Erectile Dysfunction Treatment Options

In This Article:

Pills
Injection
Suppositories
Vacuum Devices
Surgery
Hormonal Therapy
Counseling

There are solutions to be found in pills and pellets, implants and injections.

Your choice of treatment depends on your health, medical history and the cause of your erectile dysfunction.

Pills
Viagra (sildenafil citrate), is considered the most significant prescription treatment of erectile dysfunction today.

Dr. O'Leary agrees. "It certainly is the greatest innovation. It's not a panacea, it doesn't work for everybody, but it certainly was a great step forward."

How it works: Viagra improves blood flow into the penis. The drug starts to work in less than an hour, but reaches maximum effect at 60 minutes. In some studies, up to 70 percent of men had some improvement in erections after taking Viagra. Three out of 10 men are able to sustain an erection through completion of intercourse.

Side effects: The most important side effect is life-threatening, low blood pressure in men taking nitrate medications, like nitroglycerin and isosorbide. Caution is advised in patients with known heart disease and high blood pressure, but under a doctor's direction Viagra may be used. Other side effects include headaches, upset stomach and vision problems. Prolonged erections, or priapism, can occur in rare cases.

Yohimbine. Prior to Viagra, this was the primary oral prescription for impotence. Marketed under the names as Yocon, Yohimex, Yohimbine Hydrochloride or Aphrodyne, yohimbine is modestly effective in treating erectile dysfunction, Dr. O'Leary says. Made from the extract of the bark of a West African tree, yohimbine is among a class of pre-1938 remedies that are not regulated by the U.S. Food and Drug Administration for use in humans.

How it works: Yohimbine increases both heart rate and blood pressure, even at low doses. It floods blood vessels in the genitals, and raises levels of the neurotransmitter norepinephrine, which stimulates areas controlling sexual response in the brain.

Side Effects: Dizziness, headache, insomnia and nervousness. Large doses can increase blood pressure and heart rate

Patients also have claimed effectiveness of other oral drugs ™ including dopamine and serotonin agonists, and trazodone ™ but no scientific studies have proved the effectiveness of these drugs in relieving impotence.

There are other promising pill forms of treatment scheduled for review by the FDA, including:

Uprima
These tablets of apomorphine HCI are designed to work in about half the time of Viagra. The drug, in pill form, is placed under the tongue and absorbed through the lining of the mouth, stimulating the release of the brain-chemical dopamine, which in turn signals the flow of blood into the penis in as little as 15 minutes. Among the potential side effects are nausea and unexpected drop in blood pressure leading to loss of consciousness.

Vardenafil
A German pharmaceutical company is in the late trial stages of testing a drug compound called Vardenafil, that is chemically related to Viagra. The company claims that the drug not only improved erections in up to 80 percent of men who were the subject of the case study, but also increased their ability to complete sexual intercourse with ejaculation. Final FDA review is expected in 2002.

Yohimbe, an herbal medication containing yohimbine as its active ingredient, is available over the counter, but the FDA strongly advises against the use of this product, as it has serious and potentially life-threatening side effects, such as paralysis, fatigue, stomach disorders, and even death.

Additionally, the FDA warns, such unapproved treatments have not undergone rigorous safety testing and trials to substantiate manufacturers' claims. Indeed, the federal agency offers the following stern warning about bogus remedies that keep flooding the market:

"If the product being pitched to cure impotence is 'herbal' or 'all natural,' dismiss it. To date, no 'herbal' or 'all natural' substance has been shown to be an effective treatment for impotence."

Injection
Injection of medication was the principal form of treatment for impotence before Viagra was approved. Injection therapy helps up to 90 percent of men with impotence, and doctors often recommend it for men who do not respond to Viagra.

How it works: Drugs that stimulate blood flow are directly injected through a fine needle into the base or side of the penis. Patients learn how to do the injections first in their doctor's office until they feel comfortable enough to self-administer.

"Once they start taking injection therapy, if they have problems with taking a pill, they find it bearable," Dr. O'Leary says.

Alprostadil is a synthetic version of the hormone prostaglandin E used in most injection treatment. The medication relaxes smooth muscle tissue in the penis to improve blood flow. Erection takes place within five to 20 minutes and can last up to an hour.

Side Effects: Minimal pain, some bleeding, scarring and the risk of prolonged erection, or priapism.

Suppositories
Marketed under the brand name MUSE (the medicated urethral system for erection) these suppositories containing the drug alprostadil are inserted about two inches into the urethra, the opening of the penis. Sometimes a rubber band placed around the base of the penis is needed to sustained erection. About two-thirds of men respond to alprostadil suppositories.

Side effects: Minor bleeding, dizziness and formation of fibrous tissue. For some, the insertion can be uncomfortable or painful.

Vacuum Devices
How It Works: A hand pump is used to create a vacuum in a plastic tube that has been placed over the penis. Once blood has entered the penis, a tension band is slipped around the base of the penis to trap the blood. The apparatus is removed for sexual intercourse to take place. There is no waiting for medications to take effect or wear off when finished.

Downside: Time-consuming and might interfere with the mood.

Surgery
Penile implants are the primary surgical option for impotence, albeit a costly treatment, that is usually recommended after other methods have been unsuccessful.

How It Works: Inflatable devices or semi-rigid rods made of silicone or polyurethane are surgically inserted into the penis. If an inflatable device is used, a pump is placed in the scrotum to inflate the splints long enough for intercourse to take place. Erections can occur as often and for as long as desired.

Side Effects: Pain from the rods rubbing inside penis. As with any surgery, there is a small risk of infection.

There are two other types of surgical treatment for impotence that are rarely used: venous outflow surgery, a procedure to repair leaky veins in the penis that prevent maintenance of an erection, or bypass surgery to clear blocked penile arteries.

The second procedure, known as revascularization, is used most successfully in younger men who have small blockages in arteries, caused by traumatic injury to the crotch area or a fractured pelvis. An artery is taken from a leg and then surgically connected to the arteries at the back of the penis, circumventing the blockages and restoring blood flow.

Side effects: Sometimes the procedure may have to be repeated.

Hormonal Therapy
This is a rare option, because only about 5 percent of men have a testosterone deficiency linking their lack of sexual performance to erectile dysfunction.

Testosterone is usually administered by patch, topical gel or injection. While oral testosterone can reduce impotence in some men with low levels of natural testosterone, it is generally not recommended, because possible side effects include damage to the liver. When a hormonal basis is suspected for erectile dysfunction, Dr. O'Leary says routine blood testing is necessary to confirm that suspicion. Such tests may rule out or indicate some other underlying illness as the cause.

Counseling
The cause-and-effect relationship of erectile dysfunction and mental health is a complex one. Counseling often helps to clarify the issues.

"A lot of men are depressed if they can't perform sexually. If you restore that, it improves their overall sense of well-being," Dr. O'Leary says.

"The majority of men that I see in my practice, if there is an erection problem, it has probably triggered their mood problem."

Generally, the psychological obstacles to sexual fulfillment tend to appear more in younger men, Dr. O'Leary says.

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Last updated August 27, 2001