Erectile Dysfunction, or ED, is an extremely common condition seen in many men as they begin to age. Over half of all healthy men (approximately 52%) admit to experiencing some degree of sexual "difficulties" as they get older. Most men find talking about sexual issues like erectile dysfunction an awkward thing to do, but they can rest assured that they are not alone and, perhaps, not even in the minority. Clinical data reveals that ED affects to some degree approximately 40% of the male population over the age of forty years old and greater than 70% of all men over the age of seventy (as noted in the The Massachusetts Male Aging Study). This includes not only the men who reside in the US, but all men the world over!
The Causes Of Erectile Dysfunction
The condition of erectile dysfunction is not a recent phenomena. Both the Greeks and Romans documented ED cases over fifteen-hundred years ago. Characterized by the inability to develop or keep an erection during sexual activity, the condition is commonly caused by the deterioration of blood vessels in a man's penis as he ages. This degradation of the blood vessels thus results in decreased blood flow to the area. Ultimately the individual male sees the gradual and cumulative deterioration's end result: a "difficulty" in his sexual performance and a decrease in his "abilities in the bedroom".
Keep in mind that aging by itself may not be the cause of ED in certain individuals. Sometimes the condition is secondary to other disease states being present in the patient, with an increased incidence simply emerging and being seen as a man's age advances. The most common disorder that ED may be associated with is cardiovascular disease (CVD). In males with CVD, a decreased vasodilatory reserve, plus inflammation of the blood vessels in the penis and muscle dysfunction, the result is an impairment of the individual's ability to achieve and/or maintain an erection. A recent study revealed that approximately ninety percent (90%) of men with erectile dysfunction additionally had at least one risk factor associated with heart disease (hypertension or high blood pressure, elevated cholesterol levels, diabetic symptoms, or was a cigarette smoker).
Atherosclerosis accounts for roughly 50% to 60% of ED cases in men over the age of sixty, plus it's estimated that between 35% to 50% of diabetic males experience symptoms of ED to some degree. Hypogonadism has also been shown to cause ED. Starting at about the age of forty, a man's testosterone level begins to decrease by an average of 1.6% annually. This can lead to erectile dysfunction, decreased ability to maintain an erection and a severely decreased libido. Additionally, some less common causes include spinal cord damage, multiple sclerosis and Peyronie’s Disease. Psychological issues have also been associated with the onset of ED, as have certain medications where the erectile dysfunction is simply a drug side effect (such as certain high blood pressure medicines and anti-depressant medications).
Treatments For Erectile Dysfunction
For more than a thousand years men have tried various treatments for erectile dysfunction. Some of the more interesting and notable historical cures included:
- Talismans worn that were composed with the dried genitalia of goats and roosters.
- Eating the genitalia of various prolific breeding animals such as rabbits and wolves.
- Drinking semen from eagles, falcons and hawks.
- Applying creams and balms to a man's genitalia to prevent masturbation (which many physicians of old identified as the cause of the ED).
- Injecting serums prepared from the extracts of monkey, ape, dog and pig testicles.
- Administering electric current after the placement of electrodes on a man's penis and testicles.
Today the primary treatments for erectile dysfunction can be grouped into the following categories:
- Impotence Drugs
Viagra became the first FDA approved prescription drug for the treatment of ED back in 1998. Viagra (sildenafil), commonly known as "the little blue pill", is in a category of drugs named PDE5 (phosphodiesterase type 5) inhibitors. Taking these drugs orally results in an increase of blood flow to the penis, thus allowing a man to obtain and keep an erection hard enough for sexual intercourse. Along with Viagra are several other drugs that are approved by the FDA such as Cialis (tadalafil) and Levitra (vardenafil).
Injections of vasodilating drugs are also commonly used to treat ED. These drugs work by widening of the blood vessels to increase the blood flow to the penis in a man. Administered via self-injection by the patient, many consider this treatment as the best option available in men where the oral PDE5 inhibitors (such as Viagra) don't work or are contraindicated. Usually comprised of a combination of three individual vasodilating drugs (papaverine, phentolamine and Prostglandin E1, which is also known as alprostadil), many men are familiar with the mixture under the name of TriMix.
Lastly is the topical cream commonly known as the brand-name Vitaros. Vitaros is actually a cream formulation with alprostadil (or Prostglandin E) being the active ingredient. At the moment its use and sale in the US has not been approved by the FDA, but it is being presribed with some success currently in both Europe and Canada. There is currently, however, a penile suppository that is approved for use in the United States.
