Q: What causes an erection?
When a man is exposed to certain stimuli -- either tactile or visual -- there are neurological signals, accompanied by a rush of blood flow, that are sent to the penis. When those signals reach the penis, the two erectile chambers located within the penis fill up with blood. This clamps off the side veins within the penis and traps blood in the erectile chambers. All of this occurs in response to the stimuli to which the man was exposed, causing an erection.
Q: What is Erectile Dysfunction?
Erectile dysfunction is the persistent or consistent inability to sustain or maintain an erection. The majority of patients I treat have some form of erectile dysfunction, but they vary in terms of the degree and the severity of their condition.
Q: What is the difference between erectile dysfunction and impotence?
Typically, these terms are interchangeable. However, I find there are vast differences in terms of the connotations each term carries. Erectile dysfunction is the term often used to describe a range of conditions -- from an occasional inability to maintain or sustain an erection to a mild degree or inability to maintain or get an erection. In contrast, the term "impotence" sounds very definitive, almost a complete inability to have an erection. This term has a very negative connotation. It sounds like it means a loss of power or no power, meaning that if a man has erectile dysfunction, he has lost his power, and I don't think that's true.
Q: What causes Erectile Dysfunction?
There are a number of conditions that can lead to erectile dysfunction in men, some of which include:
- Age: Even in the absence of the other health conditions, age becomes an independent risk factor for erectile dysfunction. The age that doctors usually consider to be a risk factor for erectile dysfunction is about 50. However, it is not uncommon for men in their 30s and 40s to have erectile dysfunction.
- Medications: Certain medications can cause erectile dysfunction. For example, those patients who have been prescribed beta blockers or other medications to lower their blood pressure will notice that these medications may also lower the blood pressure to their penis, which can interfere with their ability to get and maintain an erection.
- Obesity: Obesity is a risk factor for almost every medical problem that we encounter today, and erectile dysfunction is no exception.
- Other Medical Conditions: Often, general medical conditions that bring patients into the doctor, such as high blood pressure, high cholesterol or diabetes, can also bring patients in to see an urologist about erectile dysfunction.
Q: If a man thinks he might have erectile dysfunction, when should he visit his doctor?
More than 90 percent of men will suffer from some degree of erectile dysfunction at some point during their lives. This does not mean that the condition will be permanent. In many instances, a man could wait before seeing a doctor if he believes that a particular event in his life may be causing his erectile dysfunction -- for example, anxiety caused by losing a job, losing a partner and other types of situational depression may contribute to a man's temporary inability to get or maintain an erection. However, if a man believes he is experiencing a persistent inability to achieve his goals sexually, this may be an appropriate time to talk to a physician.
Q: How do you diagnose a patient with erectile dysfunction?
To diagnose a patient with erectile dysfunction, my office provides the patient with a questionnaire, which we request be completed either at home before the first appointment or in the office when the patient arrives for his appointment. This questionnaire contains a set of very specific questions that physicians have proven are good indicators to use when stratifying the many causes of erectile dysfunction in patients. Once the patient returns the questionnaire, I can review his responses to the questions and stratify those responses according to a specific set of guidelines to determine whether the patient may be experiencing mild, moderate or severe erectile dysfunction. These questions also help us determine what might be the underlying cause of a patient's erectile dysfunction -- for example, whether it is a blood flow issue, anatomical issue, psychological issue or hormonal issue. Knowing the cause of a patient's erectile dysfunction helps us better understand the condition and develop the best treatment options for that specific case.
Q: Do patients need to visit a specialist to receive treatment for erectile dysfunction?
The majority of patients diagnosed with erectile dysfunction can be treated by family physicians or family practice doctors. I'm happy to treat patients for this condition, but they do not necessarily need to see a specialist like myself.
Q: What treatment options are available for patients diagnosed with erectile dysfunction?
There are a multitude of treatment options available to treat patients diagnosed with erectile dysfunction. These treatment options include:
- Medications: There are three different medications available to treat patients' mild to moderate erectile dysfunction. The first pill is Viagra, which was the first medication released on the market to treat this condition. The other two medications are Levitra and Cialis. All three of these medications are very safe and very effective.
