Erectile Dysfunction
What Is ED?
Erectile dysfunction or impotence is the inability to obtain or maintain an erection. ED is the most common sexual dysfunction in men. Over 80% of the causes are physical, and another 10% psychogenic.
Some Major Causes:
- Cardiovascular Disease
- Neurological (prior nerve injuring surgery, radiation, spine trauma, etc.)
- Diabetes
- Alcohol and Substance Abuse
- Low testosterone and other hormonal imbalances
- Obesity
- Medications
- Anxiety
** The causes are numerous, but all ultimately effecting the blood flow by some mechanism. A thorough history, physical examination and laboratory analysis need to be done prior to embarking on a treatment modality. **
Treatment Options
Vacuum Erection Devices (VEDs)
VEDs have traditionally been used prior to intercourse with a penile tourniquet to obtain and maintain the erection. The “penile pump” was the standard prior to oral therapy (PDE5s) and is now having a resurgence as research is supporting the idea of its stimulating growth factor release from platelets and tissue activation in addition to its obvious use as an erection aid. VEDs are now used particularly as an adjuvant to other autologous therapies. These devices can be a simple manual device or a sophisticated electronic one. The method of obtaining vacuum pressure (electronic vs manual) is not as important as the pressure itself. A well made comfortable device is what is important rather than frills and cost.
Penile Shockwave Therapy
Whether known by generic terms such as extracorporeal shockwave therapy (ECST), low intensity shockwave therapy (LiST), or various trademarked names - Gainswave, Stemwave, Corewave and others- it is all the same procedure. This procedure is utilizing a machine to transmit a pulsed shockwave to the penis. First utilized to treat sports injuries it has been adapted to treat erectile dysfunction that is from vascular issues. The body has a remarkable ability to heal itself if the body's healing modalities such as stem cells, growth factors and various tissue activators are mobilized. Causing micro trauma to an area activates the body's healing factors resulting in opening of blood vessels and growth of new blood vessels among other repair mechanisms.
P-Shot (PRP)
Platelet Rich Plasma injection of the penis or trade name P-Shot is the injection of your own platelet rich plasma into your penis to promote the regeneration of penile blood vessels and tissue. First used in athletic injuries the injection of high concentration of autologous platelets was found to promote healing through release of their growth factors and tissue activation factors stimulating the body's stem cells and regeneration mechanisms. Your blood is drawn prior to the procedure, centrifuged to obtain the PRP from your blood and then injected back into your penis in the concentrated form.
Oral ED Medications
These are the medications(PDE5s) that most are familiar as ED treatments. Viagra, Cialis, Leventra, and Stendra all belong to a family of drugs called PDE5s that enhance the body's ability to have and maintain an erection by inhibiting certain enzymes that allow nitric oxide to enhance blood vessel effects. They will not cause an erection, but do enhance the body's ability to have an erection when stimulated. Most men tolerate these medications but there are some side effects for certain individuals: Headaches, Lower blood pressure, Dizziness, Sinus Congestion/ Stuffy Nose, Heartburn, Skin Flushing/Redness, Blue Vision (Viagra), Muscle Cramps (Cialis), Priapism (extremely rare)
Penile Injection Therapy
Most men will respond to intracavernosal injections of either a single drug or a combination of drugs. Commonly known as “Trimix” for the three drug combination. How is it done? The patient is trained in self administration of the medication. The medication is injected through a small gauge needle into the penis 5-10 minutes prior to intercourse and the erection will be maintained usually for 20 minutes to 2 hours. Side effects may include bruising, bleeding, rarely infections, prolonged erection (priapism) requiring medical intervention, scarring and curvature of penis.
Penile Prosthesis
The final solution if all else fails. Penile implants have evolved to greater than a 90% satisfaction from the early days. Usually requiring only an overnight stay and sometimes only day surgery, the main risk is infection reported to be 1-3%. Though CMH does not offer this treatment we can assist in referral if needed.
Shockwave Therapy FAQs
What are the benefits of shockwave therapy?
Better overall blood flow to the penis
Stronger, firmer erections
Increased sensitivity in the penis
Easier to achieve and maintain erections (i.e., improved sexual stamina)
Improvement in or the resolution of penile curvature & pain from Peyronie’s Disease
Resolution of penile pain with erection
Greater self-esteem
Is shockwave therapy painful and how long does the procedure take?
A numbing cream is applied to the genitals prior to the procedure and most men report no discomfort and those that do say it is only minor. Each treatment lasts less than 30 minutes.
How many treatments will I need and how often?
That depends on the severity of the erectile dysfunction. but between 3 to 12 treatments in most cases. Treatments are once or twice a week. Enhancements are about every 18 - 24 months involving usually 1 or 2 treatments.
What are the potential complications?
Minor bruising, swelling, or very rare infection. Blood thinner medications such as Plavix, Xarelto, or Coumadin are contraindications to this treatment.
When may I return to normal activity?
You may return to normal physical activity immediately and sex in 4 hours of treatment.
Will I need any additional therapy?
A vacuum erection device is strongly recommended for use twice a day in conjunction with the shockwave therapy for several weeks to augment results.
P-Shot FAQs
What are the benefits to a P-Shot?
Better overall blood flow to the penis
Stronger, firmer erections
Increased sensitivity in the penis
Easier to achieve and maintain erections (i.e., improved sexual stamina)
Improvement in or resolution of penile curvature & pain from Peyronie’s Disease
Resolution of penile pain with erection
Greater self-esteem
Is the P-Shot painful and how long does the procedure take?
No pain or minimal discomfort as a numbing cream and if needed an anesthetic block of the penis is done prior to the P-Shot. We schedule 60 minutes for the procedure as your blood has to be drawn and centrifuged prior to the injection.
How many treatments will I need and how often?
A P-shot is a single session treatment but as it is an autologous treatment it is complimented by or with shockwave
therapy and a vacuum erection device. Enhancements can be considered every 18-24 months.
What are the potential complications?
As your own blood products are being used there is only the risk of minor bruising or bleeding, swelling and very rarely infection.
When may I return to normal activity?
You may resume normal physical activity immediately and sex after 4 hours the same day.
Will I need any additional therapy?
A vacuum erection device is recommended to be used twice a day for several weeks to optimize the P-shot. It is also encouraged that the P-shot be utilized in conjunction with 1-3 preceding shockwave treatments or at the end of the course of shockwave treatments if already receiving shockwave therapy. Enhancements can be considered every 18-24 months.