Because ED can often result from depression or from a combination of psychological and physical factors, professional counseling is often recommended. Counseling can lessen anxiety, which may in turn reduce the impact and duration of ED. Therapy is often used in combination with other treatments directed by a physician.
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Depression or stress can be a cause of erectile dysfunction.
A therapist should first evaluate whether problems such as dysfunctional relationships or alcohol and drug abuse are the causes or important co-causes of the ED. Counseling is also important in dealing with performance anxiety and other problems a man may have that interfere with sexual stimulation and erections. Professionals will work with couples to educate them regarding normal sexual response and ED so they can cope with sexual problems and help them recognize that with aging there are normal changes that occur in the man. These include delay in obtaining an erection, taking a longer time to ejaculate, not ejaculating every time, and a longer recovery time between erections. Some antidepressant medications may help with premature ejaculation, but the Food and Drug Administration (FDA) has not yet approved them for this purpose.
The involvement of your sexual partner is paramount. After all, a man can only be considered whole in relation to his entire set of relationships, especially his primary family relationships. Good, constructive therapy should help relieve anxiety and depression and improve your sexual functioning. It should also teach stress reduction and anxiety control and help you recognize the signals of increasing anxiety.
Toning muscles serving the portion of the erectile tissue that is inside the body -- the ones that become tense to help erections become stronger and that cause ejaculation when they contract -- may also be helpful. Although it doesn't usually require a conscious effort on your part to contract these muscles, some researchers in Belgium believe that men might be able to be taught to use and strengthen them, thereby improving the erection. These researchers have developed a set of pelvic floor exercises, much like the Kegel exercises for strengthening the pelvic floor muscles that are often practiced by women, that tense and tone these muscles.
Oral medications work best in men whose main problem is anxiety or other emotional problems, but it also works in men with physical problems if the erectile tissue has not been severely damaged. In clinical studies, 70 to 80 percent of men with ED obtained good results with oral medications. While the development of on-demand oral medications is a tremendous advance, they won't work for all men, and other treatments will continue to help men with erection problems. Due to the tremendous popularity of Viagra, most of the treatments that were considered first-line therapies have now been pushed back to secondary options used only after Viagra or another oral agent has failed.
©2006 Publications International, Ltd.
There are a variety of oral medications
to treat erectile dysfunction.
In addition to Viagra, Levitra, and Cialis, there are other oral medicines that may be helpful. Yohimbine is a drug in pill form that comes from the bark of an African tree called yohimbe. It is commonly given to men complaining of erection problems and low sexual desire and has been touted as an aphrodisiac for decades. Yohimbine has produced good results in animal studies, but experts do not agree about its effectiveness for men with erection problems. Some claim good results; others don't. Overall, its success rate has been little better than a placebo pill. Two studies, both financed by pharmaceutical companies, claim that yohimbine might help between 20 and 40 percent of men who take it. It might be especially good for men who don't have any advanced physical causes for their problem.
Yohimbine is associated with potentially significant side effects, including palpitations, an increase in blood pressure, tremors, agitation, and nervousness. Under no circumstances should you use this medication if you have a history of palpitations or high blood pressure.
Yohimbine is available in prescription form (Yocon) as a pill that can be taken three times a day. It is also available in health food stores, where it may be bought in its generic form (yohimbine) in varying doses. A word of caution: Studies show that over-the-counter yohimbine is inconsistent in dosage and effect and no cheaper than prescriptions. It is best to have yohimbine prescribed by a doctor.
Other medications that might help some men are Trental (pentoxifylline), Vasodilan (isoxuprine), and Desyrel (trazodone). Trental and Vasodilan increase blood flow to the leg arteries. There are minimal side effects. Desyrel is an antidepressant, but in a small percentage of men, it increases penile blood flow, helping to restore sex drive. It is considered risky by doctors, however, to use a drug for its side effects. Side effects of Desyrel include retrograde (into the bladder) ejaculation and priapism, the medical term for a prolonged erection that occurs without sexual stimulation and continues after ejaculation and orgasm. Priapism is a dangerous medical condition that can result in irreversible damage to the penis. Desyrel is often used in combination with yohimbine.
Some men have also claimed results from using dopamine and serotonin agonists, but no scientific studies have proved the effectiveness of these drugs in dealing with ED. As with yohimbine, any improvement following their use may be a placebo effect -- that is, it produces good results simply because the patient believes it will.
