Erectile Dysfunction - More Information

What is Erectile Dysfunction?

Erectile dysfunction (ED) is the inability to achieve or sustain an erection satisfactory for intercourse. Over half of men over the age of 40 and more than 75% of men over 75 have some form of ED. Nearly every one of these men can be successfully treated!

Erectile Dysfunction can be:

• A total inability to achieve an erection
• An inconsistent ability to achieve an erection
• A tendency to sustain only brief erections
  

What Causes ED?

As a result of recent medical research, it is now known that more than 80% of men suffering from ED can trace its origin to a physical problem or disorder.

For most men, the cause of E.D. can now be fairly easily identified. Once identified, proper treatment can be recommended to help return them to a satisfying sex life.

E.D. can be caused by physical disorders such as:

• An injury (i.e. brain or spinal cord)
• A disease (i.e. diabetes, high blood pressure, or high cholesterol)
• An operation (i.e. prostate gland removal)
• Substance use (i.e. tobacco, drugs, alcohol or medications)

Other facts about Erectile Dysfunction

• Approximately 30 million American men suffer from erectile dysfunction
• Most men with erectile dysfunction still have the ability to have an orgasm and father a child, but often have difficulty doing these things because they can’t get or sustain an erection.
• Erectile dysfunction is not normal, and is by no means an inevitable consequence of aging

Risk Factors for ED

As you get older, erections may take longer to develop and may not be as firm. You may need more direct touch to your penis to get and keep an erection. This isn't a direct consequence of getting older. Usually it's a result of underlying health problems or taking medications.

Poor physical and emotional health can contribute to ED. ED is associated with conditions such as diabetes, hypertension, high cholesterol and prostate disease.

The more conditions that affect a man, the higher his risk of ED. Age is also a factor. ED is more likely to occur as men get older, particularly after age 60.

ED Facts

Consider the following ED risk-factors facts:

• 39% of men 40 years old have some degree of ED
• 67% of men 70 years old and up suffer from ED
• ED can happen at any age, even after years of satisfying sex.
• Age itself doesn't cause ED
• Certain health issues, such as vascular diseases and diabetes, contribute to ED.
  

Risk Factors

A variety of risk factors can contribute to erectile dysfunction:

• Medical conditions, particularly diabetes or heart problems
• Using tobacco, which restricts blood flow to veins and arteries. Over time tobacco use can cause chronic health problems that lead to erectile dysfunction
• Being overweight, especially if you're very overweight (obese)
• Certain medical treatments, such as prostate surgery or radiation treatment for cancer
• Injuries, particularly if they damage the nerves that control erections
• Medications, including antidepressants, antihistamines and medications to treat high blood pressure, pain or prostate cancer
• Psychological conditions, such as stress, anxiety or depression
• Drug and alcohol use, especially if you're a long-term drug user or heavy drinker.

Diagnosing ED

What to Expect

Men are frequently reluctant to discuss their sexual problems, particularly erectile dysfunction or ED, and often need to be specifically asked. Opening a dialogue with Dr. Cornell allows him to begin the ED evaluation process.

Diagnosing ED focuses on identifying the underlying cause. This process typically begins with Dr. Cornell conducting an interview, followed by a physical examination, and possibly laboratory testing.

Patient History

Determining whether a person suffers from ED rather than other sexual problems is an essential first step. Finding the cause begins by obtaining a medical, sexual and psychological history. These questions can be helpful in determining the severity of ED and revealing possible medical conditions or diseases that may be causing, or merely complicating, a man's ED.

Typical patient history questions include:

• Do you have difficulty obtaining an erection?
• How long have you been suffering with ED?
• Are your erections suitable for penetration?
• Do you still have morning erections?
• Can your erection be maintained until your partner has achieved orgasm?
• What are your current medications?
• What types of surgery have you had?
• Do you have a history of trauma, prior prostate surgery, radiation therapy?
• Do you use tobacco, alcohol, caffeine, or illicit drugs?
• Do you have diminished sexual desire? If so, do you think it is a reaction to poor sexual performance?
• Do you suffer from depression?
• Do you have problems with your sexual relationship?
• Are you experiencing insomnia, lethargy, moodiness, nervousness, anxiety, or stress at work or at home?
• Is penile curvature (Peyronie's disease) a problem?
• Have you already tried any treatments for erectile dysfunction? If so, what were they and how did they work for you? Were there any problems or side effects to their use?
• Are you interested in trying a particular treatment first? Are you against trying any particular type of therapy? If so, what caused you to make this judgment?

