Understanding your treatment options
Erectile dysfunction (ED) can limit your intimacy, affect your self-esteem, and impact your relationship with your partner1. But there’s good news—today, there is treatment for erectile dysfunction (ED) for every man. It is important to discuss your options with your family physician before starting any treatment to help you make informed choices, as to the options that may be best suited for you.
Most men with erectile dysfunction start with pills, such as Viagra™, Levitra™, Cialis™ and Stendra™. These may improve blood flow to the penis, and with sexual stimulation, can help you achieve an erection2-5. If men don’t respond to oral medications, they may try other options.
PROS: Pills can help you achieve an erection quickly and may have an effect on sexual intimacy.
CONS: Some men cannot achieve a satisfactory erection with pills and other men will switch the type of pills to achieve a satisfactory outcome2-6.
These medications (alprostadil, papaverine, etc.) may be combined and injected directly into the base or side of the penis. The recommended frequency of injection is no more than three times weekly, and should produce an erection in 5-20 minutes9.
PROS: An option for physical or psychological causes of erectile dysfunction using a fine gauge needle that may feel like a pinprick9.
CONS: Beyond a possible fear of needles, men may experience pain, fibrosis, and risk of a persistent erection9-10.
These medications (alprostadil, etc.) are inserted into the urethra at the end of the penis using an applicator (also called MUSE™). Medications applied 16 minutes before intimacy can dissolve inside the penis to relax the muscle, encourage blood flow and cause an erection11.
PROS: For use multiple times a week, it may also be an option for physical or psychological causes of erectile dysfunction.
CONS: In addition to general discomfort, common side effects include penile pain and urethral pain or burning10-11.
Topical creams (such as Vitaros™) are prescribed in the form of disposable, individual applicators. A drop is applied to the tip of the penis. The alprostadil within the cream causes the blood vessels to widen so there is an increase in the blood flow into the penis, which leads to an erection16.
PROS: Once applied, the cream can take effect within 5 minutes and may last from 1 to 2 hours, or until ejaculation16. Topical creams may be an option for men who cannot take oral medications16.
CONS: Side effects may include a burning sensation and aching in the penis or genitals, or a rash. In some cases, the partner may also feel discomfort or a burning sensation in the genital area16. The cream should not be used more than 3 times a week and should be used only once in every 24 hours.
VACUUM ERECTION DEVICES [VEDS]
A mechanical erectile dysfunction pump used to pull blood into the penis can cause an erection. The system includes a plastic cylinder, an external penile pump, and a tension band to place at the base of the penis. When the penis is erect, the ring is placed at the base to maintain an erection long enough to have sex (up to 30 minutes)7.
PROS: An economical option that does not require prescription medications.
CONS: Men using VEDs reported discomfort and bruising when pumping and some men experience numbness or a cooled penis7-8. Using it right before intercourse may spoil the mood.
An implant allows direct control of both the timing and duration of an erection. The 3-piece system includes a reservoir placed in the abdomen and two fluid-filled cylinders completely concealed within the penis. Squeezing the pump in the scrotum can achieve an erection. There are other types of penile implants as well known as semi-rigid or malleable devices. More information on all the types is provided within this site.
PROS: A natural-looking appearance when flaccid or erect, the implant offers concealed support for an erection whenever and wherever desired.
CONS: Requires manual skill to use; some risks include but are not limited to, device malfunction and postoperative pain12-13.
ERECTILE DYSFUNCTION AND MEDICAL CONDITIONS
Men with diabetes are more likely to move to advanced treatments than those without diabetes14. A healthy lifestyle can help you control your diabetes and improve erectile dysfunction symptoms. Treatment options are available; however, men with diabetes are less responsive to oral ED medications15.
What’s good for the heart is good for your erectile dysfunction symptoms. If ED occurs, most treatment options are available. However, oral ED medication and heart medications don’t mix well and the medication in suppositories and some injections should not be used if you have blood-clotting problems9.
While erectile dysfunction may be a side effect of prostate cancer treatment, erectile function does not return in all cases. Penile rehabilitation and counseling may help both partners in recovery. Despite wide usage, 30% to 50% of patients who turn to sexual aids after surgery discontinue use within a year6.
ALWAYS TALK TO YOUR DOCTOR ABOUT YOUR ED SYMPTOMS AND CONCERNS
1. DiMeo PJ. Psychosocial and relationship issues in men with erectile dysfunction. Urol Nurs. 2006 Dec;26(6):442-6.
2. Viagra™ Prescribing information. Pfizer, Inc. Revised January 2010.
3. Cialis™ Prescribing information, Lily USA, LLC. Revised October 2011.
4. Levitra™ Prescribing information, Bayer HealthCare Pharmaceuticals,. Revised November 2011.
5. Stendra™ Prescribing Information. Vivus, Inc. 2014.
6. Matthew AG, Goldman A, Trachtenberg J, et al. Sexual dysfunction after radical prostatectomy: prevalence, treatments, restricted use of treatments and distress. J Urol. 2005 Dec;174(6):2105-10.
7. Osbon ErecAid™ Esteem™ Vacuum Therapy System User Guide. Timm Medical Technologies, Inc. 2011.
8. Hellstrom WJ, Montague DK, Moncada I, et al. Implants, mechanical devices, and vascular surgery for erectile dysfunction. J Sex Med. 2010 Jan;7(1 Pt 2):501-23.
9. Caverject™ Prescribing Information. Pharmacia & Upjohn Company. Revised March 2014.
10. Brant WO, Bella AJ, Lue TF. Treatment options for erectile dysfunction. Endocrinol Metab Clin North Am. 2007;36(2):465-479.
11. MUSE™ Prescribing information, Meda Pharmaceuticals, Inc. Revised March 2011.
12. Montorsi R, Rigatti P, Carmingnani G, et al. AMS three-piece inflatable implants for erectile dysfunction: a long-term multi-institution study in 200 consecutive patients. Eur Urol. 2000;37:50-55.
13. AMS 700™ with MS Pump™ Penile Prosthesis Product Line Instructions for Use. American Medical Systems. 2013.
14. Walsh TJ, Hotaling JM, Smith A, et al. Men with diabetes may require more aggressive treatment for ED. Int J of Impotence Research. 2014 May-June;26(3):112-115.
15. GoodRx. Sample Savings with GoodRx. http://www.goodrx.com/. Accessed May 2015.
16. Phé V, Rouprêt M. Erectile dysfunction and diabetes: A review of the current evidence-based medicine and a synthesis of the main available therapies. Diabetes & Metabolism. 2012;38:1.
17. Based on the Medicare 2015 deductible cap of $1260 for patients having an outpatient procedure. The estimated average out-of-pocket maximum for a patient with commercial insurance is $3,664 ($750-10,000). Medicare Advantage plans and private insurance plans vary in deductibles and coinsurance.
18. Data on file with Boston Scientific.
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