As with any other problem, before you even consider a treatment protocol, you need to confirm that the issue you are experiencing is a genuine erectile dysfunction (ed). We know that it may be difficult for some men to discuss their erectile problems (also often defined as “male impotence”) with the medical professional, but this is a necessary step to take towards identifying the set of ED treatment options that will be tailored for your own situation.
Sometimes it could be hard to figure out which treatment for erectile dysfunction will end up being the most effective for you. There are many ways you can proceed in treating your condition, some of them requiring surgery and most of them not. The most common nonsurgical treatment options for erectile dysfunction (ed) are:
- External vacuum devices
- Hormonal therapies
- Oral and topical medications
- Penile injection
- Intraurethral pellet therapies
- Sex counseling
If you doctor feels that none of the above mentioned non-surgical ED treatment options will work for you, they may consider and recommend the application of penile prosthesis. In this article we will explore the first few available nonsurgical ED treatment options – external vacuum devices and hormonal therapy.
External Vacuum Devices for ED
First of the options we'll look at in this article are specially designed vacuum devices to produce erections and they have been used successfully as treatment for many years. These devices are safe, relatively inexpensive, reliable and they do not require surgery.
The typical ED vacuum device consists of a plastic cylinder that is placed over the penis, tension rings of various sizes, and a small hand pump. Air is pumped out, causing a partial vacuum, which draws blood into the penis and creates the erection.
Once an erection is obtained, a tension ring, which acts like a tourniquet to keep the blood in the penis and to maintain an erection, is placed around the base of the penis.
Using the correct size of tension ring is critical in obtaining the best possible result from this type of ED treatment. If the ring is too tight, it can be uncomfortable. If too large a ring is used, the erection may not last. As a treatment, the tension ring should not be left in place longer than 30 minutes.
Although these ED treatment devices are generally safe, bruising can occur and the erect penis may lack some support. Other possible side effects include:
- Lower penile temperature
- No or painful ejaculation
- Pulling of scrotal tissue into the cylinder
Many of these side effects can be helped by proper selection of the tension rings and cylinder size, use of adequate lubrication, adequate practice with the device, and proper technique.
Vacuum devices are effective in a majority of men. About half of the men who use an ED vacuum device obtain good or excellent erections with them, but only half of these men consistently use the device over long periods of time.
The most common cause of failure is improper use of, complicated setup options or unfamiliarity with the device. Other drawbacks to the use of vacuum devices include the need to assemble the equipment and the difficulty in transporting it. Many men also lose interest in the device because of:
- Necessary preparations (may need to interrupt foreplay)
- Inability to hide the tension ring
- Relative lack of spontaneity
Although vacuum devices can be operated and used quickly with experience, they still are perceived by many to be less “romantic” than other nonsurgical treatment options.
The second of the ED treatment options could be Yohimbine, an herbal product, which comes from the bark of a West African tree. Its use as a treatment of erectile dysfunction is questionable, and, in studies, yohimbine is only slightly better than placebo (no drug at all).
Nonetheless, yohimbine is considered safe with few known side effects. The usual daily dose is a 5.4-mg tablet taken 3 times a day.
One of the available options could also involve some sort of hormone replacement therapy. Men with low sex drive and erectile dysfunction may have low levels of testosterone (the male hormone). As a general guideline, a testosterone level of 300 ng/dL or less is considered low, but this varies depending on the laboratory that does the testing and the time of day the sample is taken.
Hormone replacement may be beneficial, especially when used in combination with other therapies for erectile dysfunction; however, testosterone supplementation alone is not particularly effective in treating erectile dysfunction (ED).
Sexual desire (libido) and an overall sense of well-being are likely to improve when serum testosterone levels (the level of the male hormone in the blood) are restored.
Replacement testosterone (as part of ED treatment options) is available in the following forms:
- Injections: Injections are a reliable way to restore testosterone levels, but this ED therapy requires periodic injections (usually every 2 weeks) to sustain an effective level. It also causes high hormone levels right after the injection and low hormone levels just before the next shot. This is thought to be slightly more risky than other methods that maintain a moderate hormone level throughout the treatment period.
- Skin patches and gels: Skin patches and gels that are rubbed into the skin deliver a sustained dose and are generally well accepted. One of the options could be a strip that is placed in the mouth on the gums and is also widely available. With the patches and the gels, skin rashes and irritation are the most common problems.
- Injectable pellets (Testopel) are injected under the skin every 4-6 months. Testosterone levels are maintained at an effective level, but the injection can be uncomfortable and cause bruising.
- Oral therapy (pills): This is the least effective ED therapy. Pills are also associated with a small risk of liver problems. Testosterone pills are not recommended.
If your doctor prescribes long-term testosterone replacement as ED therapy, you will have follow-up visits to assess your testosterone levels, to periodically monitor your blood counts, and to undergo regular prostate checks, including digital rectal examinations and prostate specific antigen (PSA) blood tests.