Physical Examination

A physical examination is necessary. During this examination, Dr. Cornell will pay particular attention to the genitals as well as the nervous, vascular, and urinary systems. Your blood pressure will be checked because several studies have demonstrated a connection between high blood pressure and erectile dysfunction.

The physical examination may help reveal unsuspected disorders, such as diabetes, vascular disease, penile plaques (scar tissue or firm lumps under the skin of the penis), testicular problems, low male hormone production, injury or disease to the nerves of the penis, and various prostate disorders.

Laboratory Testing

Laboratory testing is needed for some men.

Tests such as these may be performed:

Testosterone Level:

• Blood tests for testosterone should ideally be taken early in the morning because that is when levels are usually at their highest
• Blood may also be tested for other hormones that can affect sexual function (eg, luteinizing hormone, prolactin)
• Your blood may be checked for glucose (sugar), cholesterol, thyroid function, triglycerides, and prostate specific antigen (PSA)
• A urinalysis looking for blood cells, protein, and glucose (sugar) may also be done
  

Self-Assessment

Patients can take the ED self-assessment by clicking here.

Treatment Options

Doctors today can successfully treat almost every case of erectile dysfunction (ED). Management of ED depends on the cause of the disorder. Treatment options have improved over the past few years and new research and medications continue to increase treatment choices.

Treatment options depend on a the following factors:

• Whether the cause of a patient's ED is physical, psychological or both
• The presence of other medical conditions
• The possibility of interaction with other medications
• Which option is most likely to be effective for a particular patient
• The preferences of the man and his partner
  

The first stage of treatment addresses controllable risk factors:

• Smoking
• Obesity
• Alcohol abuse
• Stress
• Fatigue
• Depression
• Adjustment of prescription medications

Most patients with ED will need an additional form of treatment including:

• Counseling and education
• Oral medications
• Injection therapy
• Vacuum devices
• Surgical treatments
  

Talking with Your Doctor

The first step in getting treatment for ED is for you to discuss the situation with your physician. He or she will take a careful medical history as an important first step in the treatment of ED. This is generally followed by a physical exam which may include assessment of your vascular system, thyroid gland, nervous system, prostate and genitals.

Treatment Options

When treating ED, there are many options to choose from. Depending on the cause and nature of the problem, your physician may prescribe or refer you to other specialists for the following types of treatments:

• Treatments for Psychological Causes
• Lifestyle and Medication Changes
• Treatments for Low-T
• Drug Therapy
• Vacuum Erection Devices
• Injection Therapy
• Surgical Treatments: Penile Implants

Treatments for Psychological Causes

To treat a psychological cause a doctor may recommend treatment from a qualified psychologist, psychiatrist, sex therapist or marriage counselor. Counseling can often resolve any psychological problems causing ED. Men and their partners may wish to go through counseling together. Even if the problem is physical, there may be psychological side effects. Therefore, counseling may also be part of the recommended treatment for a physical problem.

Lifestyle Changes

Recommendations for lifestyle changes may include:

Reducing fat and cholesterol in your diet
Decreasing or limiting alcohol consumption
Eliminating tobacco use and substance abuse
Losing weight, if appropriate
Getting regular exercise
Your doctor may recommend a change to your medications if you currently are taking prescription drugs which may cause ED.

Medical Treatment for ED

There are a wide range of non-invasive treatment options for men experiencing Erectile Dysfunction.

Dr. Cornell will help you to decide which options are right for you ased on your specific needs.

Non-invasive treatment options include:

• Oral Medications
  Self Injection
  Vacuum Erection Devices
  

Oral Medications

When a man is sexually aroused, the arteries in the penis relax and widen, allowing for more blood to flow into the penis. As arteries in the penis expand, the veins that normally carry blood away from the penis become compressed, restricting blood flow out of the penis. With more blood flowing in and less flowing out, the penis enlarges, resulting in erection.

When a man is sexually aroused, the arteries in the penis relax and widen, allowing for more blood to flow into the penis. As arteries in the penis expand, the veins that normally carry blood away from the penis become compressed, restricting blood flow out of the penis. With more blood flowing in and less flowing out, the penis enlarges, resulting in erection.

First-line, non-invasive treatments for ED include oral medications. These medications, known as PDE-5 inhibitors, improve blood flow to the penis by working directly on the blood vessels. They allow the arteries to expand, which could produce an erection.

