Erectile Dysfunction

Erectile Dysfunction, which used to be called Impotence, is a very common problem that affects millions of men around the world.

Erectile Dysfunction (ED) is not being able to get, or keep, an erection to have successful sexual intercourse.

Erectile Dysfunction can be:

  • Always unable to get a normal erection;
  • Sometimes unable to do so; or
  • A problem of only keeping the erection for a very short time.

ED can occur at any age and at any point in a man’s life. The thought that ED is an “old man’s problem” is wrong, and young men can suffer too.

It is not just a problem for men but also affects their partners and loved ones, causing embarrassment, frustration, depression, loss of self-esteem and relationship breakdowns. The psychological aspects of ED are now being much more recognised.

Solutions are available for this common problem. A consultation with an Urologist who is experienced in evaluating and treating ED is the best source of information.

WHAT CAUSES ERECTILE DYSFUNCTION

It is now known that more than 85% of men suffering from ED have the condition because of a physical problem or disorder.

For most men, the cause of ED can now be fairly easily identified. Once identified, proper treatment can be recommended to help return them to a satisfying sex life.

Erectile Dysfunction can be caused by physical disorders such as:

  • An injury (i.e. brain or spinal cord)
  • A disease (i.e. diabetes, high blood pressure, or high cholesterol)
  • An operation (i.e. prostate gland removal)
  • Substance use (i.e. tobacco, drugs, alcohol or medications)

OTHER FACTS ABOUT ERECTILE DYSFUNCTION

Approximately 1.2 million Australian men suffer from some level of ED.

Most men with ED still have the ability to have an orgasm and father a child, but may have difficulty doing these things because they can’t get or sustain an erection.

ED is not normal, and is by no means an inevitable consequence of ageing.

Most men in certain situations, at one time or another during their life, are unable to get or keep an erection. This is normal, often related to anxiety, tiredness or distraction, and does not indicate a problem. But many men of all ages experience this as a continuing problem.

In most cases, Erectile Dysfunction can be overcome.

HOW DOES AN ERECTION OCCUR?

An erection is an involuntary reaction in response to sexual stimulation and excitement.

Sexual stimulation and excitement cause the brain, nerves, the heart, blood vessels, and hormones to work together to produce a rapid increase in the amount of blood flowing into the two spongy chambers in the shaft of the penis. As the chambers rapidly fill with blood, they expand, the blood becomes trapped and held and the penis becomes firm and elongated.

The result is an erection.

If there are problems with any of those things (brain, nerves,heart,blood vessels, hormones, or the penis itself), erectile dysfunction may be the result.

TREATMENT OPTIONS FOR ERECTILE DYSFUNCTION

Drug therapy

Drugs for treating impotence can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis

Oral Medications

Viagra®, Cialis® and Levitra® are tablets available on prescription in Australia and they help achieve erections in response to sexual stimulation. These tablets do not cause an erection; they only make the erection better than it would be without taking them.

Known potential side effects and problems with these tablets:

  • Headaches,
  • Facial blushing,
  • Upset stomach,
  • Mild and temporary visual effects,
  • Muscle aches.

They cannot be safely used with some heart medications and won’t work for all men. Some brands are relatively expensive in Australia.

Injection treatment

Many men can get an erection by injecting medication directly into the side of the penis, causing it to become engorged with blood.

The advantages of injection therapy are:

  • They can easily be self-administered,
  • They will work even in men when tablets don’t,
  • They cause an erection even without sexual stimulation (although they work better with it).

Potential side effects and problems of injection therapy include:

  • Fibrosis (scarring) in the penis,
  • Long-lasting painful erections,

Drop-out rates from injection treatment range from 24 - 42%, with 70% of men stopping the injections within 5 years

Reasons for dropping out of treatment include:

  • Desire for a permanent treatment alternative,
  • Inadequate response,
  • Fear of needles,
  • Concern over side effects,
  • Pain,
  • Not spontaneous or “romantic”,

Inflatable Penile Prosthesis

An inflatable penile prosthesis is a device that is surgically placed into a man’s body and is designed to duplicate and cause an erection. This is a 40-minute surgical procedure, involving one night in hospital, and then a four to six-week recovery period is necessary before the implant is used.

There are different types of penile implant available, and an experienced implant surgeon, such as Dr. Love, will know the benefits and appropriate use of each, depending on the patient circumstances and expectations.

Coloplast offers the Titan Touch® inflatable implant which enables men with erectile dysfunction to have a satisfactory erection for sexual intercourse and to experience the joys of sex again. You should be able to have an orgasm with a penile implant if you were able to have one before your surgery, unless you have another medical problem that affects it. Ask Dr. Love about this.

Inflatable implants (like the Titan) produce a controlled, more natural erection.

The best type of penile implants, giving normal flaccid and erect appearance, are three - piece inflatable penile prostheses which are a self-contained, fluid-filled system. The Coloplast Titan® Touch is made from Bioflex® and silicone. Bioflex® is a supple, yet durable, biopolymer material.

Titan Touch penile implants consist of:

  • A reservoir (placed in the abdomen), including a true lock-out valve located at the base of the reservoir;
  • Two penile cylinders;
  • A pump including one-touch release button;
  • Each part is connected by silicone tubing.

The Titan Touch® is MRI conditional* and latex free.

The Titan Touch® inflatable penile implant offers a dependable method of restoring sexual function.

TREATMENTS FOR ERECTILE DYSFUNCTION

As discussed there are various methods for treating Erectile Dysfunction. Dr. Love can discuss all of these options with you in more detail. All decisions regarding your options for treating ED should be made between you, your partner and your doctor, with consideration given to your individual needs and realistic expectations, and the pros and cons of each treatment option.

To summarise the treatment options may include:

  • A penile implant procedure, which is often the best option, and is the only way to fix the problem of ED and return the penis to the most normal spontaneous functioning.
  • Lifestyle changes: stop smoking, lose weight, healthier diet, more exercise, control of blood pressure and cholesterol may all help in minimising the risk of ED occurring.
  • Oral medications (PDE5 inhibitors) like Viagra®, Cialis®, or Levitra®,

Injection therapy: injection of medication directly into the penis

ERECTILE DYSFUNCTION, HEART AND VASCULAR DISEASE

ED has exactly the same risk factors as vascular disease (atherosclerosis or “hardening of the arteries”), which are smoking, blood pressure, diabetes, cholesterol, obesity, poor fitness and ageing.

Even more importantly, we now understand that a man may develop ED as the first indication of vascular disease, with the risk he will eventually develop a heart attack or stroke if vascular disease develops in those areas of the body. If a man gets ED, he needs to be thoroughly assessed for these risk factors, and they need to be treated to try and prevent these other serious problems from developing.

Dr. Love is the highest volume, most experienced penile implant surgeon in Australia