The humiliation and sense of loss that comes with sexual dysfunction often prevents disclosure of symptoms and inquiry regarding treatment. I will outline the various causes of erectile dysfunction (ED) and treatments available for ED including current medications (Viagra, Levetra, and Cialis),  penile injection, urethral suppository, vacuum pump, and penile implants.  Let us not forget one of the most important and often disregarded forms of treatment: psychotherapy.

ED is defined as a persist inability in attain and maintain an erection sufficient for sexual activity. It has many causes including psychological (anxiety, depression, trauma), behavioral (drug use, smoking, obesity), and physiological (medication, prostate surgery, injury, aging). There are also several different treatments for this sexual dysfunction. Choosing the right form of treatment may be intimidating for a person. It is always good to consult with a professional when trying to address this problem. A urologist can discuss the medical treatments and a psychologist can assist with the personal and relational conflicts that may be associated with ED.

There are some easy fixes for ED. If the condition is caused by something like medication, obesity, or excessive alcohol use, the solution is simple: change the medication and change your behavior. For men who can achieve an erection, but have difficulty maintaining it, the use of a penis ring (also referred to as cock ring) may alleviate the problem. This mechanism is placed at the base of a flaccid penis. After arousal, it slows the flow of blood out of an erect penis, resulting in maintaining an erection. Kegel exercises could be included in a treatment regimen for ED also. This exercise supports sexual health by strengthening the pelvic floor muscles and encouraging blood flow to the genitals.

See  https://www.mayoclinic.com/health/kegel-exercises-for-men/MY01402 for instructions on how to do them correctly. There are also masturbatory exercises that  may improve body awareness.

Advances in technology and medicine have increased the options for men living with erectile dysfunction. As a result of advertising, most people are aware of the pharmaceutical options available to treat ED. Viagra class medications work by increasing the responsiveness of the erectile tissue to nitric oxide, the neurotransmitter that is chiefly responsible for penile erection. (Levy and Baldwin, 2012) While these drugs are easily accessed and convenient, they come with risk. If combined with certain other drugs they can be life threatening.

Erectile injections and suppositories are the treatment of choice when penile nerves have been damaged by prostate surgery.  Injections produce an erection by injecting a hormone (alprostadil) directly into the penis tissue.  The alprostadil suppository is a soft pellet that is inserted directly into the urethra. These methods work by opening up the blood vessels and allowing blood to flow into the penis.  Some men may not find these treatments appealing because of the potential for pain or discomfort.   There are also other limitations such as the number of days per week they can be used and health problems that prohibit the use of these methods.

The penis pump is a cylinder that fits over the penis and creates a vacuum around the penis. They can be operated manually or electrically. The vacuum created by the pump draws blood into the shaft and is trapped by a penis ring to maintain an erection. If a pump is used incorrectly it can damage penile tissue. Some other drawbacks to this method of treatment include inconvenience, limited rigidity, and discomfort.

Surgical options are often the treatment of choice when medical treatment is unsuccessful. That is, of course, if you can afford it. Often the procedure  is cost prohibitive. Some insurance companies such as Medicare or Tricare may cover the expense (or some of it) if the procedure meets “medical necessity”.  This is likely to vary from company to company.

First generation penile prosthetics/implants were hard to live with  (pun intended), because of the fact that they gave a man a permanent erection. This method uses a semi-rigid plastic rod that keeps the penis permanently stiff enough for intercourse. (Levy and Baldwin, 2012) This semi-rigid implant would need to be bent down after intercourse to conceal it’s presence. This doesn’t sound like a pleasant option, and may lead to more humiliation about ED.

Another option is the three piece inflatable implant. The implant is made of a pair of cylinders that are placed in the erection chamber, a pump is placed in the scrotum, and a fluid filled reservoir is placed in the abdomen (in a space next to the bladder). The surgical procedure is described by Dr.  Drogo Montague in this Youtube video (https://www.youtube.com/watch?v=7EVVzUI8s2U). So far the reviews of this product have been positive. While there has been some complaints about problems with deflation, many men boast about feeling like they are in their twenties again. I don’t know if I will take it that far, however, I can imagine that this method of treatment would be preferred over the pump or penile injection, which often times ruins the mood. Keep in mind, these surgical procedures are not reversible.

Psychological treatments should be considered as an adjunct to the aforementioned treatments. If there is not some clear medical cause of ED, a therapist may be helpful in identifying sources of anxiety,depression, and trauma that may affect symptoms. Even if there is a clear medical correlate, psychotherapy can assist a person in making life altering changes and coping with an experience of loss which often accompanies ED. Whatever the cause and course of treatment erectile dysfunction is not a death sentence, you can still achieve sexual satisfaction.