Several medications are available which can promote and help sustain a natural erection. These medication include:

• Viagra
• Levitra
• Cialis
  

Viagra, Levitra, and Cialis all act similarly to prolong and enhance the body’s natural potency mechanism. They differ largely in their duration of action and side effect profile. The appropriateness of these medications for each patient is determined by a review of one’s medical history and medication requirements.

Pills are generally taken about an hour to several hours before planned sexual activity, and must be combined with sexual stimulation to provide an erection. While widely talked about and available today, drug treatments do not work for 20 to 30 percent of men.

Self-Injection

Self-Injection is a good option for many men with erectile dysfuntion (ED). Self-injection involves using a small needle to inject medication directly into the erectile tissue of the penis, producing an erection that lasts from 30 minutes to a few hours.

The patient or his partner uses a needle to inject medication directly into the base of the penis. The relaxation of muscle tissue allows blood to flow into the penis, creating an erection. Because this therapy can sometimes be uncomfortable, many men discontinue use within the first year.

These drugs have been shown to produce erection in 80% of men who inject them. The injections are relatively painless and create an erection that begins about 5 to 15 minutes after the injection. It is recommended that self-injection be performed no more than once every 4 to 7 days.

Before therapy is prescribed, each patient receives a penile doppler ultrasound quantifying his degree of vasculogenic erectile dysfunction and specific teaching of proper injection dosage and technique.

Notes About Self-injection

Self-injection pateients should be aware of the following:

• You may feel mild burning during injection. If you feel pressure or severe pain, stop the injection
• Inject only the side of the penis
• Rotate inject sites to prevent scarring
• Do not use self-injection if you have a bleeding disorder
• Get medical help if your erection lasts more than three hours
  

Vacuum Erection Device (VED)

Vacuum Erection Devices (VEDs) work by manually creating an erection. The penis is inserted into a plastic tube which is pressed against the body to form a seal. A hand pump attached to the tube or battery activated suction is used to create a vacuum that draws blood into the penis, causing the penis to become engorged.

After 1 to 3 minutes in the vacuum, an adequate erection is created. The penis is then removed from the tube and a soft rubber O-ring is placed around the base to trap blood and maintain the erection until removed. The ring can be left in place for 25 to 30 minutes.

Vacuum pumps are not prescribed for patients who have bleeding disorders, sickle cell anemia or are on anticoagulants. They also can be cumbersome to use.

Dr. Cornell recommends the Augusta Medical Systems SomaerectStf:

The SomaTherapy-ED SOMAerectStf represents the new generation of uniquely custom fitted vacuum therapy systems for restoring penile health. It offers 3 cylinder sizing options so you can precisely find the anatomically correct sizing option that neatly fits your fully rigid penis size.

The custom sizing technology was developed to ensure that each patient receives the highest level of comfort when treating their ED. The custom sizing will prevent the loose non-penile tissue from around the base of the penis (supra-pubic fat or scrotal skin) from being drawn into the mouth of the cylinder during the creation of an erection. The use of the customizable system guarantees a much more comfortable erection experience every time.

Surgical Therapy for ED

If drug treatments, injections and other non-surgical therapies are not successful in resolving ED, and psychological causes are not suspected, you and Dr. Cornell may consider penile implant surgery. Penile implants can help you return to an active sex life, and studies show high satisfaction among patients and their partners.

A penile implant (also called a penile prosthesis) is concealed entirely within the body, and requires some degree of manipulation before and after intercourse to make the penis erect or flaccid. There are different types of implants based on the manner of operation, naturalness of the erection and the number of components implanted.

In choosing a penile implant, considerations include medical condition, lifestyle, personal preference and cost.

Penile implants are surgical solutions and have the risks associated with surgery, including anesthesia reactions, infections, pain and other complications.

Penile implants are surgical solutions and have the risks associated with surgery, including anesthesia reactions, infections, pain and other complications.

An inflatable penile prosthesis consists of two soft silicone tubes inserted in the penis, all through a single, small and imperceptible incision in the scrotum.

To produce an erection, a small pump placed in the scrotum is squeezed until sufficient fluid is transferred from a reservoir into the penile cylinders, achieving a firm erection.

When the erection is no longer desired, a valve allows the fluid to return to the reservoir with the simple push of a button on the same scrotal pump. Inflatable prostheses are the most natural feeling of penile implants and allow for control of rigidity and duration of potency.

