Treating Male Erectile Disorder

Of all the sexual dysfunctions, there are more treatment options for male erectile disor­der than for any other sexual dysfunction. A tremendous amount of research has been dedicated to finding causes and treatment options for ED. Depending on the cause, treat­ment for ED includes psychological treatment, pharmacological treatment (drugs), hor­monal and intracavernous injections, vascular surgery, vacuum constriction devices, and prosthesis implantation (Dinsmore, 2005; Fink et al., 2002). The success rate for treating male erectile disorder (ED) ranges from 50% to 80% (Lue, 2000). Research has found that 3 years after treatment, men show significant improvement in the ability to maintain erections during stimulation and in duration of foreplay (DeAmicis et al., 1985).

Psychological Treatment The primary psychological treatments for ED include systematic desensitization and sex therapy that includes education, sensate focus, and communication training (Heiman, 2002). These treatments can help reduce feelings of anxiety and can evaluate issues that are interfering with erectile response. Relationship therapy can also help explore issues in a relationship that might contribute to erectile dysfunction, such as unresolved anger, bitterness, or guilt.

Pharmacological Treatment In 1998 the FDA approved the use of Viagra (sildenafil citrate), the first oral medication for ED (Fink et al., 2002). Viagra can be used in a vari­ety of ED cases—those that are psychogenic (sike-oh-JEN-nick), illness-related, or those that have physical causes (Heiman, 2002). Two newer drugs, Cialis and Levitra, which are similar to Viagra, were recently approved by the FDA.

All of these drugs produce muscle relaxation in the penis, dilation of the arteries supplying the penis, and an inflow of blood—which can lead to penile erection. They do not increase a man’s sexual desire and will not produce an erection without adequate sexual stimulation. Typically, a man must take Viagra about 1 hour before he desires an erection, and Cialis and Levitra often work within 15 to 30 minutes. Erections can last up to 4 hours, although Cialis can aid in erections for up to 36 hours.

There are several side effects with these medications, including headaches, a flush­ing in the cheeks and neck, nasal congestion, indigestion, and vision changes. In 2005, the FDA called for revised labeling of all erectile drugs, outlining possible vision side ef­fects (Kaufman, 2005). Users of erectile drugs have an increased risk of vision problems, including changes in color vision and possible total vision loss. These vision problems are due to a blockage of blood flow to the optic nerve. Cialis users also may experience an increase in back pain, which will go away within 48 hours of using the drug. Critics of pharmacological treatment for ED point out that drug use focuses solely on an erec­tion and fails to take into account the multidimensional nature of male sexuality (B. W. McCarthy & Fucito, 2005).

Yohimbine, a substance that is produced in the bark of African yohimbe trees, has been found to improve erections and is most successful in cases with nonphysical causes (Ernst & Pittler, 1998). It works by stimulating the parasympathetic nervous system, which is linked to erectile functioning. Side effects include dizziness, nervousness, irri­tability, and an increased heart rate and blood pressure.

Hormonal Treatments Hormonal treatment may help improve erections in men who have hormonal irregularities (such as too much prolactin or too little gonadal hor­mones; Lue, 2000). Excessive prolactin can interfere with adequate secretion of testos­terone and can cause erectile dysfunction. A man with low testosterone levels can be prescribed testosterone therapy either through injections, patches, gels, or creams. These therapies will not improve erectile functioning in a man with normal hormone levels.

A testosterone patch is applied directly to the scrotum, whereas gels and creams can be applied to other parts of the body such as the arms or stomach. AndroGel, a clear, colorless, odorless gel, was approved by the FDA in 2000 for the treatment of low testos­terone (Morley & Perry, 2000). It is applied daily and is absorbed into the skin. Some men prefer this type of application over a painful injection or patch. Side effects are rare but include headaches, acne, depression, gynecomastia, and hypertension. None of these testosterone preparations should be used by men with prostate cancer because they can exacerbate this condition.

