Erectile Dysfunction (ED)

Erectile Dysfunction (ED) is the consistent inability to sustain an erection sufficient for sexual intercourse. This includes problems with getting an erection, difficulty having an erection hard enough to penetrate, and/or losing an erection sooner than desired. ED can show possible heart disease or other vascular problems in the future.

At least 30 million men in the U.S., generally aged 45 to 75, suffer from ED and often do not seek treatment. At your appointments, we encourage frank conversation to help you achieve better health.

Most ED is caused by an identifiable issue, such as:

  • Aging
  • Diabetes, heart disease, or another disease
  • Injuries to the spinal cord or pelvis
  • Prostate cancer treatment, or other exposure to radiation
  • Prostate removal
  • Substance abuse
  • Use of certain medications

Treatment of ED

ED is often first treated with oral medications. Most physicians or providers can prescribe the medication. When these medications fail, you can request a referral to urology. Most urologists are comfortable treating ED, and some are experts.

Other treatment options include:

Injection therapies

A syringe containing a small dose of medication is used to inject the medication into the side of your penis at the base. The medication increases blood flow, thus creating an erection.

The erection should happen within 15 to 20 minutes and can last 30 to 120 minutes. These medications are generally not covered by insurance but are cheap. These medications also do not work for everybody. Injection therapy usually requires teaching to be most effective.

Risks include:

  • Bleeding/bruising
  • Penile pain
  • Prolonged erection greater than 4 hours
  • Rarely penile curvature

Intraurethral suppositories

An applicator containing a small pellet of medication is inserted into your urethra. The pellet is released and the applicator is removed.

The medication in this pellet is more powerful than oral drugs, but needs to act locally and cannot be taken by mouth. The pellet dissolves and increases blood flow, thus creating an erection.

The advantage is that this is a safe and easy method with low risks. Disadvantages include penile pain. These medications do not work for everybody.

Penile prostheses

A penile prosthesis is a device that we implant via surgery to give you reliable erections on demand. There are many device options available depending on your needs.

These devices have the highest satisfaction of all treatments for erectile dysfunction.

But, surgery is not without risk. A thorough conversation is important before proceeding with surgery. Good questions to ask before surgery include:

  • How experienced is my surgeon?
  • How will this device work?
  • What are the potential complications?
  • How will my penis be different after surgery?

Penile prosthesis placement is an option for most patients with ED and is a definitive solution to the problem.

Vacuum erection devices

You place your penis in a vacuum tube and suck out the air via hand crank or motor. Blood is drawn into the penis as a result. You then place a ring at the base of your penis to keep the blood there. These devices are cheap and generally very reliable.

The advantage is that this is a safe and easy method with low risks and no medications.

Disadvantages include:

  • Bruising
  • Cold erection
  • Pain with ejaculation
  • Poor quality erection

What can I expect at my consultation visit to discuss ED?

Do not be afraid to talk and speak your mind about ED at your visit. It is normal to feel frustrated, anxious, disappointed, and embarrassed by ED.

We have treated many patients for sexual dysfunction issues. We find that the more frank our conversation, the better the outcomes. We will ask you questions about your ED history and health, and we will examine you.

Then, we will discuss your options and review next steps. Please feel free to ask questions to make sure you understand your treatment options.

We recommend that you bring your sexual partner with you so that they can ask questions as well.

We'll work very hard to ease your worries by providing a friendly and informative visit.

Learn more

Page reviewed on: Jan 30, 2020

Page reviewed by: Martin Gross, MD