Impotence (ED) (cont.)
Dennis Lee, MD
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Siamak T. Nabili, MD, MPH
Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- What is erectile dysfunction?
- How common is erectile dysfunction?
- What is normal penis anatomy?
- How does erection occur?
- How is erection sustained?
- What are some of the risk factors for erectile dysfunction?
- What are the causes of erectile dysfunction?
- How is erectile dysfunction diagnosed?
- What are the treatments for erectile dysfunction?
- What medications are used to treat erectile dysfunction?
- Oral phosphodiesterase type 5 (PDE5) inhibitors
- Sildenafil (Viagra)
- Vardenafil (Levitra)
- Tadalafil (Cialis)
- Intracavernosal injections
- Intraurethral suppositories
- How effective is testosterone in treating erectile dysfunction?
- Can low testosterone level be replaced?
- Vacuum devices
- Surgery for erectile dysfunction
- What will the future bring for erectile dysfunction?
- Erectile Dysfunction At A Glance
- Impotence (Erectile Dysfunction, ED) FAQs
- Find a local Urologist in your town
What are vacuum devices?
Mechanical vacuum devices cause an erection by creating a vacuum around the penis that draws blood into the penis, engorging it, and expanding it. The devices have three components:
- a plastic cylinder, in which the penis is placed;
- a pump, which draws air out of the cylinder;
- an elastic band, which is placed around the base of the penis, to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back into the body (see figure 2).
One variation of the vacuum device involves a semi-rigid rubber sheath that is placed on the penis and remains there after attaining erection and during intercourse.
Surgery for erectile dysfunction
Surgery for erectile dysfunction may have as its goal:
- to implant a device that causes the penis to become erect;
- to reconstruct arteries in order to increase the flow of blood to the penis;
- to block veins that drain blood from the penis.
Implantable devices, known as prostheses, can cause erections in many men with impotence.
Malleable implants usually consist of paired rods, which are inserted surgically into the corpora cavernosa, the twin chambers running the length of the penis. The user manually adjusts the position of the penis and, therefore, the rods. Adjustment does not affect the width or length of the penis.
Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid (see figure 3). Tubes connect the cylinders to a fluid reservoir and pump, which also are surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis somewhat. They also leave the penis in a more natural state when not inflated.
Possible problems with prostheses include mechanical breakdown and infection. Mechanical problems have diminished in recent years because of technological advances.
Surgery to repair arteries (penile arterial reconstructive surgery) can reduce impotence caused by obstructions that block the flow of blood to the penis. The best candidates for such surgery are young men with discrete blockage of an artery because of a physical injury to the pubic area or a fracture of the pelvis. The procedure is less successful in older men with widespread blockage of arteries.
What about psychological therapy?
Experts often treat psychologically based impotence using techniques that decrease anxiety associated with intercourse. The patient's partner can help apply the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when physical impotence is being treated. If these simple behavioral methods at home are ineffective, referral to a sex counselor may be advised.
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