Intracavernous Injections Intracavernous (in-truh-CAV-er-nuss) injections are a

relatively new development in the treatment of ED (Lue, 2000). Men and their partners are taught to self-inject these preparations directly into the corpora cavernosa (see Chapter 5) while the penis is gently stretched out. The injections cause the blood ves­sels to relax and as a result, blood flow to the penis is increased. The majority of patients report very minor pain from these injections. However, each time a man desires an erec­tion, he must use this injection. The higher the dosage of medication, the longer the erection will last.

Priapism, a possible side effect of treatment, occurs in 4% to 8% of men who use these injections. Other side effects are more related to the injection than to the drug it­self and may include pain, bleeding, and/or bruising (Israilov et al., 2002). Another treatment method that works to increase blood flow to the penis involves the insertion of prostaglandin pellets directly into the opening of the penis. The prostaglandin is then absorbed by the penis and works similar to intracavernous injections. Typically an erec­tion will occur within 20 minutes and will last for an hour and a half.

Vacuum Constriction Devices Vacuum constriction devices, which use suction to induce erections, have become more popular in the last several years, in part because they are less invasive and safer than injections. One such device, the ErecAid System, involves putting the flaccid penis into a vacuum cylinder and pumping it to draw blood into the corpora cavernosa (similar to the one Austin Powers was caught with in International Man of Mystery). To keep the blood in the penis, a constriction ring is rolled onto the base of the penis after it is removed from the vacuum device. This ring is left on the penis until the erection is no longer desired. When it is removed, the man will lose his erection. Side effects include possible bruising and, in rare cases, testicular en­trapment in the vacuum chamber (Lue, 2000). Overall, these devices can be expensive, bulky and noisy, and they reduce spontaneity, which some couples find unappealing.

Surgical Treatments Surgical intervention has increased as a treatment for erectile dysfunction. In some cases, physicians perform revascularization to improve erectile functioning; in other cases, prosthesis (pross-THEE-sis) implantation may be recommended. Acrylic implants for erectile dysfunction were first used in 1952, but they were replaced by silicone rubber in the 1960s and then by a variety of synthetic materials in the 1970s. Today there are two main types of implants: semirigid rods, which provide a permanent state of erection but can be bent up and down; and inflat­able devices that become firm when the man pumps them up (J. McCarthy & McMillan, 1990). Sexual intercourse may safely be engaged in 4 to 8 weeks after

Vacuum constriction devices, such as the ErecAid, are often used in the treatment of ED. A man places his penis in the cylinder and vacuum suction increases blood flow to the penis.

surgery. After prosthesis implantation, a man is still able to orgasm, ejaculate, and im­pregnate (J. McCarthy & McMillan, 1990).

Sexual satisfaction after a prosthesis implantation has been found to be related to several factors, such as a man’s relationship with his partner and feelings about his own masculinity (Kempeneers et al., 2004). Between 10% and 20% of patients remain dis­satisfied, dysfunctional, or sexually inactive even after prosthetic surgery (J. McCarthy & McMillan, 1990). In some cases, if a man has psychological factors that contribute to his erectile difficulties, these issues are likely to resurface once a prosthesis is implanted.

Question: A couple of guys I know have some Viagra, and they have been trying to get me to take it. Is it safe to use this drug if you don’t have ED?

Although Viagra was first marketed to older men, today it is being marketed to younger men. It is estimated that the fastest growing group of users are between the ages of 18 and 45 (Delate et al., 2004). Even so, Viagra’s manufacturer, Pfizer, does not suggest the use of this drug just for kicks. All Viagra users should undergo a clinical evaluation with a physician to evalu­ate their erectile condition and past medical history. Truth be told, however, it’s fairly easy to get Viagra without a prescription these days, and more and more college students are reporting they have tried Viagra as a "recreational" drug. In 1999, Ben Affleck spoke up about his recreational use of Viagra and said that he was told it would make you feel "like you were 14 and jerking off six times a day" (Keller, 1999). Even so, Affleck told Playboy Magazine that he suffered serious side effects after using Viagra including an in­creased heart rate, dizziness, and uncontrollable sweating.