Print-Article

In This Article:

• Pills
• Injection
• Suppositories
• Vacuum Devices
• Surgery
• Hormonal Therapy
• Counseling

Ways to treat erectile dysfunction (impotence) can be found in pills and pellets, implants and injections. Your choice depends on your health, medical background and the cause of your erectile dysfunction.

Pills

Phosphodiesterase E5 (PDE5) drugs -- Viagra (sildenafil), Levitra (vardenafil) and Cialis (tadalafil).

These drugs are the most prescribed treatment of erectile dysfunction today.

How it works: PDE5 drugs improve blood flow into the penis. They differ in how quickly they start to work and how many hours they remain effective. In some studies, up to 70% of impotent men had some improvement in their erections after taking one of these drugs. Three out of 10 men are able to keep an erection long enough to complete intercourse.

Side effects: In men taking nitrate medications, such as nitroglycerin and isosorbide, the most important side effect is life-threatening, low blood pressure. PDE5 drugs also appear to interact with alpha blockers, a type of drug commonly used to treat prostate problems and high blood pressure. Erectile dysfunction drugs may be used in patients with known heart disease, but only under a doctor's direction, Other side effects include headaches, upset stomach and vision problems. Prolonged erections can occur in rare cases.

Yohimbine. Yohimbine is modestly effective in treating erectile dysfunction. Made from the extract of the bark of a West African tree, yohimbine is not regulated by the U.S. Food and Drug Administration.

How it works: Yohimbine increases heart rate and blood pressure, even at low doses. It floods blood vessels in the genitals, and raises levels of 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

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

Injection

Before Viagra was approved, injecting medicine into the penis was the main way to treat impotence. It helps up to 90% of men with impotence. Doctors often recommend it for men who don't get erections using Viagra and the other PDE5 drugs.

How it works: Drugs that stimulate blood flow are injected through a fine needle into the base or side of the penis. Men learn how to give themselves shots in their doctor's office.

Alprostadil is a synthetic version of the hormone prostaglandin E. It is used in most injection treatment. It relaxes smooth muscle tissue in the penis. This improves blood flow and allows an erection to take place within five to 20 minutes. The erection can last up to an hour.

Side Effects: Some pain, some bleeding, scarring and the risk of prolonged erection.

Suppositories

Sold under the name MUSE (medicated urethral system for erection), these suppositories contain the drug alprostadil. Men insert the pellets about two inches into the opening of the penis. Sometimes a rubber band is placed around the base of the penis to sustain the erection.

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

Vacuum Devices

This option doesn't have any side effects or discomfort.

How It Works: A hand pump creates a vacuum in a plastic tube placed over the penis. Once blood has entered the penis, a rubber band is slipped around the base of the penis to trap the blood. The plastic tube is removed for sexual intercourse.

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

Surgery

Penile implants are the primary surgical option for impotence. This is a costly treatment. It is usually recommended only after other methods have failed.

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 other types of surgical treatment for impotence that are rarely used: venous outflow surgery, which repairs leaky veins in the penis that keep a man from maintaining an erection, or bypass surgery, which clears blocked penile arteries.

Another procedure, known as revascularization, is used most successfully in younger men who have small blockages in arteries. These are caused by injury to the crotch area or a fractured pelvis. An artery is taken from a leg and surgically connected to the arteries at the back of the penis. This restores blood flow by going around the blockage.

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

Hormonal Therapy

This is a rare option. Only about 5% of men have a testosterone deficiency that causes erectile dysfunction.

Testosterone is usually administered by patch, topical gel or injection. Oral testosterone can reduce impotence in some men with low levels of natural testosterone, but it is generally not recommended because possible side effects include damage to the liver.

Counseling

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

Depressed men may have trouble performing sexually. If you get rid of the depression, the sex drive may come back.

Psychological obstacles to sexual fulfillment tend to appear more in younger men.

Treatment Options