Choosing the Treatment That's Right for You
ED is treatable. There is usually more than one option to choose from – your urologist can help you and your partner determine which treatment is right for you.
Oral medications used to treat erectile dysfunction include selective enzyme inhibitors (e.g., sildenafil [Viagra®], vardenafil HCl [Levitra®], and tadalafil [Cialis®]).
Self-injection involves using a short needle to inject medication through the side of the penis directly into the corpus cavernosum, which produces an erection that lasts from 30 minutes to several hours.
Urethral suppositories may be an alternative to injection. Using a hand-held delivery device, a man inserts a prostaglandin pellet through the meatus (penis opening) into the urethra. Prostaglandin is absorbed through the urethral mucosa and into the surrounding erectile tissue. It is available with a prescription, is well tolerated, and may improve erections in 60% of men who use it.
Vacuum devices work by manually creating an erection. The penis is inserted into a plastic tube, which is pressed against the body to form a seal. A hand pump attached to the tube is used to create a vacuum that draws blood into the penis, causing the penis to become engorged. After 1 to 3 minutes in the vacuum, an adequate erection is created. The penis is removed from the tube and a soft rubber O-ring is placed around the base of the penis to trap blood and maintain the erection until removed. The ring can be left in place for 25 to 30 minutes.
Penile implants involve surgical insertion of malleable or inflatable rods or tubes into the penis. A semi-rigid prosthesis is a silicon-covered flexible metal rod. Once inserted, it provides the rigidity necessary for intercourse and can be curved slightly for concealment. It requires the simplest surgical procedure of all the prostheses. Its main disadvantage is that concealment can be difficult with certain types of clothing.
Watch the operating room video showing the placement of the inflatable penile prosthesis and artificial urinary sphincter. (Be advised, this educational video contains images of male genitalia.)
A small percentage of men undergo vascular reconstructive surgery to improve blood flow to the penis. Revascularization involves bypassing blocked veins or arteries by transferring a vein from the leg and attaching it so that it creates a path to the penis that bypasses the area of blockage. Young men with only local arterial blockage are the best candidates for this procedure.