Dr. Scott is well-experienced in diagnosing and treating erectile dysfunction.
Since the discovery that the drug sildenafil, or Viagra, improved erectile dysfunction, most people have become aware that ED is a treatable medical condition. But we are seeing younger and younger men present with ED. Some are coming in just to improve the quality of their erections.
ED is affecting more and more men in their 30’s. By age 40, the incidence is at 40%. The incidence increases by 10% every 10 years thereafter. The good news is that there is more we can do now, than ever before.
What is Erectile Dysfunction?
Erectile dysfunction (ED) is defined as persistent difficulty achieving and maintaining an erection sufficient to have sex.
- Causes are usually medical but can also be psychological.
- Medical causes are usually related to low hormones, poor blood flow, or as it relates to the nerves supplying the penis.
- Numerous prescription drugs, recreational drugs, alcohol, and smoking, can all cause ED.
Physical causes account for about 90% of ED cases, with psychological causes being much less common. However, sometimes both can be contributing factors.
The physical causes of ED can be categorized as relating to hormones, blood flow, and innervation (nerve supply).
- Low Testosterone
Atherosclerosis is a common cause of blood flow problems, as it causes a narrowing or clogging of arteries in the penis, preventing the necessary blood flow to the penis to produce an erection.
- High Blood Pressure
- Heart Disease
- High Cholesterol
Obesity increases the risk of erectile dysfunction by lowering testosterone levels and damaging blood vessels. Obesity damages blood vessels, and thereby lowers blood flow to the penis, by increasing the risk of high blood pressure, diabetes, high cholesterol, and it creates an overall state of inflammation.
Neurologic, such as:
- Surgical treatments for Prostate disease
- Injuries to the pelvis or spinal cord
- Multiple Sclerosis
Numerous prescription medications can also cause ED, including those below. Anyone taking prescription medications should consult their doctor before stopping or changing their medications:
- High blood pressure medications
- Heart medications such as digoxin
- Drugs that act on the central nervous system, including some sleeping pills and amphetamines
- Antianxiety and antidepressant medications
- Opioid painkillers
- The peptic ulcer medication Cimetidine
Psychological factors can include:
- Fear of intimacy
- Severe anxiety
Treatment for ED:
The good news is that there are many treatments for ED, and most men will find a solution that works for them.
Vacuum “pumps” are a mechanical way of producing an erection for men who do not want or cannot use drug treatments, or find they are not working. The penis is made rigid by the use of a vacuum pump sealed around it that draws up blood. This is prevented from then leaving the penis by the use of an accompanying band. The lack of spontaneity with the use of vacuum devices means that many men find other treatments for ED preferable.
- PDE-5 inhibitors. Most of these pills are taken 30 to 60 minutes before sex
- The “blue pill”- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Ardenafil (Levitra)
- Avanafil (Stendra) – The most common side effects are headaches and flushing.
- The anti-aging peptide, PT-141
- TriMix is a self-injected penile injection that consists of three medications (phentolamine, papaverine and alprostadil). When injected into the penis, TriMix’s blend of three vasodilators causes the blood vessels in the penis to relax, expand and fill with blood. It’s an alternative to PDE5 inhibitor tablets and is ideal for men who cannot take, have not had good results with, or experience severe side effects from tablets such as Viagra®, Levitra® or Cialis®.
P-Shot (Platelet Rich Plasma)
Low-Intensity Shockwave (EWST) Therapy
There are several surgical treatment options for ED:
- Penile implants: These are a final option reserved for men who have not had any success with drug treatments and other non-invasive options.
- Vascular surgery: Another surgical option for some men is vascular surgery, which attempts to correct some blood vessel causes of ED.
Surgery is a last resort and will only be used in the most extreme cases. Recovery time varies, but success rates are high.