Erectile dysfunction (ED), commonly known as “impotence,” is defined by the National Institute of Health as: “Inability of the male to attain and maintain erection of the penis to permit satisfactory sexual intercourse.” In other words, ED is the difficulty for a man to get and keep a firm penis for sexual activity.
This problem affects men of all ages, but as men get older, there is a greater chance of developing erection problems. Population studies show that nearly 20% of men over age 20 and about 50% of men over the age of 50 have ED.
What Causes Erectile Dysfunction?
The primary cause of ED is poor circulation to the penis. Just as poor circulation to the heart may result in a heart attack, so too in ED, the penis often suffers from lack of adequate circulation which results in poor erections.
Sexual dysfunction is known to be related to:
- High Blood Pressure
- High cholesterol
- Cardiovascular disease such as previous heart attacks or strokes
Since the penis arteries are very small, they tend to become diseased prior to the larger coronary (heart) or carotid (neck) arteries. Thus, erectile dysfunction is yet another sign of vascular disease predating heart attacks and strokes. In other words, patients who develop ED, are at higher risk of having a heart attack or a stroke in the future.
We recommend that ALL of our patients with ED get a heart and stroke screening checkup with their primary doctor.
Less common causes of ED include:
- Low testosterone (male hormone) levels
- Peyronie’s Disease (penile curvature and plaque formation)
- Neurological diseases – like neuropathy, multiple sclerosis, spinal cord injury
- Drug Side Effects – most commonly implicated drugs are blood pressure medications (which may cause ED simply by doing what they are intended to do-lower blood pressure) and antidepressants, due to their neurological effects
- Psychogenic – only 10% of cases are related to a psychological problems like anxiety, post traumatic stress disorder, depression, stress, relationship problems
Cancer and cancer treatments that involve the pelvic area including colon cancer surgery, prostate cancer surgery or radiation treatments may cause neurological as well as vascular damage which may lead to sexual dysfunction as well.
Evaluation of a Man Presenting with ED
The evaluation of a man who presents to our office includes an open, honest and absolutely confidential discussion about the current sexual function and overall medical health. A thorough physical exam and generalized, as well as specialized, bloodwork are often done. We also offer patients blood circulation studies of the penis to further delineate the cause of ED.
Treatments of Erectile Dysfunction
At Broward Urology Center, we focus on a goal-oriented approach to erectile dysfunction treatment. The treatment options for ED include:
The Priapus Shot Or P-Shot® PRP (Platelet Rich Plasma) Penile Injection
PRP is an injection of your own body’s platelet growth factors to stimulate cellular regeneration and tissue repair of the penis. Learn More about the P-Shot®
Low Intensity Shockwave Therapy (LiST)
Low intensity shockwave therapy(LiST) is a groundbreaking “drug and surgery-free” procedure that uses acoustic waves to stimulate a cascade of biological actions that lead to the healing and regeneration of the sexual organs. Simply…LiST helps your body heal itself! Learn more about Low Intensity Shockwave Therapy.
Oral Medications for ED
Oral medications for ED are called PDE-5 inhibitors. The drugs in this class include medications like Viagra, Levitra, Cialis, Stendra and more. This class of drugs is considered first line therapy for those men presenting with ED. Learn More About Oral Medications for ED.
Penile Injection Therapy
Penile injection therapy involves an injection of a medication into the shaft of the penis on an as needed basis to produce a rapid erection. It is commonly used by patients who have failed oral medications. Learn more about this very effective treatment.
Urethral Pellet Therapy
The same medicine used for penile injection may be used as a very small suppository placed into the tip of the penis to provoke an erection.
Vacuum Erectile Device (VED)
A safe and non-drug treatment in which a cylinder-shaped device is placed on the penis and with the magic of negative pressure, the device pulls the blood in to the shaft of the penis to produce an erection.
Penile Implant (Penile Prosthesis)
A surgical procedure that involves the placement of a balloons inside the shaft of the penis that a patient is able to manually pump the device to inflate and get an erection. The erection lasts as long as needed and with a simple push of a button, the penis is once again soft. Learn more about the implant option by clicking here.
ED is rarely caused by severe pelvic trauma from major accidents in younger patients. Revascularization is an operation to bring new or additional blood vessels to the penis to improve the circulation that may have been severed by the initial trauma. This is a very rare type of treatment and is not recommended for the typical patient.
After identification of a psychogenic source for ED, we will refer patients to a therapist with expertise in treating sexual dysfunction. We often recommend low dose medications for ED in conjunction with the therapist’s recommendations.
Herbal and Over-The-Counter (OTC) Supplements
There are various over the counter supplements and herbs that promise to enhance erections. One thing that has been proven time and time again is that because these substances are not regulated, there is no way to guarantee that the supplement contains the correct herb or is in a safe and correct dose. Multiple studies examining ED supplements show that the majority of them are laced with pharmaceutical ED medications like Viagra, at times in doses that are not safe to the public. Broward Urology Center does not promote any herbal or OTC ED supplementation at this time.