- Injections: Another treatment option for erectile dysfunction is an injection, which requires a needle that is filled with a special medication to be directly inserted into the penis.
- Surgery: In those men for whom other treatments do not work or do not produce satisfactory results, a penile implant may be considered. A penile implant is a device that is inserted into the penis during a half-hour operation performed under general anesthesia.
Q: How effective are the medications that are used to treat erectile dysfunction?
Medications that have been developed to treat erectile dysfunction can be very effective for certain patients. Men who have mild or moderate erectile dysfunction often experience great results after using these medications. In general, approximately 70-80 percent of men will experience some benefit from using these medications.
Q: Will the medications cause side effects?
There are some minor side effects associated with medications developed to treat erectile dysfunction. These side effects can include headaches, facial blushing and upset stomach. A very small percentage of men who take these medications may also experience temporary vision disturbances, such as seeing blue or a blue discoloration in the background.
Q: Are there any men who should not take the medications?
Men who have coronary artery disease, particularly those who take nitrates or nitroglycerine, should not take these medications. These medications can cause a very unsafe drop in blood pressure for those individuals.
Q: When should a man consider talking to his doctor about penile implant surgery to treat his erectile dysfunction?
Men who are unsuccessful or not satisfied with medications and injections should consider talking to their doctors about having a penile implant inserted into the penis. A penile implant is a device that is inserted in the penis during an operation.
Q: How is the implant procedure performed?
This procedure takes approximately half an hour and requires a general anesthetic. During the procedure, the implant is placed in the patient's penis through one tiny incision in the scrotum. Through this incision, two cylinders are placed into the erectile chamber. The pump used to manipulate the implant is then hidden in the scrotum.
Q: What is the implant made of?
Depending upon the brand, penile implants can be constructed from a variety of materials. The implant I often use is made of silicone. Its cylinders fill up with saline (salt water). Regardless of the brand, however, all of these devices are made to prevent infection.
Q: How much time is required to recover after the procedure?
After the procedure, the patient will be sore for a few days. However, full recovery lasts for approximately one month, after which time patients can begin using the device.
Q: How does a penile implant work?
The cylinders of the implant, which are inserted into the erectile chamber of penis act as a reservoir that hold the saline next to the bladder. When the patient pumps the device using the button that has been inserted into the scrotum, the cylinders will fill up with the saline from the reservoir, giving the patient a normal erection. To return to the flaccid state, the patient simply presses the button once more and everything returns to normal.
Q: Can the implant be seen from the outside of the body?
No. The implant is placed completely inside of the patient's body. The patient will not look any different from the outside.
Q: What results do patients typically experience after undergoing this procedure?
The long-term results for patients who undergo the implant procedure are very good. In fact, one survey conducted among patients who received the implant reported that 90 percent of patients remained satisfied with the implant three years after undergoing the procedure. In addition, 96 percent of patients would undergo the procedure again if given the opportunity and 92 percent of patients would recommend the implant to others. However, the implant is not used as often as pills or injections to treat erectile dysfunction because patients do need to see a surgeon or urologist who has experience performing the procedure and with whom they are comfortable. Though, when a patient does decide to go forward with the procedure, they are usually very happy with the results.
Q: Will the implant ever need to be replaced?
No. Very few implants ever break thanks to modifications that have been made to the device throughout the years. Modern implants will work for the rest of the patient's life, until he chooses not to use it anymore.
Q: If erectile function were to resume later in the patient's life, could the implant be removed?
Because this implant procedure is an "end-of-the-line" treatment, we would hold off going forward with it if the patient feels that he may regain sexual function later in life.
Q: Are there some men who might not be good candidates for the implant procedure?
Almost all men diagnosed with severe erectile dysfunction will be candidates for this procedure. An urologist may choose not to perform the procedure on a patient if he does not possess the manual dexterity necessary to use the pump or if he could not make it through a half hour operation for specific health reasons.