sexual partner.

A sex therapist can help the couple improve communication between them, reduce psychological stress and anxiety related to sexual performance, and solve marital problems that contribute to erectile dysfunction.

Phosphodiesterase inhibitor oral pills

Oral phosphodiesterase enzyme inhibitors such as sildenafil, vardenafil, avanafil, and tadalafil are the main treatment for erectile dysfunction. It is used more often than other medications because it is easy to use.

These drugs increase blood flow to the penis but differ in how long they work, their side effects, and their interactions with the blood. The effect of tadalafil lasts longer than other drugs, up to 36 hours.

Most phosphodiesterase inhibitors work well when taken on an empty stomach, at least one hour before sexual activity. It can cause some side effects, such as a headache, a rash on the face or mild redness, and indigestion.

It is also worth noting that these erectile dysfunction medications are only available with a prescription and under the supervision of a doctor because they have drug interactions and dangerous side effects, especially on the heart.

Taking phosphodiesterase inhibitors is contraindicated with medicines that contain nitrates, such as medicines to increase blood flow in the coronary arteries in heart patients, and it is also forbidden to take them for anyone whose physical, medical, or psychological condition does not allow them to have sex.

Testosterone replacement therapy

Testosterone is called the male hormone. A low level of testosterone in the blood can cause low sexual desire or erectile dysfunction. These testosterone preparations are used in patches or gel forms that are applied to the skin.

Your doctor may also sometimes recommend the use of testosterone in the form of nasal sprays and subcutaneous implants. Patients with very low levels of testosterone may need to use testosterone injections as often as twice a month.

Sometimes doctors may prescribe a combination of sildenafil and testosterone replacement therapy, which can be successful.

Alprostadil MUSE or injection

In some cases, the doctor can prescribe a drug called "Alprostadil," a drug that dilates blood vessels, which can be used to treat erectile dysfunction when the previous options of medications are not appropriate. It can be given as an intraurethral MUSE or intracavernosal injection.

The doctor may inject alprostadil alone or in combination with papaverine and phentolamine, which are directly injected into the penis using a very thin needle, helping most men achieve a good erection.

In the penis. Usually, the doctor trains the patient to inject the drug himself during a visit to the doctor's office. After that, the man can inject himself with these drugs at home

Alprostadil and oral phosphodiesterase inhibitors may be combined in men for whom oral medications alone are not sufficient to treat their conditions

Vacuum constriction device:

Patients who can achieve but not maintain an erection can use constriction rings. Once an erection occurs, a plastic ring is placed around the base of the penis, preventing blood from flowing back and keeping the penis firm.

If a man cannot achieve an erection, a suction device may be used on the penis to help achieve this goal. The device sucks blood into the penis by applying light suction, after which the plastic ring is placed at the base of the penis to maintain the erection.

Among the negative effects of this method are bruising of the penis, a cold head, and loss of spontaneity in the sexual process. Occasionally the tightening rings and the suction device can be combined with drug treatments.

 

Surgical treatment of erectile dysfunction

Surgical intervention is considered the last option in the treatment of erectile dysfunction and is only used in severe cases. Penile surgeries used to treat erectile dysfunction include penile prosthesis implantation and penile revascularization surgery.

Penile prosthesis implantation:

This surgery is the last option for men who have not been successful with drug treatment and other non-surgical treatment options

The penile prosthesis implant may take the form of solid silicone rods or hydraulic devices that can be inflated or vented. Both types involve risks of general anesthesia, infection, and implant defect.

This surgery is simple, and its success rate is outstanding. The doctor’s participation in the decision-making process and the therapeutic measures greatly increase the chances of success.

Penile revascularization surgery

This surgical procedure aims to correct and treat any abnormality in the blood vessels that causes erectile dysfunction

It is another surgery available, but with relatively low success rates. In some special cases, this operation may be an effective treatment.

This article was written and reviewed by Dr. Hassan Ali - Urologist