Erectile Dysfunction: Finding A Cure

Here’s a real conversation I had with a particularly memorable 72-year-old patient of mine who referred himself to the clinic because he was having difficulty urinating:

Me: “Tell me sir, so do you take any medications?”

Him: “Nope! Just my vitamin.”

Me: “That’s great! Do you have any other medical issues?”

Him: “Not at all doc, I’ve always been healthy.”

Me: “Ok, so when’s the last time you’ve seen a doctor?”

Him: “Oh, I don’t know…30 years ago?”

*crickets*

It’s no secret that, on average, men aren’t that great at taking care of themselves. I can attest to this, both as a man and as a physician. It’s sobering reality that the average life expectancy for men is ~5 years less than that of women. Men often delay going to the doctor and even when they make it, they tend to minimize their problems and instead try to ‘tough things out.’

Things are even worse when it comes to sensitive issues like erectile dysfunction (ED). In the United States alone, it’s currently estimated that over 39 million men are suffering from some degree of erectile dysfunction. Now while 57% of those men are thought to be suffering to moderate or severe ED, only 7% are actively seeking treatment. That means 93% of men with erectile dysfunction aren’t getting treated.

I want to break down some of the stigma surrounding ED and raise awareness about how common it really is while briefly touching on what treatment options are available to men.

What is erectile dysfunction?

Erectile dysfunction is defined as the persistent or repeated inability to achieve or maintain an erection sufficient for intercourse in at least 50% of attempts. Occasional failure to perform, especially in the presence of extenuating factors such as high stress levels or difficulty in a relationship, may not be true erectile dysfunction.

Who gets it? 

This is an important point – every man has the potential to develop erectile dysfunction if he lives long enough. This is an incredibly common condition. If you’re a patient, you should know that you are not alone and there is no shame in seeking help.

Current research estimates that the prevalence of erectile dysfunction in adult men (over the age of 20) worldwide ranges from 10-20%, with most studies estimating closer to 20%. But there’s a known increase in prevalence as men age. The prevalence of ED in men under 40 is only 1-10%, but this rate increases sharply to 30% for men in their 50’s, 40% for men in their 60’s, and even higher beyond that.

How can I prevent it?

Many different things can place men at an increased risk for ED, including diabetes, low testosterone, and heart disease. Avoiding these conditions through regular exercise and a healthy diet may decrease your risk for ED, but some risks are unavoidable. For example, while we have some fantastic treatments now for prostate cancer (including both surgery and radiation), all of these carry a risk for developing erectile dysfunction.

What treatment options are available?

It's important to know that no matter how bad your ED may be, there is option for you.The most commonly prescribed treatments for ED are oral medications known as phosphodiesterase inhibitors. These include medication such as Viagra (sildenafil) and Cialis (tadalafil). These medicines allow a man’s natural pro-erectile chemical signals to accumulate in greater concentrations, allowing men with mild ED to have stronger erections. But not every man can take these medications, and they tend not to work well in men with more severe ED. Fortunately there are other options!

For men with more severe erectile dysfunction, injection therapy is an option. Intra-cavernosal injections work on the same concept as the oral medications with the difference being in how the medication is delivered. With injections, a more concentrated version of the same type of medication present in the oral medication (along with some others) is placed into solution and injected with a small needle directly into the penis. This delivers the medication right to the source – allowing men who have failed oral medications to still achieve great erections. Other options, like vacuum devices or intra-urethral suppositories, are less commonly used but can also be great adjuncts. New therapies, like shockwave therapy or plasma rich platelet injection, appear promising but these are so new that there is insufficient data to say they work for sure (despite what some people may advertise).

What if the pills don’t work and I don’t like the sound of injections?

While pills and injections can be great options for some men, both of these are associated with ongoing monthly costs and they lack spontaneity. It can be difficult to time things correctly and even the injections may not work for men with severe ED. And some men just don’t like needles!

For these men, we tend to recommend placement of a penile prosthesis. A penile prosthesis is a private, concealed device that replaces the body’s natural erectile cylinders with inflatable silicone ones. This allows the patient to obtain an erection ‘on demand’ by squeezing a small pump hidden inside the scrotum. The device is extremely private and completely hidden inside the patient’s body. Most partners don’t even know the patient’s ever had anything done! The sensation of sex remains the same – the only difference is that, for the first time in a man’s life, he can obtain an erection whenever he wants and have it last as long as he wants.

Prosthesis placement is a relatively straightforward outpatient procedure done through a single small opening in the skin that takes only an hour or less. Although the procedure is easy for the patient, it’s important to find a surgeon who’s experienced in placing them. Visit www.edcure.org/find-a-specialist to find an expert in your area!

Any questions or comments? Let me know below or reach out using any of the links at the top or bottom of the page!