Sexuality is an important part of the human experience, which is why a diagnosis of erectile dysfunction (ED) can be troubling for men and many couples. The good news is that there are many options to consider.
“As couples age, they may lose intimacy unnecessarily,” says urologist Stanton Honig, MD, director of the Yale Medicine Male Sexual Medicine Program. “They might not know that there are treatments to help them restore it, especially if oral medications don't work.”
ED, or impotence, is the inability to achieve or sustain an erection long enough for sexual intercourse. While the condition most commonly affects older men (more than 50 percent of men over 40 have ED), it can occur at any age. “I see young men—students in college—all the way to men in their 80s for ED,” says Yale Medicine urologist Harris Foster, MD.
Erectile Dysfunction Causes
Certain medical conditions can cause ED, including hypertension, diabetes, high cholesterol, coronary artery disease and peripheral artery disease. According to Dr. Foster, these disease processes can damage blood vessels in the penis.
And that’s a problem because erections are a vascular process. Here is how it works: When a man is sexually stimulated, the smooth muscle located inside blood vessels should relax, or dilate. This allows blood to flow into the corpora cavernosa, which are cylinder-shaped erectile bodies in the penis. The result is an erection. As blood continues to flow into the penis, its veins gradually constrict to form a “seal,” which helps to maintain the erection.
Problems in achieving or maintaining an erection are often caused by insufficient blood flow into the penis or by a venous “leak,” which occurs when blood flows into the penis but then seeps out.
Other reasons for ED can include smoking, taking certain prescription antihypertensive or antidepressant medications, prostate removal surgery or nerve damage from a spinal cord injury. Low testosterone can affect sexual interest or libido, but it may also affect erection quality.
For younger men who don’t have other health conditions, ED can be caused by stress. “We know stress can inhibit erectile function,” says Dr. Foster. “Stress or anxiety, which releases adrenaline, constricts blood vessels.” And that means the erectile bodies won’t fill with enough blood.
Standard Erectile Dysfunction Treatment
Doctors often prescribe oral medications (phosphodiesterase type 5 inhibitors) as the first-line treatment for ED. Viagra (sildenafil), Levitra (vardenafil), Stendra (avanafil) and Cialis (tadalafil) work within 30 to 60 minutes and their effects last for between 4 and 8 hours (for Viagra, Levitra and Stendra) or 36 hours (for Cialis). These medications act as a smooth muscle relaxant, allowing increased blood flow to the penis when a man is sexually stimulated.
Although oral ED medications are estimated help 70 percent of men who try them, some may require a stronger dose of medication than is available orally.
“If oral medications aren’t working or right for you, other effective treatments are available,” says Dr. Honig.
Additional Erectile Dysfunction Solutions
Injection therapy for erectile dysfunction
A urologist may recommend a medication that is delivered directly to the penis through injection therapy. The doses can be increased, as needed, by your doctor.
Injection therapy is FDA-approved for erectile dysfunction. The man injects a prescription medication (alprostadil or papaverine) into the side of the penis (where, Dr. Honig says, there isn’t a significant pain response). The medication helps increase blood flow to the penis. “If you can tolerate a flu shot, you can tolerate this,” he says.
Another way medication can be delivered locally is through a suppository or intraurethral agent. The man (or his partner) inserts the thin applicator a centimeter into the urethra and injects a pellet-sized bead of alprostadil. The medication dissolves and dilates blood vessels in the penis.
How long until it takes effect? 5 to 15 minutes
How long does an erection last? 60 minutes
Vacuum devices for erectile dysfunction
A vacuum device does not involve medication. It is, however, more cumbersome and less discrete. The device costs between $200 and $400. A man or his partner places it over his flaccid penis. It creates negative pressure to draw blood into the penis to create an erection, explains Dr. Honig. A ring then needs to be placed at the base of the penis to keep blood within the erectile bodies; once removed, the erection will subside.
How long until it takes effect? 5 minutes
How long does an erection last? An erection may last more than an hour; however, to minimize the risk of penile injury, the ring should be removed within one hour.
Penile implant surgery for erectile dysfunction
When other methods are not working, your urologist may suggest a penile implant, which is an outpatient procedure—you can go home the same day. According to Dr. Honig, because this option can restore spontaneity and is reliable in most cases, the patient satisfaction rate is high.
“The goal of the operation is to give you a functioning penis, so you can have penetrative sex,” says Dr. Foster.
As with any surgery, there are risks such as the chance of infection, but there is another factor men need to consider. “Implants are a one-way street,” says Dr. Foster. “When you put an implant in, you can’t take it out and try the injections or suppositories.”
During the surgery, which takes about an hour, the doctor makes an incision in the scrotum, or base of the penis, and measures the appropriate implant length.
The urologist then installs the device (usually an inflatable implant) that sits inside the scrotum, plus a reservoir that holds the fluid (salt water solution) in the lower abdomen. The fluid functions like blood flow, filling the erectile bodies. The man controls it with a pump that’s placed in the scrotum (a button causes the fluid to flow in and out as desired).
How long until it takes effect? Following surgery, men can resume sexual activity within six weeks.
How long does an erection last? There are no time limits. “Once they pump it up, it stays up,” says Dr. Foster.
In the end, which—if any— erectile dysfunction solution you choose depends on the right method for you.
“If sexual activity is important to you, see a doctor if you’re experiencing problems with erections—no matter what age you are or what your health condition is,” says Dr. Foster.
“We have a treatment for everyone; it just depends on what you want to do to fix the problem,” says Dr. Honig.
Click here for more information about the Yale Medicine Urology Male Sexual Medicine Program. Or, to make an appointment, call 203-785-2815.