There is no loss of sensation during intercourse or in the ability to achieve an orgasm (ejaculate).

Types Of Penile Implants

• AMS Implants:
  • AMS 700 Series
  • AMS Ambicor

• Coloplast Implants:
  • Genesis Implant
  • Titan OTR Implant
    

Dr. Cornell is respected as one of the nation’s foremost prosthetic urologists. He specializes in placing both the three-piece inflatable penile implant and artificial urinary sphincter (AUS) through a single scrotal incision in a single surgical procedure.

AMS Implants

AMS has been a leading innovator in the field of erectile restoration for over three decades. Today AMS offers a broad line of penile implants.

Depending on your specific needs, Dr. Cornell recommends two AMS Implants:

• AMS 700 Series 3-Piece Inflatable Penile Implant
• AMS Ambicor 2-Piece Inflatable Penile Implant
  

Every AMS penile implant is engineered to provide a satisfying solution to erectile dysfunction (ED). More than 300,000 men have received an AMS implant and studies show that over 90 percent are happy with the device.

Benefits of a Penile Implant

The benefits of an AMS penile implant include:

• Can help you return to an active, satisfying sex life
• Offers a permanent, long-term solution to ED
  
• Provides the ability to have an erection anytime you choose
• Allows for greater spontaneity—have sex when the mood strikes
• Enables you to maintain an erection as long as you desire
• Eliminates the need for costly pills or shots
• Does not interfere with ejaculation or orgasm
  

Risks of a Penile Implant

The risks of a penile implant include:

• Requires surgery and healing period
• Eliminates the possibility of return of natural erections
• May require repeat surgery due to infections, erosions or mechanical problems with the device
  

The Procedure

Placing a penile implant may be performed as an outpatient procedure, which generally lasts from 30 minutes to over an hour. The procedure is performed under local or general anesthesia.

Before the procedure, Dr. Cornell will give you a thorough explanation of what to expect during your surgery and how to prepare for it.

AMS 700 Implant

The AMS 700 Series provides a natural appearing erection and greater flaccidity than two-piece or malleable implants.

These advanced, three-part prostheses are inflatable implants available in a variety of models and sizes for a custom fit. Each consists of a reservoir implanted in the abdomen, a pump placed in the scrotum and a pair of cylinders implanted in the penis. The entire device is totally concealed in the body.

The gold standard for innovative penile implant technology, the AMS 700 Series now features InhibiZone Antibiotic Surface Treatment and a special wear-reducing Parylene micro coating that increases the reliability and durability of the cylinders.

The AMS 700 is ideal for a man with good mental and physical dexterity who wants a natural looking erection—and a more natural flaccid state—than one- or two-piece implants can provide.

Advantages of the AMS 700 Implant

The AMS 700 penile implant offers the following advantages:

• Acts and feels like a natural erection
• Expands the girth of the penis
• More firm and full than 1- or 2-piece implants
• Feels softer and more flaccid when deflated than 1- or 2-piece implants
• Totally concealed within the body
  

Disadvantages of the AMS 700 Implant

The AMS 700 penile implant has the following disadvantages:

• Requires some manual dexterity
• Possibility of leakage or malfunction
• Possibility of unintentional erections
  

Risk Information for the AMS 700 Implant

Penile prostheses, inflatable and non-inflatable, are not for men with the following conditions:

• With active urinary infections or active skin infections in the region of surgery.
• With a known sensitivity or allergy to silicone.
• With a known allergy or sensitivity to rifampin or minocycline or other tetracyclines.
• With lupus erythematosus.
• Taking warfarin, thionamides, isoniazid and halothane
• With renal disease.
• Certain physical or mental conditions may make you unsuitable for a penile prosthesis.
  

Implanting a penile prosthesis will make natural or spontaneous erections impossible. Implantation of penile prosthesis may result in penile shortening, curvature or scaring. You should talk with your doctor about benefits and risks before moving forward with any treatment option.

AMS Ambicor Implant

The AMS Ambicor is for men with erectile dysfunction (ED) that are seeking a permanent, yet satisfying solution to their condition. Ambicor is ideal for men with good dexterity who want an easier to operate inflatable device.

The AMS Ambicor is a uniquely designed two-piece inflatable prosthesis consisting of a pair of cylinders implanted in the penis, and a single pump bulb implanted in the scrotum. You simply squeeze the pump to inflate and bend the penis to deflate the prosthesis.

