Erectile dysfunction is the inability to develop and maintain an erection for satisfactory sexual intercourse. The following treatment options are available for the treatment of erectile dysfunction after a comprehensive medical review and correction of reversible risk factors.
Oral medications (Viagra®, Cialis®, Levitra®) rely on intact erectile nerves to work and they help to augment an erection. Although they are of the same class of medication, differences in duration of action, drug absorption and side effect profile do exist so one needs to pay attention of their specific instructions of use. These medications cannot be taken in conjunction with Nitrates (patch for high blood pressure or spray/tablet under the tongue for angina).
A vacuum constriction device is a cylinder with suction (manual or battery operated) which creates a negative pressure to draw blood into the penis. Erection is then maintained by sliding a constriction ring at the base of the penis. This device has found to be useful to maintain penile stretch length after radical prostatectomy.
Penile injection therapy involves injection of a vasoactive medication directly into the penis to cause an erection. There are preloaded syringes (Caverject Impulse®) or a mixture of medication which can be purchased from a compounding pharmacy. The dose needs to be titrated (start at low dose and increase incrementally to find the optimal dose for a good erection). It is recommended that a test injection be performed so one can be familiar with the injection technique and its effect.
A penile prosthesis can be considered when other modalities are not helpful. There are one piece non-inflatable, two piece inflatable or three piece inflatable prostheses available. The one piece non-inflatable prosthesis is a malleable device so one can bend it into position for use. The two piece inflatable device consists of the two cylinders and a scrotal pump so the it be inflated and deflated. The three piece inflatable has the addition of a balloon reservoir and gives the most natural erection. These devices have undergone progressive improvements and are designed to last. There are surgical risks involved so a consultation and assessment of the suitability of these devices by a specialist is important.