Erectile Dysfunction

What is erectile dysfunction (ED)?

ED refers to the inability to have or maintain an erection, making intercourse difficult or impossible. It may happen at different times and in different situations – only with a partner or only during masturbation, or both.

Why am I having trouble getting erections?

ED can be caused by a variety of health conditions, including diabetes, high blood pressure, and cardiovascular disease. There are also more ordinary factors to consider, including stress, lack of rest, anxiety, and emotional issues. Drinking alcohol can also affect your ability to maintain an erection.

How is erectile dysfunction treated?

ED is usually treated with medication, therapy, penile injections, or surgery, depending on what’s causing it. Some lifestyle changes can also be very effective treatment; the doctor can help figure out the best method of treatment.

The treatment of ED

Counselling: Treatment of erectile dysfunction may simply involve counselling and explanation of the normal anatomy and physiology of erections. Counselling can benefit relationship issues that may be contributing to the erection problems.
Oral medication: A common and popular treatment these days is the use of oral medications known as PDE5 inhibitors. The products available on the Australian market include Viagra™, Cialis™ or Levitra™ tablets. These medications are taken as required 1-2 hours before planned sexual intercourse. These medications are effective in most situations but cannot be used if the patient is not fit enough to engage in sexual intercourse or is on nitrate heart medication. For further information, see document on PDE5 inhibitors.

Penile injections: When oral medication is not effective, penile injection therapy may work. The injection is self administered into the shaft of the penis, the dose needs to be carefully regulated so that a prolonged erection (priapism) does not occur. The injection medication may consist of a single chemical called alprostadil known as Caverject Impulse™ available by a doctor’s prescription through a regular pharmacy. If the single medication injection is not adequate, then a compounded triple mixture that contains alprostadil (here also called prostaglandin – PGE1), phentolamine and papaverine is obtained through an approved compounding chemist. Priapism is defined as an erection lasting more than 4 hours and is treated with the application of ice packs and the taking of pseudo-ephedrine tablets (Sudafed™). Occasionally a visit is required to the local emergency room to drain the priapism.

Vacuum device: A less invasive treatment is the use of a vacuum erection device that allows an erection to occur by creating a vacuum with a plastic cylinder placed over the flaccid penis. The induced erection is then held in place by a constricting band placed around the base of the penis for a maximum time of 30 minutes.

Shock wave therapy: Low intensity extra corporeal acoustic shock wave therapy is a recent innovation relying on the effects of sound waves when applied to the shaft of the penis creating new blood vessels (angiogenesis). Shock wave therapy works best in men with ED arising from penile blood flow changes (vasculogenic ED). It may change a poor PDE5i responder to an improved PDE5i responder.

Surgery: In some cases regular treatments are not effective and a final treatment option is to insert a penile prosthesis or implant which is an internally placed hydraulic device that has no obvious external appearance of the genitals. This operation is performed by a urologist.

Vascular surgery is mainly performed in younger men when trauma has damaged the blood vessels leading to the genitals. Some men with venous leakage may benefit from erectile restoration vein surgery or vein stripping surgery.