What're the treatment options for impotence or erectile dysfunction?
Treatment depends on the cause. Testosterone supplements may be used for cases with hormonal deficiency. However, usually the cause is lack of adequate penile blood supply as a result of age-dependent damage of inner walls of blood vessels. Previously, medical substances (e.g. apomorphine) were used to be directly injected into the erectile tissue of penile shaft to treat impotence. In some cases refractory to the medical treatment, a penile implant (penile prosthesis) could be advised. After the discovery of orally active agents that increase the efficacy of NO, which dilates the blood vessels of corpora cavernosa, more conservative methods were started to be used.
Most physicians suggest that treatments for impotence proceed along a path moving from least invasive to most invasive. This means cutting back on any harmful drugs is considered first. Psychotherapy and behavior modifications are considered next, followed by vacuum devices, oral drugs, locally injected drugs, and surgically implanted devices (and, in rare cases, surgery involving veins or arteries).
Psychotherapy: Experts often treat psychologically based impotence using techniques that decrease anxiety associated with intercourse. The patient's partner can help apply the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when physical impotence is being treated.
Drug Therapy: Drugs for treating impotence can be taken orally or injected directly into the penis. Oral testosterone can reduce impotence in some men with low levels of natural testosterone. Patients also have claimed effectiveness of other oral drugs, including posphodiesterase type 5 inhibitors (PDE5) inhibitors such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis), ohimbine hydrochloride, dopamine and serotonin agonists, and trazodone--but no scientific studies have proved the effectiveness of these drugs in relieving impotence. Some observed improvements following their use may be examples of the placebo effect, that is, a change that results simply from the patient's believing that an improvement will occur.
Many men gain potency by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine, and prostaglandin E1 widen blood vessels. These drugs may create unwanted side effects, however, including persistent erection (known as priapism) and scarring. Nitroglycerin, a muscle relaxant, sometimes can enhance erection when rubbed on the surface of the penis. Research on drugs for treating impotence is expanding rapidly. Patients should ask their doctors about the latest advances.
Vacuum Devices: Mechanical vacuum devices cause erection by creating a partial vacuum around the penis, which draws blood into the penis, engorging it and expanding it. The devices have three components: a plastic cylinder, in which the penis is placed; a pump, which draws air out of the cylinder; and an elastic band, which is placed around the base of the penis, to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back into the bod. One variation of the vacuum device involves a semirigid rubber sheath that is placed on the penis and remains there after attaining erection and during intercourse.
Surgery: Surgery usually has one of three goals:to implant a device that can cause the penis to become erect;
to reconstruct arteries to increase flow of blood to the penis;
to block off veins that allow blood to leak from the penile tissues.
Implanted devices, known as prostheses, can restore erection in many men with impotence. Possible problems with implants include mechanical breakdown and infection. Mechanical problems have diminished in recent years because of technological advances. Malleable implants usually consist of paired rods, which are inserted surgically into the corpora cavernosa, the twin chambers running the length of the penis. The user manually adjusts the position of the penis and, therefore, the rods. Adjustment does not affect the width or length of the penis. Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid (see figure 3). Tubes connect the cylinders to a fluid reservoir and pump, which also are surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis somewhat. They also leave the penis in a more natural state when not inflated.
Surgery to repair arteries can reduce impotence caused by obstructions that block the flow of blood to the penis. The best candidates for such surgery are young men with discrete blockage of an artery because of an injury to the crotch area or fracture of the pelvis. The procedure is less successful in older men with widespread blockage. Surgery to veins that allow blood to leave the penis usually involves an opposite procedure--intentional blockage. Blocking off veins (ligation) can reduce the leakage of blood that diminishes rigidity of the penis during erection. However, experts have raised questions about this procedure's long-term effectiveness.
More information on impotence (erectile dysfunction)
What is impotence or erectile dysfunction? - Impotence is the inability of the male to have an erection. Some men may become impotent after having diabetes for a long time because the nerves or blood vessels have become damaged. Impotence may have a physiological or psychological basis.
How does erection occur? - Erection begins with sensory and mental stimulation. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the open spaces.
What causes impotence? - A common cause of impotence is a high level of atherosclerosis in the arteries feeding the penis. Damage to arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of impotence.
What are the physical causes of impotence? - Physical impotence occurs when there is a problem with any of the systems needed to get or maintain an erection. Hardening of the arteries can affect the artery leading to the penis so that it cannot dilate enough to deliver all the blood necessary for an erection.
What are the psychological causes of impotence? - Psychological causes of impotence often include work pressures, financial worries, fear of aging, or frustration with relationships. Depression and anxiety disorders are cited as the most common causes of psychological impotence.
How is impotence (erectile dysfunction) treated? - Treatment depends on the cause. Testosterone supplements may be used for cases with hormonal deficiency. Drugs for treating impotence can be taken orally or injected directly into the penis.
What're non-prescription treatments for impotence? - Among the herbs used for erectile dysfunction are yohimbine, gingko biloba (to increase blood flow), ginseng, pygeum, and muira puama. A penile sheath is a rigid or semi-rigid support put over the penis to support it for intercourse.
What is MUSE? - MUSE is short for "medicated urethral system for erection." This treatment is based on the discovery that the urethra can absorb certain medications, which can then pass into the surrounding erectile tissue creating an erection.
What is Viagra (sildenafil citrate)? - Viagra (sildenafil citrate), a prescription medication for the treatment of erectile dysfunction, is the first pill available that's been proven to improve erections in most men with impotence.
What is Levitra (vardenafil)? - Levitra (vardenafil HCl) is a PDE inhibitor drug. This medication helps improve erection during sexual arousal and activity but erection should end after sexual activity is complete.
What is Cialis (tadalafil)? - Tadalafil (Cialis?) is a drug used to treat male erectile dysfunction (impotence). The generic name for this compound is tadalafil.
What about penile injection therapy? - Penile injection therapy is non surgical technique used to treat impotence. Penile injections have the advantage of not involving surgery. They are also effective in many dialysis patients.
What are penile implants for impotence? - Penile implants (often called "internal penile pumps") are one of several erectile dysfunction treatment options. The inflatable penile prosthesis is a pump system surgically placed in the penis.
What is hormonal therapy for impotence? - Sexual desire (libido) and an overall sense of well-being are likely to improve when serum testosterone levels (the level of the male hormone in the blood) are restored.