Erectile Dysfunction

Erectile dysfunction is the repeated inability to get or keep an erection firm enough for sexual intercourse. The percentage of men who typically experience erectile dysfunction relates closely to age. For example, 50% of 50-year-olds, 60% of 60-year-olds and so on will have problems with erections. But there are plenty of men in their 70s, 80s, and 90s with great sex lives. ED can be treatable at any age.

An occasional inability to achieve an erection is normal. But the inability to reach or sustain an erection more than half of the time, at any age, indicates erectile dysfunction. Other symptoms may include decreased sexual desire and less rigid erections.

There are various physical and psychological issues that can result in poorer erectile function. These include, but are not limited to:

• Increasing age
• Diabetes
• Unhealthy diet
• Heart disease
• High blood pressure
• Low testosterone
• Peyronie’s disease (penile curvature)
• Stress/mental health issues
• Certain medications
• Side effects from treatments for other diseases such as prostate cancer

During your visit to Spokane Urology, your doctor will ask about your medical history and may examine your abdominal and genital area. You’ll be asked about situations when you have difficulty obtaining erections, presence of morning/overnight erections, and any prior surgery or radiation.

It is essential to provide a detailed history of medication and drug use since nearly 25% of ED cases can be attributed to medications for other conditions.

Tests that may be performed during or after your visit:

• Blood tests to determine testosterone level may be obtained.
• Urinalysis to determine the amount of protein and sugar in the urine. Abnormal measurements of these substances can indicate diabetes or kidney disease, which can cause ED.

Non-Surgical Treatments

• Lifestyle changes: A healthy lifestyle is the best way to prevent ED. This includes maintaining a healthy weight, controlling blood pressure and blood sugars, limiting alcohol, stopping smoking, and exercising regularly.
• Medications: Several drugs including Viagra, Levitra, Stendra, and Cialis can improve blood flow to the penis to enhance your erection in response to sexual stimulation. Certain drugs require you to take them within a specific time period before intercourse. Others should not be taken at all if you have high blood pressure or chest pain. Consult your pharmacist for specifics on these drugs.
• Injection therapy: Self-injection of a medication into the base of your penis that dilates the blood vessels can help achieve satisfactory erections. Erections should start within 10 minutes and should not last more than 1 hour. For erections lasting more than 4 hours, you must contact your physician immediately or go to the emergency room.
• Urethral suppository: This treatment involves placing a small suppository into the tip of your penis to improve blood flow to the penis. Erections start within 10 minutes and typically do not last more than 1 hour. The most common side effect is penile pain or minor bleeding.
• Penile pump/Vacuum Erection Device: This hand-powered vacuum erection device works by pulling blood into the penis. Once erect, a ring is placed over the base of the penis (do NOT keep ring on penis for more than 30 minutes). These erections tend not to be as firm, can result in bruising, may be cold to the touch, and ejaculation will be obstructed by the restriction band.

Surgical Treatments

Your doctor may suggest a penile implant to address your ED if other treatments do not work or do not fit your lifestyle.

The physician can implant one of two types of penile devices:

• Malleable implant: This device consists of two rods that are placed in the erectile tissue (corpora cavernosa). Malleable implants produce a permanently firm penis, while the inflatable implants produce a controlled, more natural erection. Using a malleable implant, the patient can simply move the penis into the desired position.
• Inflatable implant: A self-contained, fluid-filled system composed of two cylinders. An inflatable implant comes in two- or three-piece models, including a reservoir and pump. With an inflatable implant, the patient presses a pump button in the scrotum. The pump transfers fluid from the reservoir to the cylinders in the penis, inflating them and causing an erection. The patient can restore the penis to a flaccid state by pressing a deflation valve at the base of the pump, which returns the fluid to the reservoir.

Implants enable men with erectile dysfunction to have satisfactory erections for sexual activity. Men with implants should still be able to have orgasms if they were able to before the surgery.