How can I treat ED?
ED can be assessed and treated relatively easily. There are many treatments available, with evidence showing efficacy and results in improving patient quality of life.
There are many non-licensed treatments promoted to patients that claim to treat and sometimes 'cure' ED, especially on the internet. Evidence to support the safety and efficacy of these products is limited. However, the anonymity of the internet can be seductive to men desperate to find a solution. Such a situation reinforces the need for practitioners to proactively bring up the subject of sex as a routine part of their health screening programme.
Erectile dysfunction can be treated in a variety of ways. These include:
There are three options within this class of PDE5is which help men get an erection in response to sexual stimulation. PDE5is have rapidly become the first line pharmacological treatment for ED worldwide. Because they only work when the patient is sexually stimulated, this method may feel more spontaneous and natural than other treatment options.
Injection into the corpus cavernosum. Side effects may include prolonged erection, pain from injection and scar tissue on the penis. These are useful for some patients except those with sickle cell anaemia or other conditions that predispose to priapism. Special care needs to be taken in patients on anticoagulant therapy. The main drugs used are alprostadil, papaverine hydrochloride with/without phentolamine or a combination of all three.
These are prescription-only tablets or pellets containing alprostadil. They are inserted into the penis to help get an erection. They can be an alternative for men who don't want to use injection therapy. The tablets may cause localised pain in some men and should not be used if their partner is pregnant or planning to become pregnant.
With this method a vacuum tube is placed over the penis to help create an erection by suction. A ring is placed around the base of the penis to help keep the erection. Vacuum devices are generally safe but should not be used for more than 30 minutes at a time because the penis may become cold and painful.
Silicone cylinders, which may be semi-rigid or inflated when needed, can be surgically implanted into the penis to produce an erection. While many men and their partners report satisfaction with this treatment, the surgical procedure may be painful, and there is a risk of infection both during and after the surgery.
A small proportion of cases of ED are caused by hormone abnormalities, the most frequent of which is a reduced level of testosterone. This would normally be restored by appropriate testosterone replacement therapy.