Erectile dysfunction (ED) is a common problem affecting nearly 1 in 2 men after the age of 40 years. It can affect the self-esteem of a man, intimacy with his wife and their marital relationship. Moreover, it can be a marker for an underlying heart problem also.
With modern Andrological developments, there is a cure for every patient with ED. The treatment options depend on the age, cause of ED, co-morbidity, personal preference, economic consideration etc.
- Oral Medications for ED:
These belong to a group of drugs called phosphodiesterase-5 (PDE5) inhibitors. The commonly used drugs are sildenafil and tadalafil. Other drugs like yohimbine and apomorphine are occasionally used. These are usually the first line of treatment.
Pros: Simple to use; achieves a quick erection.
Cons: Some side effects like headache, back ache and flushing etc. Contraindicated in men taking certain cardiac drugs. May not work initially itself in some patients and can stop working after some years in many patients.
- Vacuum erection device (VED):
This is a mechanical device which is held over the penis to suck blood into the penis and achieve an erection. It contains a plastic cylinder, a pump, and a band to apply over base of the penis.
Pros: Can be used in men having side effects with drugs.
Cons: There may be numbness in penis since the band constricts penile nerves also. If used for prolonged periods (>30 min) it can damage the penis. May not give the feeling of achieving a natural erection.
- Penile Injections:
Some drugs like papaverine and alprostadil can be injected directly into the penis using an insulin like syringe and needle system. These will induce an erection in 5 to 20 minutes. A maximum use of three times a week is recommended.
Pros: Works in both psychological and physical causes of ED. Can work after failure of oral medications.
Cons: Can lead to prolonged erection which needs immediate medical attention and even surgical procedure in some patients. Can lead to pain, bruising and fibrosis. Some men with fear of needles may not be able to use it.
- Intraurethral Suppository:
Some drugs like alprostadil can be applied into the urethral opening to induce an erection.
Pros: Can be used in any frequency.
Cons: Can cause pain in penis and burning while passing urine. It can cause dizziness in some patients. The drug can have toxic effects if it reaches the fetus in a pregnant woman.
- Penile Implants
Penile implant is a permanent treatment and the only proven surgical cure for ED. In this procedure, two fluid filled cylinders are placed inside the penis. A small balloon like reservoir is placed inside the lower abdomen. When the pump placed in the scrotum is activated, fluid enters from the reservoir into the cylinders inside the penis. This will mimic blood entering the penis during a natural erection. Thus a complete erection is achieved. Since the penile nerves lie on the surface of the penis, the sensation is not altered unlike in VED. After intercourse, the pump in the scrotum can be used to deflate the penis to restore the natural flaccid state of penis.
Pros: The surgery is a minimally invasive one without any obvious scars or visibility from the outside.
It works in all cases of failed medications or injections.
It gives a natural appearance during flaccid and erect state.
Erection can be achieved within minutes in any situation.
Cons: It needs some manual skill to use. There are some risks including but are not limited to postoperative pain and device malfunction.