Causes
TREATMENT OPTIONS
Testosterone replacement
Medications - PDE5 Inhibitors (Cialis, Viagra, Levitra)
Compounded Rapid Acting Sublingual Formula
Intra-cavernosal Injections - (Caverject or Trimix compound preparation)
Side Effects
Compounded Formula
Penile Prosthesis
Vacuum device
Erectile Dysfunction (ED) is the persistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual intercourse. It is a very common condition affecting over 2 million men in Australia over the age of 40 years. It can result in mental and psychological distress affecting every facet of one’s health, relationships and quality of life. The underlying causes could be multi-factorial from limited blood flow and/or neural input to the penis. This needs a thorough assessment. Fortunately there are various effective treatment options depending on the underlying cause and severity of the condition.
Causes
- Psychological
- Vascular – (ie damage from smoking or high blood pressure)
- Hormonal (Endocrine system)
- Neurogenic – (ie pelvic surgery, diabetes)
- Drugs or prescription medications
TREATMENT OPTIONS
Lifestyle changes, psychological treatment and medication changes
- Overall review of cardiovascular risk factors
- Optimise health and diet
- Review of medications and change if necessary
Testosterone replacement
- If levels below normal on two blood readings
- Thoroughly evaluate for any contra-indications to replacement
- Underlying reversible causes managed first
Medications - PDE5 Inhibitors (Cialis, Viagra, Levitra)
- Very safe with 80% response rate
- Take 40 min prior to intercourse
- Know how long they last depending on type taken
- Need normal stimulation
- Avoid alcohol/ fatty food just prior to ingestion
- Need to try it a few times before giving up
- Side Effects – overall these medications are very safe but may cause:
- Low blood pressure
- Facial / nasal flushing
- Headache
- Reflux
- Visual disturbance – blue discolouration
- Cannot use with: High risk cardiac patients* and those on certain medications (Nitrates, Beta-blockers and Antiarrythmics)
Compounded Rapid Acting Sublingual Formula
- Either in sublingual absorbable strip or lozenge
- Sildenafil (Viagra) and Phentolamine formula
- More effective and onset of action as fast as 5 minutes
- Similar side effects as Sildenafil (Viagra)
Intra-cavernosal Injections - (Caverject or Trimix compound preparation)
- Effective treatment for men who cannot take oral agents or for whom oral agents are no longer effective
- It takes 5 – 15 minutes to work
- Needs to be dose adjusted to each individual patient
- Expensive
- Psychological barrier to injection
Side Effects
- Priapism – sustained erection more than six hours which may risk permanent damage to penis tissue
- Pain
- Infection
- Penile Fibrosis (scarring) in long term usage
- High blood pressure and heart rate
Compounded Formula
- Either for injection or cream formula for non-injectable application
Penile Prosthesis
- Surgical insertion of patient controlled device
- Overall high satisfaction rate of up to 90%
- Concealed
- Long term solution
- Still have orgasm and ejaculation (if no pelvic surgery)
- Indications:
- Patients who have failed other therapies
- Peyronie’s disease (penile angulation) – moderate to severe with ED
- Severe vasculogenic disease
Vacuum device
- 15-20 different types. Cost varies from $60 – $800
- Pros:
- Suitable for most patients
- Minimal discomfort
- Cheap in comparison to other treatments
- Cons:
- Rigidity not satisfactory for most
- Noise of vacuum
- Erection may feel cold and un-natural
- Ring can only stay on 30 minutes at a time
Written by Dr. Shekib Shahbaz and Dr. Tony de Sousa
Urology Care Foundation, (2021), Erectile Dysfunction (ED), [https://www.urologyhealth.org/urology-a-z/e/erectile-dysfunction-(ed)], accessed 19/02/21.
McCabe, M. P., Sharlip, I. P., Atalla, E., Balon, R., Fisher, A.D., Laumann, E., Won Lee, S., Lewis, R., Segraves, R. T., (2016), Definitions of sexual dysfunctions in women and men: A consensus statement from the fourth international consultation on sexual medicine 2015, Journal of Sexual Medicine, 13(2), [https://pubmed.ncbi.nlm.nih.gov/26953828/], accessed 19/02/21.