Erectile dysfunction

Erectile dysfunction is the inability to achieve or maintain an erection adequate for sexual activity. To achieve an erection requires appropriate brain messaging, adequate testosterone levels, and healthy nervous and vascular systems.? Erectile dysfunction affects approximately 25 million in the United States alone.

Causes:

Illness - hypertensity, diabetes, high cholesterol

Oral medications
PDE-5 (phosphodiesterase-5) inhibitors - including sildenafil citrate (brand name: Viagra), vardenafil (brand name: Levitra) , tadalafil -(brand name - Cialis) increase natural sexual signals, improving and prolonging erection

Penile injection
Patient self injection of a intraurethral medication into the penis. This allows the blood vessels to relax and expand, increasing the blood flow into the penis, causing swelling of the tissues, and resulting in the ability to achieve and maintain an erection. Medications used are Alprostadil or prostaglandin E1 (PGE1) (brand name: Caverject) or Trimix - a combination of papaverine, phentolamine, and prostaglandin E1 (PGE1).

Concerns that should be addressed at once:

• Bleeding
• Bruising
• Erection that continues for 2-3 hours
• Non-response to the injection
• Scarring
• Severe pain

Transurethral suppositories
Alprostadil

Vacuum therapy
Manual or battery-operated vacuum therapy and tension system that utilizes a vacuum to produce increased blood flow to the penis, enabling the patient to achieve and maintain erection

Surgical Management

Penile prosthesis
A prosthesis is an artificial substitution for a missing body part for functional and/or cosmetic purposes. A penile implant or prosthesis is a device, consisting of paired silicone rods, implanted into the body to enable a man to achieve an erection - either permanent or via inflation.

Post-op instructions

• Abstain from sexual activity until directed otherwise by your physician
• Follow the cautions listed on your medication
• Limit physical activity for at least the first four weeks

Concerns that are normal:

• Pain for the first four weeks

Concerns that should be addressed at once:

• Infection