Erectile dysfunction (ED) is the politically correct term for impotence. In plain English, it is when a male has difficulty in obtaining or maintaining an erection to allow for the mutual satisfaction of the individual and their partner. Before understanding the science behind erections, ED was felt to be mostly from psychological problems. Now that the process is better understood, this information has shown that most ED is from a physical or "organic" cause. This new knowledge has enabled us to treat ED effectively by directing the treatment directly at the cause.

 

There are 5 items that should be intact to allow a normal erection to occur:
1. Arteries - good arteries to get blood flow to the penis
2. Venous System - this traps the blood in the penis and then lets it drain out at the appropriate time
3. Nerves - allows messages from sensation to go to the brain and then messages of excitation to go back to the penis to stimulate an erection
4. Hormones - an appropriate hormonal environment must be present for the mechanism to work
5. Psychological state - appropriate so as not to interfere
 
most commonly there are problems in more than one of these categories!!

 

Treatment Options
  • medications
  • vacuum pumps
  • constriction devices
  • surgery
  • sex / psychotherapy

 

Medications
  • oral
  • injectable
  • transdermal
  • transurethral
Viagra is an effective oral agent in the treatment of erectile dysfunction. Although it is a relatively safe drug, caution must be used in those with coronary artery disease. One should not be on nitrates because of the profound low blood pressure that the combination may cause.  Levitra and Cialis have been approved as well.  Both medications are in the same chemical class as Viagra but there are differences.  A patient should have a detailed discussion with their urologist on the risks, benefits and alternatives prior to taking any new medication for the treatment of genitourinary problems. 

The drug alprostadil has been used for many years in an injectable form to induce an erection. It has been a very effective agent with minimal side effects when administered properly. Caverject or Edex, are the brand names for the injectable form of alprostadil that was FDA approved in 1996.  These agents are injected directly into the shaft of the penis. 

 
Muse is a delivery system for the drug alprostadil. Using the specially designed applicator, a minute suppository is inserted into the urethra. The medication is then rapidly absorbed through the urethra into the penis (80% of a dose in 10 minutes). It works the same way that the injections do on the penis. At the correct dose, an erection will occur 5 to 10 minutes after inserting the medication. Although variable from patient to patient, the medication should work for 30 to 60 minutes. It may be used up to twice a day.