A diagnosis of Erectile Dysfunction (ED) can be difficult to deal with, but together we will navigate treatment options. The process of erection, sexual intercourse, and, orgasm requires a highly coordinated response from the neurologic, vascular, psychologic, and sensory systems. The penis should be thought of as an inflatable rod and the cardiovascular (heart) system is the pump that inflates the rod. If the blood vessels in your heart are not functioning well, it is likely that blood vessels in your penis are not functioning well. Among many causes of ED are things like coronary artery disease, neural compromise from spinal problems or trauma, diabetes, smoking, drug use including alcohol and marijuana, etc.
If you are safe for sexual activity, this means that you can walk up at least 2 flights of stairs or at least 50-100 yards without getting winded, short of breath, chest pain, or dizziness then the 1st treatment option is an oral medication like sildenafil or tadalafil, the active ingredients in Viagra® and Cialis®, respectively. Certain populations such as diabetics, post pelvic surgery, smokers or those with Peyronie’s disease patients can commonly fail medical therapy for ED.
A 2nd treatment option is a Vacuum Erection Device (VED). Now you might be thinking… A vacuum WHAT device? This is a plastic tube that fits over the penis and is pressed against the skin surrounding the base of the penis and pubis. It then uses suction via a hand or battery-powered pump to pull blood into the phallus and cause engorgement. When it is used for sexual activity it is often used in conjunction with a penis ring that fits around the base of the penis to trap the blood in after the vacuum pulls the blood into the penis. The whole point is to fill the penis with blood and then trap it there for a temporary period of time just like the normal physiologic processes with an erection. This cannot be used with the ring for more than 30 minutes at a time. Patients have reported negative reviews in the past related to a somewhat wobbly base of the shaft of the penis where the ring is or the sensation of a cold glans penis. For sexual activity the VED must be used with the ring for most patients. Discuss with your doctor if you take anticoagulation medications (Coumadin, Aspirin, Plavix, Warfarin, Lovenox, etc.) as these can sometimes be prohibitive of use.
The 2nd (and more common in our practice) use for a VED can be maintaining penile length in the face of increasingly Severe ED. This is certainly used for patients who have had prior prostate surgery or other radical pelvic surgery, but also any patient who has more severe erectile dysfunction in which the loss of nocturnal or stimulated erections occurs. Typically, nocturnal erections occur to engorge and stretch the penile tissue and revitalize the blood-filled capillaries with oxygen. In many more severe forms of ED loss of nocturnal erection occurs. In this case, setting the vacuum erection device is used 3-5 times per week for approximately 20-30 minutes at a time with NO penile ring. This is to cause engorgement in and stretching of the phallus. This is thought to be helpful because it can otherwise help to prevent shortening from decreased blood flow and the normal stretching of the tissues that occur with the erection process. Caution again should be advised for patients taking anticoagulant medications.
Stay tuned for further options beyond a VED as 2nd and 3rd line therapies for ED. Together we will find a cure to get that function and confidence back in your life.
