Erectile Dysfunction (Impotence): Treatment and Therapy

Managing erectile dysfunction: Treatment options

Non-invasive treatments are typically attempted first. Most well-known treatments for ED are effective and safe. Oral drugs, testosterone therapy, penile injections, and penile implants are among the treatment options.

• Oral drugs or pills known as phosphodiesterase type-5 inhibitors are most often prescribed in the U.S. for ED (Viagra, Cialis, Levitra, Stendra)
• Testosterone Therapy (when low testosterone is detected in blood testing)
• Penile Injections (ICI, intracavernosal Alprostadil)
• Penile Implants

Oral drugs (PDE5 inhibitors)

Drugs known as PDE type-5 inhibitors increase penile blood flow.

• Viagra ® (sildenafil citrate)
• Levitra ® (vardenafil HCl)
• Cialis ® (tadalafil)
• Stendra ® (avanafil)

For best results, men with ED take these pills about an hour before having sex. The drugs require normal nerve function to the penis. PDE5 inhibitors improve on normal erectile responses helping blood flow into the penis. Use these drugs as directed. About 7 out of 10 men do well and have better erections. Response rates are lower for Diabetics and cancer patients.

If you are taking nitrates for your heart, you SHOULD NOT take any PDE5 inhibitors. Always speak with your health care provider before using a PDE5 inhibitor to learn how it might affect your health.

Most often, the side effects of PDE5 inhibitors are mild and often last just a short time. The most common side effects are:

• Headache
• Stuffy nose
• Facial flushing
• Muscle aches
• Indigestion

In rare cases, the drug Viagra ® can cause blue-green shading to vision that lasts for a short time. In rare cases, the drug Cialis ® can cause or increase back pain or aching muscles in the back. In most cases, the side effects are linked to PDE5 inhibitor effects on other tissues in the body, meaning they are working to increase blood flow to your penis and at the same time impacting other vascular tissues in your body. These are not ‘allergic reactions’.

Testosterone therapy

Testosterone Therapy may fix normal erections or help when combined with ED drugs (PDE type 5 inhibitors).

Intracavernosal (ICI) therapies

If oral drugs don’t work, the drug Alprostadil is approved for use in men with ED.

Self-Injection therapy

Alprostadil is injected into the side of penis with a very fine needle. It’s of great value to have the first shot in the doctor’s office before doing this on your own. Self-injection lessons should be given in your doctor’s office by an experienced professional. The success rate for getting an erection firm enough to have sex is as high as 85% with this treatment. Many men who do not respond to oral PDE5 inhibitors can be ‘rescued’ with ICI.

ICI therapy often produces a reliable erection, which comes down after 20-30 minutes or with climax. Since the ICI erection is not regulated by your penile nerves, you should not be surprised if the erection lasts after orgasm. The most common side effect of ICI therapy is a prolonged erection. Prolonged erections (>1 hour) can be reversed by a second injection (antidote) in the office.

Men who have penile erections lasting longer than two to four hours should seek Emergency Room care. Priapism is a prolonged erection, lasting longer than four hours. It is very painful. Failure to undo priapism will lead to permanent penile damage and untreatable ED.

Niti Navanimitkul, M.D.
Urologist 
Water Vapor Therapy Specialist & Sexual Dysfunction 
Urology Center
Bangkok Hospital Pattaya