Erectile Dysfunction

Erectile dysfunction (ED) is common, affecting half of men age 40 to 70. As men become more open to discussing their sexual concerns, sexual medicine physicians use up-to-date research and guidelines to treat them.

However, other groups have appeared, reaching out to patients directly with aggressive advertising promoting unapproved and often unproven treatments with inflated promises. You may have already heard about such things as penile shock wave therapy, penile platelet rich plasma (aka P shot) or stem cell injections. These treatments typically require significant out-of-pocket costs.

What Causes Erectile Dysfunction?

Blood-flow problems can cause erectile dysfunction. It also can be caused by physical or emotional stress. It’s important to determine what’s causing your erectile dysfunction, because you could have an underlying illness that’s causing the ED. Some diseases that can cause ED include diabetes, heart disease and high blood pressure.

How is Erectile Dysfunction Diagnosed?

It’s normal to have erectile problems from time to time. When it happens more than 50 percent of the time, a diagnosis of erectile dysfunction can be made. Blood and urine tests for diseases like diabetes and heart disease are important if you have ED. You may also need some erectile-function testing to see if the blood vessels, nerves and muscles of your penis and pelvic area are working properly.

What are the currently approved erectile dysfunction (ED) treatments?

Lifestyle Changes

There are some lifestyle changes that can improve ED, like quitting smoking and avoiding drugs and alcohol. Any underlying emotional problems should also be treated. If there is no improvement, there are medications for erectile dysfunction.

Oral medications for ED

Oral medications include PDE inhibitors (Viagra, Cialis, Levitra, Stendra). If your ED is not improved with oral medication, you still have options. Alprostadil is another drug for erectile dysfunction that can have success rates up to 85 percent. Using a very thin needle, you inject the drug into the side of the penis. Another method of using Alprostadil is to insert a tiny pellet of the medication into the urethra, though success rates are lower with this method.

Medical Devices for Erectile Dysfunction

Medical devices include Intraurethral suppository (MUSE), penile injections, and penile prosthetics (malleable or inflatable implants).

Another alternative to treat ED is use of a vacuum erection device. A plastic tube slipped over the penis makes a seal with the skin of your lower abdomen. A pump on the end of the tube creates a low-pressure vacuum which produces an erection. Then you slip an elastic ring onto the base of the penis to keep the blood in for up to 30 minutes. While some training is needed, almost all men can get and keep an erection with this device.

Do any treatments help restore normal erectile function?

The approved treatments above are used as needed for satisfactory erections but don’t treat the underlying cause of ED. Our doctors will work to restore health factors that affect hormones and blood flow important for penile health.

Animal research has suggested that low-intensity penile shock wave therapy (SWT) may restore improved blood flow to the penis. Some human studies have shown benefit while others have not. Long-term results and side effects are not well known. This treatment is
not currently FDA-approved for ED in the United States.

Penile injections of platelet rich plasma (PRP) or your own stem cells are also offered by some groups. These treatments are experimental with little data. Injecting your own cells is outside FDA approval but you can see important information below regarding
national guidelines.

What do national guidelines say?

Separate panels of experts convened by the American Urological Association (AUA) and the Sexual Medicine Society of North America (SMSNA) reviewed available research to create ED treatment guidelines.

AUA ED guidelines released in early 2018 stated that SWT and restorative penile injections “should be considered investigational.” The SMSNA position statement published in March 2018 likewise considers restorative treatments “experimental and should be conducted under research protocols.”

Surgery for Erectile Dysfunction

A penile implant can help you to have normal sex. In a minority of cases, surgical repair of the blood vessels in the penis may be required to treat erectile dysfunction.

How do I protect myself?

Before starting any treatments, do your homework and ask appropriate questions. Ask who will be treating you. Your primary care physician and a urologist are best versed to review your concerns and overall health, and to determine appropriate treatment. When seeing a new doctor, ask about his/her training background. Any physician other than your primary care physician, including all urologists, should have specific training in ED. Urologists with additional experience or training in sexual medicine are also
available for complex cases.

Ask what technology/machine your doctor will use. For penile SWT, some groups are not using true shockwave machines but rather acoustic vibrators which will not provide the right energy level for treatment.

Find out the cost of treatment. Sexual satisfaction is important to quality of life and insurance covers most doctor visit costs. Coverage of approved treatments varies but your physician should be able to discuss this openly with you. Question any high-cost treatments; you don’t want to be surprised with a bill later.

Resources