- Erectile Dysfunction Vacuums
Commonly called the "Penis Pump." the erectile dysfunction vacuum works effectively for many men with ED. Also known as a VCD (Vacuum Constriction Device) or a VED (Vacuum Erection Device), it is a non-invasive treatment that has proven to be safe despite its drawbacks. Basically, the VCD is simply a cylinder that has an external pump attached to it. The cylinder may be attached directly to a man's penis and then the pump is used to make the penis erect by creating a vacuum within the cylinder. Additionally, there may be a constriction ring or band on the other end of the cylinder that's used by the man to help maintain the erection.
- Surgical Treatment For ED
The types of surgery used for treating erectile dysfunction can be broken down into two primary categories:
1. Penile Implants
Penile implants are a surgical procedure where a medical device called a penile prosthesis (or implant) is surgically implanted within a patient's penis. This procedure is an option when the less invasive treatments (such as oral drugs or vacuum erection devices) prove to be unsuccessful or are contraindicated in a patient. There are two types of penile implant devices: non-inflatable (semirigid) devices and inflatable (hydraulic) devices.
2. Vascular Surgery
Another surgical option for some men is vascular surgery, also commonly referred to as penile revascularization. In this surgical procedure a damaged blood vessel that may be causing the erectile dysfunction is "bypassed" by using a healthy blood vessel from the patient (similar to the procedure commonly seen in a coronary bypass surgery), thus improving blood flow to the penis. This surgery is not used for the vast majority of men with erectile dysfunction, being primarily used in men who have sustained severe pelvic fracture trauma. Patients with ED related to cardiovascular issues and diabetes would not benefit from this surgery.
- Shockwave Therapy Treatment of Erectile Dysfunction
Low-intensity extracorporeal shock wave therapy (LI-ESWT) is one of the newer methods being used successfully for treating erectile dysfunction. Basically, the use of LI-ESWT has been proven in studies to successfully result in the formation of new blood vessels from damaged preexisting blood vessels in a process known as angiogenesis. Commonly known by the name GAINSWave™, this treatment for men with ED is rehabilitative or even curative, enabling a patient to regain spontaneous sexual activity with normal intimacy.
GAINSWave™, or shockwave therapy treatment is very different from all other ED treatments in that it aims to restore the actual erectile mechanism in a patient, thus enabling a man to have a "natural" or spontaneous erection. Both painless and side effect free, GAINSWave™ also eliminates the basic disadvantages associated with all of the other ED treatments, such as having to use or "take on demand" and/or "time limited duration or effect".
- Natural Remedies for Erectile Dysfunction
Numerous "natural" remedies are available for the treatment of ED. Historically used around the globe, these herbs and plants are proclaimed by many users to be "somewhat" effective in the treatment of erectile dysfunction. Few scientific studies have actually been performed on the majority of these natural remedies, but beneficial results have certainly been observed in some men. Usually available without a prescription in pharmacies and herb stores, they include a variety of plants such as ginkgo, pomegranates, ginseng, yohimbine and horny goat weed.
Changing Your Lifestyle For Erectile Dysfunction
In addition to the ED treatments discussed above, all men with ED should perhaps consider changing some aspects of their lifestyle when exploring their options. When researching and becoming educated about the problem, it's important that a patient becomes aware that some adjustments to their style of living may be a significant way to help them to ease their problem.
A recent study revealed that men who were physically active were much more likely not to experience ED when compared to men who failed to exercise and lived a more sedentary lifestyle. Additionally, the study revealed a significant increase in symptoms for males who also had diabetes or an increased cardiovascular risk (such as hypertension or high blood pressure). The conclusion that was drawn was that regular exercise and eating healthier diet could result in decreasing the incidence and severity of ED for most men.
Questions about ED Treatments? Contact Philadelphia Urology Associates For Answers
At Philadelphia Urology Associates, Dr. Bruce Sloane is a nationally renowned specialist in Men's Health issues and Age Management Medicine. Throughout Philadelphia and the surrounding areas, patients seek his expertise to treat erectile dysfunction and other sexual performance issues. Using state-of-the-art equipment and having extensive specialized education and training, Dr. Sloane will find the treatments and solutions that will work for you.
If you have any questions about the treatments available for Erectile Dysfunction (ED) or other urological disorders, we urge you to contact us now online or call us at (215) 563-1199 today to discuss how we can help you!