There are a number of treatment options that exist for the management of erectile dysfunction. These are enumerated below:
Lifestyle changes
Amongst the most commonly advocated measures, a large body of evidence exists highlighting the efficacy of lifestyle and behavioral modification on the course of problems like erectile dysfunction. Some of the changes that should be incorporated in an individual’s’ life include regular exercise, weight loss, cessation of smoking, drug and alcohol abuse, as well as maintaining good control of one’s blood pressure and blood glucose levels. Some patients report an increased efficacy of oral medications in treating erectile dysfunction when treatment includes such lifestyle modifications.
Adjusting and/or changing your medications
A number of medications used to treat hypertension, increased cholesterol levels and depression may be responsible for aggravating erectile dysfunction in affected patients. For example, certain beta blockers and diuretics such as hydrochlorothiazide may contribute to the disease. Some medicines such as angiotensin receptor blockers (ARBs) may be beneficial for such individuals. It may thus help patients with erectile dysfunction to adjust their long-term medications, albeit with the consultation of a professional medical provider.
Oral drugs
The commonly used oral medications used to treat erectile dysfunction belong to the class of phosphodiester type 5 (PDE 5) inhibitors. The USFDA approved drugs that are included in this category are sildenafil (Viagra), vardenafil (Levitra), avanafil (Stendra) and tadalafil (Cialis). These drugs help the muscles of the corpora cavernosa to relax, thereby allowing the penis to fill up with blood effectively during an erection.
These drugs have a propensity to cause a fall in blood pressure and hence, must be avoided in patients taking nitrates for episodes of chest pain (angina). Additionally, patients taking medicines for an enlarged prostate (i.e. alpha blockers such as Flomax and Cardura) must also consult their doctors prior to using these drugs.
Other common side effects of these drugs include a headache, flushing, nausea, diarrhea, dyspepsia, and flushing. Please consult your medical provider to assess the suitability and safety of these drugs in you.
Intraurethral suppositories
Inserting prostaglandins such as alprostadil into the urethra may help affected individuals attain erections far more easily and for a longer duration. These are available in pellet form and most therapeutic pellets require a dosage of 500 to 1000 micrograms.
Intracavernosal injections
Medications such as papaverine, phentolamine, and prostaglandins may be injected directly into the muscles of the corpora cavernosa to help attain erections. These work by increasing the blood flow to the penile structures. This method of treatment may be associated with penile pain.
Testosterone therapy
Treatment with testosterone may be needed in patients with hypogonadism and with other signs and symptoms of low testosterone. These patients may still need oral medications to additionally treat erectile dysfunction. They, however, show a much better response on combining both treatments. Patients report an improved libido following such treatment.
Vacuum constrictive devices
These vacuum pumps work by creating a vacuum around the penis, thus allowing blood to fill the penis effectively enough to cause an erection. These devices have shown good efficacy in studies and must be removed on completion of intercourse.
Penile prosthetic devices
Several different types of penile prostheses are available, ranging from simple malleable devices to the more complex three-piece inflatable prostheses. These devices report a high rate of satisfaction amongst users. They are surgically implanted into the scrotum on an outpatient basis and may lead to occasional occurrences of scarring within the penile structures. Complications are reported in 8-20% of users, with the risk of infection a particularly grave concern.
Surgery
Extremely rarely, patients suffering from erectile dysfunction may require surgical repair of the arteries supplying the penis. This helps by relieving obstructions that may impede blood flow into the penis. The best candidates for such surgeries are young men, with the success rate decreasing in older men.
Psychotherapy
Impotence arising from psychological issues needs to be treated, with the aim being to decrease the anxiety levels during the process of intercourse. Involving the affected individual’s partner may be beneficial. A referral to a sex counselor may be needed in a select few patients.
Natural home remedies and alternative medicine
Home remedies such as ginseng, arginine, DHEA and other supplements have been tried for treating erectile dysfunction but have not been proven to show any efficacy in this regard. Instead, the harmful ingredients found in some of these formulations may cause irreparable and dangerous harm. Acupuncture has also not been shown to have any positve beneficial effect. Other home remedies that have been tried include eating blueberries, citrus fruits, and red wine.
