Until the 1970's, no one, not even the scientific community, was exactly sure how erections occurred or, more importantly, how to treat those men with erection problems. This created an unfortunate and unnecessary situation for thousands of couples at the time. It is now estimated that over 30,000 American men suffer from some form erection problem.
Impotence or erectile dysfunction, as it is now referred to since the introduction of Viagra in 1998, is defined as the inability to achieve or maintain an erection sufficient for intercourse. This difficulty, once blamed on emotional or psychological reasons or advancing age, is now understood to represent a distinct medical problem worthy of medical attention. Advancing age does not cause erectile dysfunction; indeed, great sex for life can be a reality.
Before we discuss how erectile dysfunction can be treated, let's first understand how an erection occurs. The penis consists of two sponge-like chambers surrounded by a fibrous sheath, known as the corpora cavernosa. Following sexual stimulation, this spongy tissue expands dramatically as blood vessles entering the penis open, filling the penis with blood. While this is happening, those vessels carrying blood away from the penis contract causing entrapment of
blood in the penis resulting in penile rigidity, otherwise known as an erection.
Specifically, sexual arousal triggers the release of a neurotransmitter called nitric oxide (NO), which in turn triggers the production of another biochemical substance called cyclic GMP, which has the ability to relax the smooth-muscle cells causing them to release their grip on the arteries sending blood into the erectile chambers. This allows the sponge-like tissue to swell and, at the same time, cause compression of local veins that would otherwise carry
blood away from the penis.
Unfortunately, this fine mechanism can become disrupted, not simply by advancing age, but by diseases like diabetes, medications that treat high blood pressure, anxiety and depression, or from complications following treatment of prostate cancer. The good news is that, in the right hands, nearly every man can be afforded the ability to achieve and maintain an erection.for life.
Since the introduction of Viagra (Sildenafil Citrate), the public awareness of erectile dysfunction as an actual disease process is now finally being realized. The term "erectile dysfunction" was, indeed, coined by the pharmaceutical company Pfizer in 1998 following their launch of Viagra. Since then, two other companies have produced their version of this medical therapy to compete with Viagra. Levitra (Vardenafil HCl) and Cialis (Tadalafil) are agents similar
to Viagra in their mechanism of action, all functioning to delay the breakdown of cyclic GMP by blocking the enzyme PDE-5, thereby promoting the effect of the neurotransmitter NO released during sexual arousal. These agents differ in their rate of absorption, metabolism and receptor specificity, but exert their intended effect through the same mechanism, as PDE-5 inhibitors. As many as 70 percent of patients with erectile dysfunction will see a noticeable improvement
in their potency with the help of these agents. There remain many, however, both patients and physicians, who still believe that erectile dysfunction is a problem for which there is no good solution and something to just
"live with". This perception couldn't be further from the truth.
For those 30% of men who don't respond to one of the oral PDE-5 inhibitors, referral to a Urologist is warranted. In experienced hands, nearly every patient with persistent erectile dysfunction can be offered a solution to his problem; one that is both convenient and effective for him and his partner.
Generally, the next step in the treatment paradigm for patients with persistent erectile dysfunction failing medical therapy is consideration of what are considered the "minimally-invasive" options. These include vacuum erection devices (VEDs) or injectable medications. Use of the VED involves placing a plastic cylinder over the penis, forming a seal at the base of the penis with the body wall, creating a vacuum inside the chamber, thereby drawing blood into
the penis before sliding an occlusive rubber band over the base of the penis to trap the drawn-in blood. The penis typically remains rigid as long as the rubber band is applied, and can be left in place for an hour or two without damage to the penile tissues. While the VED can provide an erection sufficient for intercourse, in most situations, it is cumbersome, often uncomfortable, and particularly inconvenient for both the patient and his partner.
Another "minimally-invasive" option for treating erectile dysfunction resistant to oral medicine is injectable therapy. Intracavernosal injection therapy involves injecting into the erectile bodies of the penis, known as the cavernosal bodies, medication that causes dilatation (opening) of the arterial blood vessels carrying blood into the penis. As the penis becomes engorged with blood, in a manner similar to a normal erection, venous blood vessels carrying
blood away from the penis are squeezed closed allowing the penis to remain erect until the medication "wears off". An erection achieved in this manner typically lasts approximately 2 hours, as the dosage required to achieve a sufficient erection is determined in the Urologist's office.
Side effects from intracavernosal injection therapy are rare, but should be understood. Because scarring of the fibrous sheath encasing the erectile bodies can occur with long-term use at the same injection site, it is recommended that injections be limited to 2 or 3 per week and at different sites along the penile shaft. Because the paired penile bodies are connected to each other by an incomplete septum, injection need only be performed on one side to achieve
erection of both corporal bodies. Different medication cocktails are available for those patients experiencing sensitivity or pain from the medication itself, and the needles used for this therapy are extremely small and often allow a relatively painless injection. Because, however, this strategy involves needles, is limited to a few uses each week, and can cause penile discomfort and scarring, approximately 60% of patients using intracavernosal injection therapy
will eventually discontinue its use in search for a better alternative.
The most effective and reliable treatment for erectile dysfunction remains the inflatable penile prosthesis (IPP). Created in 1973 by F. Brantley Scott, for whom the Scott Department of Urology at Baylor College of Medicine was named, and, incidentally, the residency program in which I trained, the IPP has undergone numerous revisions and today represents an excellent option to treat erectile dysfunction resistant to PDE-5 inhibitor medical therapy.
The three-piece IPP consists of two cylinders in which expansile polypropylene material lies between two layers of silicone. This construct permits natural expansion of the cylinders during inflation similar to a natural erection while maintaining axial rigidity to prevent buckling of the device during intercourse. The material is soft enough to be indistinguishable from a normal phallus when the device is in the deflated position.
The entire prosthesis is coated with antibiotic material that has reduced the rate of infection to less than 1%. Mechanical failure-free rates at 3 years are are 92% and at 5 years are 86%. More importantly, 96% of patients implanted indicated they would do it again. Of the partners of men with an IPP, 93% were pleased that their partner had the procedure and 89% find intercourse pleasurable with the device.1
The IPP permits immediate potency without the need for advanced planning and preparation that can interfere with romantic spontaneity. It offers freedom from expensive medications and remains fully erect for as long as the patient desires with complete rigidity and no alteration in penile sensation during intercourse or in the normal sensation during ejaculation. There is also complete freedom to deflate the device whenever one chooses. In fact, the result
is so natural that a cosmetic difference is entirely unnoticeable.
Many medical insurers cover 90% or more of the total cost for the penile prosthesis and its implantation, and Medicare requires only a modest copayment, covering the remainder of the bill. For those patients not responding to or unable to afford the expensive pharmaceuticals that treat erectile dysfunction, you're not alone and you're not without recourse. There are an elite group of Urologists available to help find the right solution for you. Just realize
that a solution does exist and that great sex can be had.for life! |