Five percent of all cases of ED are caused by abnormal levels of sex hormones, such as low levels of testosterone, excess prolactin, or excess estrogen. If your testosterone level is low, your urologist may prescribe a series of intramuscular testosterone injections every few weeks for several months or testosterone patches that you place on the scrotum or on your torso. Oral testosterone is rarely recommended because it is often ineffective and can cause liver damage. While a low testosterone level is rarely the cause of erectile problems, it might be a contributing factor, especially in older men, because it decreases sexual desire.
There are some serious questions about testosterone injections, however, because there is evidence that the prostate gland responds to testosterone levels. Testosterone might make the prostate grow larger, causing urination problems. It may also play a role in the development of prostate cancer. Hormones also thicken the blood, increasing the risk of circulatory problems. Another drawback is that hormone supplementation may lead to a lifetime dependency, as it reduces the body's ability to produce its own hormones, causes testes to shrink, and thickens blood by increasing red blood cells.
The indiscriminate use of oral testosterone or oral DHEA (the precursor to testosterone, which is available at many health food stores) may be associated with significant side effects, such as interference with blood triglyceride and cholesterol levels, increased risk of stroke, increased benign enlargement of the prostate, and, most importantly, acceleration of the growth of microscopic amounts of prostate cancer that may previously have been undetectable.
Aside from medication, vacuum devices are the least invasive treatment for ED. Although mechanical and somewhat cumbersome to use, they do work. Used properly, a vacuum device will produce an erection in just about any man. In fact, they have caused erections in paralyzed men who have no feeling at all in their penises.
These mechanical devices cause an erection by creating a vacuum around the penis, drawing in blood and making it erect. The devices have three parts: a plastic cylinder in which the penis is placed; a pump, which draws air out of the cylinder; and an elastic band (constriction ring), which is put around the base of the penis to maintain the erection after the cylinder is removed (and during intercourse) by keeping the blood from flowing out of the penis. A variation of the vacuum device uses a semirigid rubber sheathe that is placed on the penis and left there after the penis is erect and during sex.
Instruction in the use of a vacuum device is important so that you can use it properly and successfully. Since a constriction ring at the base of the penis maintains the erection, the part of your penis that is inside the body may not be as rigid, producing a hinge effect. And your penis might be a little colder than normal because of the restricted blood flow.
Although vacuum devices may be inconvenient and take away some from the spontaneity of lovemaking, they are very safe and noninvasive and have no significant side effects. Some men even claim that after a few uses they can attain normal erections without the device.
Vacuum devices don't come cheap, however. Most manufacturers require a prescription, and a good device will cost anywhere from $200 to $400. The cost is often covered by insurance, though. And many urologists are willing to lend vacuum devices on a trial basis.
A word of caution: Do not leave the constriction ring on longer than 30 minutes or you may cause damage. Also, please be aware that the bands used with vacuum devices are not the same as rubber bands purchased from an office supply store; regular rubber bands can cause serious damage to the penis and should never be used.
Injection therapy, which has been used since 1990, involves the self-injection of medication into the shaft of the penis. It produces good quality erections for about 70 to 80 percent of men who have ED. The medications used, including prostaglandin E1, papaverine, and phentolamine, all relax the smooth muscle of the penis, allowing blood to flow into the penis and to not escape.
Injection therapy requires a prescription. A urologist will determine the correct dose and teach you how to inject yourself. Although it sounds scary and painful, most men do not report much discomfort. A very fine needle (the same kind used to give allergy shots) is used, and it is put into an area with very few nerve endings. In some men, however, the medicine itself, not the shot, does cause a burning sensation.
The upside is that the shot produces a very good erection that will last from 30 to 60 minutes, or longer. The erection may last even after ejaculation, and sometimes until the medication wears off, which could be as long as two or three hours.
Injection therapy is less risky than surgery, and the erections look and feel more natural than those produced by a vacuum device, although some men say that the erection produced by injection is also unnatural. But there are downsides, too. First, the thought of putting a needle into the penis may be a turnoff to many men. And, like the vacuum device, injection therapy means interrupting sexual activity and disrupting spontaneity. More troubling downsides include a 7 to 10 percent chance of scarring of the elastic tissue, causing a deformity to the erect penis, and the risk of getting priapism, which is an erection that won't go down. Priapism is more of a risk early in treatment, when the urologist is trying to fine-tune the correct dosage. Any erection that lasts longer than three or four hours requires a trip to the doctor or emergency room to prevent permanent damage to the penis.
Finally, there is the issue of cost. The cost of injection therapy depends on the manufacturer and ranges in price from $10 for each injection to $80 for a three-month supply of injections. Not all insurance plans cover injection therapy.
Though they might not be the preferred option, surgical treatments might succeed where non-invasive treatments have failed. We will discuss these measures in the next section.
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This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.