What to do in case of Erectile Dysfunction or Impotence?
If you have erectile dysfunction, you’re not alone. At least 52% of all men experience erectile dysfunction or Impotence, and it’s estimated that up to 75% of all men with poorly controlled Diabetes also have erectile dysfunction or Impotence. It’s important to know that there are many different types of treatments or therapies to minimize this problem or make it disappear completely. Communicating with your partner can be fundamental so look for the best options that may help you. Your partner could visit the doctor with you, give you emotional support, and you can receive all the information together as well as all the knowledge you need to find the best alternative for your case.
Your doctor will perform a series of tests to determine the origin, or circumstances that may be causing your erection problem. Based on this results, your doctor may determine if he or she should prescribe an initial treatment, or refer you to an urologist, endocrinologist, or psychologist, and based on the treatment to be used, may also refer you to a cardiologist.
Treatment options for Erectile Dysfunction
Currently there are many alternatives to address the factors that cause Erectile Dysfunction or Impotence. Here we’ll mention some currently available treatments:
- Oral medications or pills
- Hormone therapy (Testosterone)
- Intraurethral therapy (injectables and suppositories)
- Vacuum suction devices (vacuum pumps)
- Artery surgery
- Penile prosthesis implants (malleable or inflatable)
- Psychotherapy or behavioral therapy.
Oral Medications or Pills
Oral medications or pills have been very successful in helping a high percentage of men with erectile dysfunction. For a proper erection to occur, blood needs to enter the corpora cavernosa and fill it completely, but if the muscle that allows blood entry to the penis is contracted, it won’t flow in, even when the sexual stimulation signal is working properly in the brain. These pills work by improving nitric oxide action, causing the penis muscle to relax, allowing the blood required for a full erection to enter.
Sildenafil known as Viagra™, Tadalafil known as Cialis™, Vardenafil better known as Levitra™ or Staxyn™ and Avanafil known as Stendra™, are the four oral medications or pills currently available in the market. These drugs can cause side effects, which can be dangerous in some cases, especially if you have heart problems; therefore it’s very important for you to be evaluated by a cardiologist before using them. These drugs vary in dosage, time to take effect and side effects. Side effects include redness, pain, vision changes, nasal congestion, headaches and upset stomach.
It’s extremely important for you to tell your doctor if you take any medications that contain nitrate (nitroglycerine) such as Minitran, Notrostat and Nitro-Dur, among others. You should also tell him or her if you have low blood pressure (hypotension), high blood pressure (hypertension), liver disease or a kidney disease that requires dialysis, because these treatments can be very harmful if they interact with oral medications or pills used for erectile dysfunction.
Hormonal Therapy (Testosterone)
Some men have erectile dysfunction due to complications because of low testosterone levels. In this case, Testosterone replacement therapy may be recommended as a first step. Some men may have low Testosterone levels, the male hormone, which can cause erectile dysfunction or impotence, among other problems. A lack of sexual desire (low libido) and inadequate functioning of the erection process in men can be caused due to low Testosterone.
Testosterone is a hormone produced by the testicles and is responsible for the development of male sexual characteristics. Testosterone levels decline as men get older, or due to an infection or loss of testicles. Other reasons may include: kidney failure, chemotherapy, dysfunction of the pituitary gland, stress, alcoholism, obesity and liver cirrhosis, among others. Fortunately, these levels can be increased and reach normal values through treatment with tablets, patches, gels or Testosterone injections.
In some cases, the erectile dysfunction problem can improved or solved with Testosterone based hormone therapy.
Intraurethral Therapy (Injectables and suppositories)
Another alternative that may help improve an erectile dysfunction problem is intraurethral therapy through injections or suppositories, which have to be inserted into the penis. Intraurethral Therapy (injections or suppositories) widen the blood vessels, allowing blood to enter the corpora cavernosa, leading to an erection.
Intraurethral Therapy has had high success rates in men who use it. In the case of intraurethral injections, the percentage of men who get an adequate erection is of over 80%, while in the case of intraurethral suppositories, this percentage only reaches 30% to 40%.
There are different intraurethral injection and suppository therapy options, which include:
Injectable Alprostadil – This is a medicine that can either come as a powder with a sterile liquid ready to be mixed or already premixed in a jar, ready to be administered. This drug is sold under the brand names: Caverject, Edex and Prostin, among others. It can only be prescribed by an urologist or a treating physician; generally, your doctor will administer the first dose of this medication in his or her office to determine the exact dose you need. You’ll need to stay at the doctor’s office until your erection has subsided.
Contents found in the Intraurethral Injectable Therapy Case
The Intraurethral Injectable Therapy Case contains the following elements:
- A capsule with the drug with the lid closed
- A large covered needle
- A small sealed needle
- Disinfectant wipes
- A syringe filled with a liquid, closed with a lid
- Wash your hands with soap and water
- Remove all of the lids so you can mix the liquid with the drug
- Pour the contents of the syringe into the capsule that contains the white powder and mix until all the powder has dissolved and a clear liquid remains. Re-inject the dissolved medicine with the long needle back into the syringe. Remove the large needle and place the small needle to inject the drug into the penis. Even if the instructions indicate that you should inject in the proximal part of the penis, many urologists recommend injecting in the distal part because blood vessels are smaller and more distant in this area, reducing the risk of hematoma.
- Disinfect the area with disinfectant wipes, pull back the foreskin and move the glans forward, fully inserting the injection perpendicularly (90 degrees) so it can reach the corpora cavernosa.
