Most men who experience erectile dysfunction (ED) can achieve stimulation through oral medications like Viagra®, Levitra® and Cialis®. Lifestyle changes can also help remedy the problem. They may quit smoking or lose weight, or undergo psychotherapy.
While these are the most common methods, they may not work for everyone. For example, male heart patients who take coronary vasodilators (to help open up coronary arteries) should not take medication for ED in the first place because both types of medications lower the blood pressure, and in combination, they lower the blood pressure too much, according to urologist Drogo “Karl” Montague, MD. Fortunately for these men, there are a few other options, each with its own pros and cons. The choice generally comes down to personal preference, he says.
“We do see an increased percent of ED as men age, but it’s due to age-related disorders, and a lot of those disorders are based on lifestyle,” he says. “ED may also be the result of a relationship disturbance or death in the family. When you have sudden onset of ED with somebody who has something [emotionally upsetting] going on in his life, it may well be related.”
He recommends three other options for ED when medication or lifestyle changes do not solve the problem:
Some men use a vacuum device into which they insert their penis: They grease the tube, lower a rubber ring and squeeze a pump that creates a vacuum inside the chamber. With the rubber ring in place for 30 minutes, men often are then able to have sex, Dr. Montague says. Some find it too mechanical, and it has a “hassle factor,” he says, and the device also can be uncomfortable and/or impede ejaculation.
“This can often be made to work,” he says. “It’s not acceptable for some people. But it’s safe, and effective.”
Other men opt for a penile injection, using a diabetic’s syringe and needle. The injected medication dilates the arteries and increases blood flow every time they want to have sex. The needle is small, so the injection is not terribly painful, but the treatment can be expensive, Dr. Montague says.
“If the erection starts to become curved, we need to know,” he adds. “If the erection doesn’t go down after two hours, you need to come in for a reversal. But there are men who use this for years.”
Those who would prefer not to use either of these first two options can turn to a surgical procedure. The surgeon inserts two cigar-shaped cylinders filled with saline attached to a small pump between the testicles and places a saline-filled reservoir inside the abdominal muscles. None of this is visible from the outside, although you can feel the pump from the outside of the scrotum. Squeezing that pump causes the saline to fill the cylinders, which simulates blood flow into the penis and causes “something close to a normal erection,” says Dr. Montague.
“The head of the penis doesn’t fill up, but otherwise it’s the same,” he says. “Each time the man pumps it up, it gets fully firm. Most men are a little shorter than previously. But it gets firm, stays firm, and he doesn’t have to worry about losing the erection. It doesn’t go down until he withdraws and presses a relief valve.”
The downside of implants is a 2 percent chance of infection, which requires removal of the device, and a 6 percent chance of the device failing within five years (and 19 percent within 10 years), Dr. Montague says.
“The attractive thing about an implant is that it’s part of your body,” he says. “If you go on vacation, you don’t have to remember to take syringes or medications. It’s MRI safe, and it doesn’t set off any detectors at the airport. You can have sex whenever you want, at no cost per use, with the same response every time.”
Surgical implants are typically not a man’s first choice, he adds, but men rate them most highly of all options in satisfaction surveys.
A man’s wife or significant other typically is supportive of a patient with erectile dysfunction, in the sense that partners typically say, “Honey, it’s OK. I still love you, and it’s not important,” Dr. Montague says.
But he encourages partners to mention that it’s a common problem and that there are straightforward solutions that a man can discuss with his urologist.
“She should encourage him to mention this to the doctor as part of his annual checkup,” he says. “Some doctors screen for this, and some don’t. If a man has a problem in this area, he will invariably get referred to a urologist. Most will prescribe oral medications. If they fail, then they go to a urologist who specializes in erectile dysfunction.”