➨ The Treatments: New Habits to Impressive Implants
The American Urological Association outlines a number of valid treatments for ED and we talk to our patients about every option. Medication is often tried, except for patients who have no erections after prostate surgery. Different patients respond better to different treatments.
Behavioral changes can positively impact patients with mild ED and even heart disease. The American Heart Association recommends watching your weight, blood pressure, and cholesterol, as well as exercise and a healthy diet.
Pde5 inhibitors–e.g. Viagra–can be effective for mild to moderate ED. These oral medications are taken on an empty stomach well before sexual activity is planned.They work to increase blood flow to the penis, but don’t work well if a man lacks normal nerve stimulation and good blood flow, such as men with diabetes or those who have had treatment for prostate cancer. About 40 percent to 50 percent of men are satisfied with oral pills, but satisfaction rates are far lower for men with more advanced ED.
Vacuum erection pumps are external pumps that are applied to the base of the penis to create suction and increase blood flow. They’re minimally invasive but can create a cool or cold erection, a different color erection, bruising at the base of the penis and penile discomfort.
Muse is a pellet that a man inserts into his urethra to deliver a natural protein medication that may increase blood flow. It can cause some urethral burning that can be transmitted to his partner. An erection may occur within five to 10 minutes.
Injections of medication into the penis are designed to enhance blood flow. The erection is achieved within 10 to 15 minutes, but preparation time to create the injections can diminish spontaneity. Success rates are fairly high. but many patients balk at the process required to produce an erection. The meds must be stored in the freezer, thawed, drawn into the needle and injected into the penis. Then you wait for sexual stimulation. This is a reasonable option if you have only occasional sexual encounters and don’t mind the process and the cost. Injections generally work better than Muse, and, like Muse, have a limit on how often they can be used.
Penile implants, like those developed by Boston Scientific, are great for men with both mild and more advanced ED and have helped over 500,000 men over 40 years old return to normal sex lives. Overall, 92 percent of patients are satisfied with implants and 96 percent of their partners are satisfied. Implants provide full erections every time they’re desired and they look and feel like natural erections. A man doesn’t need to be sexually stimulated to get an erection, which makes a penile implant attractive for the woman. It takes under a minute to achieve an erection–less time than it takes for a natural erection– which stays as long as the couple desires.
Made of soft plastic that’s inflated with saline, the most common three-piece implant is entirely concealed in the genital area. A reservoir in the belly holds the fluid when a man doesn’t want to be erect, and a pump in the scrotum, operated by the patient, moves the fluid from the reservoir into two cylinders that have been inserted into the penile muscle to create a full and firm erection. When sexual intercourse is over, the man pushes pushes a separate button on the pump to move the fluid back into the reservoir. I insert everything through one incision under the penis. The cylinders are sized to fit the patient. I can’t create new length, but I can optimize a patient’s length and girth.
Research shows the implant lasts 10 to 15 years, when slow-leaking saline may necessitate the need for a new Implant. Mechanical failure rate is quite rare. Risk of infection is quite rare in my practice, where we use several precautions and progressive antibiotics to prevent infection. The implant also is coated in an antibiotic coating.
If your goal to have reliable, spontaneous erections for many years to come, the implant makes the most sense. Most women value the spontaneity it offers, as opposed to the complicated processes involved with external pumps or needles for every sexual encounter. Implants are covered by Medicare and most private insurance.
➨ Who is the ideal candidate for a penile implant?
Ideal candidates are couples at any age who have A) Communicated honestly about the value of their sexual health as an important component of a satisfying relationship B) Acknowledged that ED has created isolation and distance C) Decided together that they want to explore options that help them restore sexual health and relational intimacy. I have patients in their 70s and 80s who are still motivated to be sexually healthy. Men with mild to advanced ED who have been unsuccessful with medication also make excellent candidates.
➨ Giving Up Is NOT The Solution!
We must learn to talk about our sexual health challenges, find ways to celebrate intimacy, and invite the possibility of recovery, even if it looks different than it did when we were 30. At Edcure.org, a superb website sponsored by Boston Scientific, men can take an assessment, learn about custom treatment options, and get expert advice on how to find their best EDCure.