- If you feel pain or notice that your skin is inflaming when you inject, please remove the needle immediately and proceed to inject again in the correct position (90 degrees).
- After completing injection, press over the injection site to prevent bleeding.
- Make sure to alternate the injection site each time you use it to prevent skin problems.
Note that you should use this drug immediately after placing it in the injector: you can’t save it for later. This drug usually works within 5 minutes of being administered and can only be used once a day and shouldn’t be administered in more than 2 consecutive days or more than 3 times a week. Erection time may vary, but it approximately lasts for 1 hour, and in some cases may persist after ejaculation.
Side effects of this medicine:
- Penis, urethra, or testicular pain
- Penis discharge
- Stuffy nose
You should contact your doctor immediately if your erection lasts for more than 4 hours or if you feel any pain, as this may be a sign of priapism and have to be treated immediately, because they can lead to permanent damage.
You SHOULDN’T use this drug:
- If you’ve had any adverse reactions to this drug
- If you have a history of priapism (painful and prolonged erection)
- If you have a penile implant
- Curvature or birth defects in your penis
- Bleeding problems
- If you take anticoagulants
Your partner may also feel some side effects such as itching, irritation or burning in body parts that come in contact with the penis.
Alprostadil Suppository – Also known as a Transurethral Pellet, is about half the size of a rice grain and is inserted into the opening of the penis (urethra) using a plastic applicator included in the package.
How to use the Suppository:
- First, you should urinate.
- You can use a small amount of lubricant or the small amount of urine left in the urethra that often remains after urinating, this will help dissolve the suppository.
- Massage your penis for about 10 seconds to help dissolve the suppository.
- Stand or walk for a few minutes to increase blood flow to your penis and help the erection.
- Check with your doctor if you have any questions, since misuse of this medication can damage the urethra.
If you use Alprostadil (either as an injection or suppository) and plan on having sex with a pregnant woman, you should use a condom, because the side effects of this drug on the fetus haven’t been determined yet.
Vacuum suction devices
Also known as a vacuum pump, it’s a hollow tube where the penis is inserted and, being hand operated, draws air, creating a vacuum, sucking the blood into the corpora cavernosa leading to an erection. This process lasts for about 5 minutes and the erection shouldn’t last for more than 30 minutes. Once you’ve gotten an erection, you should slip a tension ring around the base of the penis to trap the blood and maintain a firm erection which shouldn’t last for more than 30 minutes, when you’ll need to remove the tension ring and allow blood to outflow.
Nowadays there are several types of suction devices and your doctor may recommend the one that best suits your needs.
Artery surgery, also known as vascular reconstructive surgery, can help improve penis blood flow to maintain an erection in men who’ve been diagnosed with a blood vessel blockage or leakage, which prevents them from having a normal erection.
Generally doctors don’t often suggest this type of treatment because it doesn’t offer much chance of success and is very expensive. Which is why it’s usually only used in young men where a trauma or accident has caused erectile dysfunction.
Penile prosthesis implants (malleable or inflatable)
A penile prostheses or implant involves surgically placing semirigid or inflatable rods on both sides of the penis. Inflatable rods allow control of when and for how long to have an erection. In contrast, rigid rods, keep the penis firm yet flexible at all times.
This treatment has a high degree of satisfaction, although doctors only recommend it as a last resort, to patients who’ve already tried other methods and haven’t had positive results.
What to expect in surgery
During implant surgery, you’ll be placed under general anesthesia and then your doctor will proceed to make an incision under the penis head to then stretch the spongy tissue and insert a rod implant or two cylinders inside the penis. If the implant is inflatable, the prosthesis consists of two cylinders – a reservoir and a pump, which are surgically placed inside the body. The two cylinders are inserted in the penis and connected by a tube to a separate liquid tank. The reservoir is implanted under the groin muscles. A pump is also connected to the system and is inserted under the loose skin of the scrotum, between the testicles.
To inflate the prosthesis, you need to press the pump located in the scrotum which will cause the fluid of the reservoir located in the groin to be directed toward the prosthesis, filling it with fluid to cause an erection. Once you’re done, you can press the deflating valve so the fluid can return to the reservoir deflating the prosthesis.
Semirigid rod surgery, is less common than the inflatable implants but also less expensive and simpler, only requires minor surgery and has less risk of rejection. This implant works when the man manually extends his penis to have sex, and after it, he can fold his penis back towards his body. The disadvantage is that the penis will always be stiff, and the constant pressure can cause damage to the tissue within the penis.
It’s important to note that, as with any surgery, there are risks of infection.
Psychotherapy or behavioral therapy
If your erectile dysfunction problem is due to stress, anxiety, depression or due to tension in your relationship, your doctor may advice you, or you and your partner, to visit a psychologist or marriage counselor.
Living under constant stress, makes you secrete the hormone Cortisol which maintains glucose levels above normal range. This not only constricts blood vessels and raises blood pressure, it also leads to erectile dysfunction, among other health problems. So we invite you to look for ways to avoid this and destress such as: managing your time and money well, following relaxation techniques like yoga and contemplate calm and entertaining moments to have a better quality of life.
Sexual dysfunction in some men worsens or is caused due to lifestyle. Here are some recommendations that may help:
- Lose Weight
- Exercise daily
- Stop smoking if you smoke
- If you have addictions, get help and,
- In addition, there are certain medications that can cause erectile dysfunction, especially certain hypertension medications.
Staying informed and well educated on any problems that may harm your sexual health is very important, so you must acquire the knowledge you need that will help you solve any problem to enjoy a healthier and more pleasurable sex life.