ERECTILE DYSFUNCTION

Erectile dysfunction (ED) is a very common form of sexual dysfunction that affects about a quarter of men by age 40. It can present itself as decreased rigidity or losing an erection too soon (early detumescence).

Erectile dysfunction is generally caused by one of three factors, or a combination of the three.

Most commonly, ED is vasculogenic (caused by impaired blood flow into the corpora cavernosa of the penis). This happens with age, high cholesterol, high blood pressure, diabetes, or other causes of vascular disease, as well as certain medications. Patients with vasculogenic ED should be evaluated for possible vascular issues, including heart disease. This can be done by a primary care physician.

ED can also be neurogenic, meaning caused by damage to the nerves that initiate blood flow to the penis. This can happen with diabetes or back injuries. Additionally, neurogenic ED is common in men who have been treated for prostate cancer. All prostate cancer treatments can potentially cause neurogenic ED.

The third type of ED is psychogenic. This happens when arousal is impaired due to psychological factors. This is commonly due to performance anxiety & is the most common cause of ED in young patients. That being said, psychological factors can contribute to ED in any man. Basically, if you are thinking about whether or not your erection is going to work rather than focusing on your partner, you are out of the game.

Although low testosterone is not generally a direct cause of ED, it can cause decreased interest in sex,
which can secondarily impair erections. A critical amount testosterone is generally required for good erections.

treatments for
erectile dysfunction

oral therapies

Most people have heard of the drugs commonly prescribed for Erectile Dysfunction (ahem, the little blue pill to name just one). Generally the generics are utilized, as they are much more affordable. Insurance companies make coverage of these medications difficult, so most patients opt to pay cash for these medications. The two most commonly prescribed Erectile Dysfunction medications are both within the class of medications called phosphodiesterase-5 (or PDE-5) inhibitors. PDE-5 inhibitors cause dilation of the blood vessels and increased blood flow into the corpora cavernosa (the structures within the penis which fill with blood to cause an erection). These medications are effective for mild to moderate vasculogenic or psychogenic ED. They work less effectively for neurogenic ED. In order for pills to work well, the man has to be aroused or “turned on.” There are critical differences between oral medications for ED. Dr. Kubinski would be happy to explain this further during your visit.

In addition to prescription medications, there is some evidence that certain natural supplements can improve erections & sexual health, although they are typically less extensively studied.

Low-intensity shockwave therapy (LIST)

LIST--particularly focused shockwave therapy--has been shown to improve mild to moderate ED, most effectively in the vasculogenic type. This works by stimulating production of the growth factors that cause regrowth of blood vessels to the corpora cavernosa of the penis. Focused shockwave for ED is painless, safe, and effective for Erectile Dysfunction in most men with ED due to impaired blood flow. Efficacy for neurogenic ED is not well documented.

The P-shot

The P Shot for ED is still being studied for efficacy, but is used for many other purposes in medicine, and of theoretical benefit for Erectile Dysfunction.

Inflatable penile prosthesis (IPP)

An IPP is a surgically implanted device that is typically used for ED that is unresponsive to other therapies. Dr. Kubinski can discuss this in detail with you, and if you are interested he can refer you to a urologic surgeon who does this surgery frequently.

Urethral suppositories

This is typically the same type of medicine as in the injections for erectile dysfunction. However, the medicine is inserted into the urethral opening at the tip of the penis, rather than injected directly into the corpora cavernosa.

Vacuum Erection Devices
(VEDs)

These devices work manually by drawing blood into penis and are usually used in conjunction with an elastic ring that is put on the base of the penis to prevent leakage of blood out of the corpora cavernosa, keeping the penis erect. These will be available for purchase through our office or you can shop online for them.

intracavernosal injection therapy

There are a variety of combinations of medications that can be injected directly into the penis through a very small needle which can be effective for even severe ED, including neurogenic ED. They tend to work predictably, with minimal risk of side effects. Moreover, they can work regardless of state of arousal or libido. We have told countless patients “It doesn’t matter if you are thinking about sex, sports, cars, or food, these medications will work the same.” These medications will be available for purchase at The Men’s Center or can be sent directly to your house.