Before pursuing ED treatments, though, bear in mind that improving
heart health by losing weight, eating a healthier diet, exercising more and
quitting smoking
typically enhances erectile performance as well as one’s overall
health. In addition, sex therapy counseling sessions can often ease or
eradicate ED symptoms, if the underlying cause is psychological in
nature, says Drogo Montague, M.D., director of the Center for
Genitourinary Reconstruction at the Cleveland Clinic.
1. Vacuum erection device (penis pump)
Penis pumps produce erections by drawing blood, via air suction, into
the penis. The devices consist of a cylindrical tube, 12 to 18 inches
long, connected by a small air hose to a hand pump (on many models this
resembles the squeeze mechanism on a blood pressure monitor). Users
place the tube over the penis then pump to produce an erection. They
must then place an elastic band around the base of the penis to keep the
blood there and maintain the erection.
“Obviously this isn’t the most spontaneous thing,” says Tobias
Kohler, M.D., assistant professor of urology at Southern Illinois
University School of Medicine. “You can imagine someone having sex with a
partner for the first time and pulling out this lunch box.”
While the pumps produce erections for 90 percent of users, most
abandon it for other treatments, says Trinity J. Bivalacqua, M.D.,
assistant professor of urology and oncology at the Johns Hopkins Medical
Institution.
The pumps are “very cumbersome and clumsy,” Bivalacqua says. Despite
reliably producing erections, pumps have the lowest satisfaction rate of
any erectile dysfunction treatments. “In my practice, most men who try
it will say, ‘Not for me,’ ” he adds.
Insurers typically cover 80 percent of the roughly $500 cost for a
prescription pump, leaving consumers with around $100 in out-of-pocket
expenses.
If you opt for a pump, experts say it’s important to get one through a
doctor’s prescription. The pumps sold in sex shops tend to be novelty
items that don’t work and may even cause injuries.
Next: No. 2: Penile suppositories or injections. »
2. Penile suppositories or injections
These produce erections by injecting or inserting into the penis a
drug that increases blood flow. Urethral suppositories, the size of a
grain of rice, are inserted via the head of the penis; injections are
self-administered near the base of the penis.
The actual insertion of the suppository into the penis isn’t painful,
say experts. Nor is the injection itself — done with a very small, thin
needle. “Both [methods] are around a 1.5 to 2 on a zero-to-10 pain
scale,” Kohler says, “where zero is no pain and 10 is getting run over
by a truck.”
The biggest complaint about these treatments is a burning sensation
in the penis as the drug takes effect. The frequency, intensity and
duration of that side effect vary by method and user but can, in some
cases, be bad enough, Montague says, that “a man will get an erection
but be too uncomfortable to use it.”
Suppositories “were developed so men wouldn’t have to use needles,”
Bivalacqua says. They contain the drug alprostadil (also known as
prostaglandin E1) and are sold under the brand name Muse. If they are
going to work, it takes about five to 10 minutes. However, Muse produces
erections in only 30 to 40 percent of patients, usually those with mild
ED, because some of the drug is absorbed systemically and diverted from
its function of opening penile arteries to allow more blood to flow in.
The out-of-pocket cost is around $20 to $30 per suppository.
For men who don’t mind needles, injections come in various
formulations: alprostadil alone; a two-drug combo called bi-mix, which
can either be alprostadil mixed with phentolamine or phentolamine mixed
with papaverine; and tri-mix, a three-drug mixture of phentolamine,
papaverine and a low dose of alprostadil.
Of these formulations, alprostadil alone carries the highest reported
rate (50 percent of users) of burning and pain; in bi-mix users the
rate of burning is around 10 percent, and in tri-mix users it drops to
less than 3 percent of users, says Nehra. “And that improves
dramatically over time as men get used to the injection,” he adds
.
Because the burning side effect is triggered by alprostadil, the
formulations with the least alprostadil — tri-mix and certain versions
of bi-mix — could work for men who experience burning with the
single-drug formula. But some men might choose alprostadil alone because
the multi-drug cocktails can cost more and must be dispensed by a
compounding pharmacy — one that is authorized to mix medications on site
— which could mean the added hassle of a long drive to pick up the
drug.
Some injectable formulations need to be refrigerated — yet another
reason many men steer away from the needle option. Among ED treatments,
injections are also the most common cause of extended erections —
rigidity lasting more than four hours, also called priapism — which
afflict about 3 to 7 percent of users, Kohler says. That condition,
while easily treated with an adrenaline shot, requires urgent attention
at a clinic or hospital. The cost of this ED treatment is $2 to $5 per
injection.
Next: No. 3: Surgically implanted prostheses. »
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. Surgically implanted prostheses
A surgically implanted prosthesis can virtually guarantee erections
on demand. “Overall, these have the highest satisfaction for both the
patient and his partner,” Nehra says.
Ninety-five percent of prostheses implanted in men in the United
States are pump-and-chamber devices in which the man activates a pump —
via a discrete subdermal push button in the scrotum — that fills his
penis with sterile saline from a reservoir implanted along with the
pump.
The other 5 percent of prostheses are either pump devices in which
the saline is permanently in the prosthesis, not in a separate reservoir
(urologists may recommend this for men who have had multiple
surgeries); or a pair of semi-rigid, malleable rods implanted in the
penis, which render it hard at all times. The patient manually shifts
the penis into an erect position for sex.
With the pumps, erections last until the user hits the deflate button, which Kohler says “doesn’t happen” accidentally
. He adds
that
pump prostheses “are locker-room proof: Nobody can see that you have
one.” (Obviously, this is not the case with the always-on malleable rod
option.) Implanted pumps are reliable, experts say, with more than 90
percent of the devices working for 12 to 15 years.
The downside to these prostheses includes the standard risks of
surgery, the very low risk of infection — less than 2 percent in most
patients, slightly higher in diabetics — and a slight drop in penis
length versus a natural erection or other ED treatments. Also, unlike
with other methods, any hope for a natural erection is abolished once a
pump is implanted. The cost for surgical options varies, and insurance
coverage is typically good.
All of the above treatments preserve men’s sensation in the penis and ability to achieve orgasm.
Choosing the treatment that is best for you comes down to preference and efficacy. Montague
cites a
study
that surveyed three groups of men, all of whom were successfully using
an ED treatment. One group was on oral medications, one was using
injections and a third had surgically implanted pumps. The most
satisfied users were those with the implanted prostheses.
Once implanted, the pumps become “part of their body,” Montague
explains. “No out-of-pocket cost per use. Predictable response. Works
every time.” Pills, even when they work, might be less effective if
you’ve had more than a couple drinks or are out of sorts for other
reasons. Injections are slightly more reliable than pills but, Montague
says, are still subject to variability.
Originally published April 2012
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Dr. Pepper Schwartz | Relationship Expert
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