Advantages of the AMS Ambicor Implant

The AMS Ambicor provides the following advantages:

• Simple to use
• Fast and simple one-step deflation
• Natural flaccidity compared to non-inflatable implant
• Totally concealed within the body

Disadvantages of the AMS Ambicor Implant

The AMS Ambicor has the following disadvantages:

• Requires some manual dexterity
• Possibility of leakage or malfunction
• Flaccidity not as natural as 3-piece device
  

Risk Information for the AMS Ambicor Implant

Penile prostheses, inflatable and non-inflatable, are not for men with the following conditions:

• With active urinary infections or active skin infections in the region of surgery.
• With a known sensitivity or allergy to silicone.
• With a known allergy or sensitivity to rifampin or minocycline or other tetracyclines.
• With lupus erythematosus.
• Taking warfarin, thionamides, isoniazid and halothane
• With renal disease.
• Certain physical or mental conditions may make you unsuitable for a penile prosthesis.

Coloplast Implants

One in four men over the age of sixty experiences some degree of erectile dysfunction. One highly effective and satisfying treatment option for ED is a penile implant. Every year 20,000 men worldwide reclaim their sexual relationships by using a penile implant.

A penile implant is a device that is implanted into a man's body and is designed to help him get an erection. Following a routine outpatient procedurem a four to eight week recovery period is necessary before the implant is used. Dr. Cornell will provide you with more specific details regarding your individual recovery.

Types of Penile Implants

Coloplast offers two types of penile implants:

• Genesis Implant
• Titan OTR Implant
  

Both types enable men with ED to have a satisfactory erection for sexual intercorse and to experience the joy of sex again.

The primary difference between the two implants is that flexible rod implants (Genesis Implant) produce a permanently firm penis, while the inflatable implants (Titan Implant) produce a controlled, more natural erection.

Genesis Implant

The Genesis penile implant consists of two malleable rods. The rods are implanted in the chambers of the penis. When an erection is desired the patient positions the penis into an erect state. When the erection is no longer desired, the patient returns the penis to its original flaccid-like position.

The Genesis implant has the following features:

• Hydrophilic Coating
• No springs, cables, or moving internal parts to compromise reliability
• Distal shaft column strength helps prevent buckling
• Positionability virtually eliminates springback
• Trimmable - custom fit to each individual
• Easy assembly - no special tools required
  

Titan Implant

ED is not an inevitable part of aging. It is treatable, and the Titan implant is a long-term solution: one that provides consistent, satisfactory erections that allow men to experience the joys of sex again.

The Titan Inflatable Penile Implant exhibits significant enhancements to previous implant designs. In addition to high patient ratings for favorable rigidity, girth, and concealability, the Titan implant has other distinctive features that make it easy to use.

The Coloplast Titan OTR inflatable penile prosthesis is a self-contained, fluid-filled system made from Bioflex and silicone. Bioflex is a supple, yet durable, biopolymer material. It is designed to emulate the look and performance of a natural erection.

The Titan OTR features one-touch release touch pads for easy, one-handed deflation and ease of patient training.

Components

The Titan OTR penile implant has the following components:

• A reservoir (placed in the abdomen)
• Two penile cylinders
• A pump
• OTR - One-touch release touch pads
  

Each part is connected by silicone tubing. The Titan OTR is MRI conditional* and latex free.

Features

The Titan OTR penile implant has the following features:

• Bioflex cylinders allow for girth expansion to 21+ mm and excellent rigidity
• Lock-out
• True-lock
• Hydrophilic coating proven to increase absorption of an aqueous solution
• OTR - One-touch release touch pads for easy, one-handed deflation and ease of patient training

Implant FAQs

Can I have an orgasm with a penile implant?

You should be able to have an orgasm with a penile implant if you were able to have one before your procedure. Consult your physician about your expected outcome.

Is the penile implant covered by insurance?

A penile implant is prescribed by your physician. Most insurance, including Medicare, cover the implant. Check with our office to determine your actual cost.

What is the recovery time?

Each individual is different and therefore their recovery will be different as well. Typical recovery is between 4-6 weeks. Dr. Cornell will determine what you can and cannot do during this time. It is important to follow the recommendations that Dr. Cornell gives to you to ensure the best outcome.

Will I lose any length after getting a penile implant?

Each penile implant is custom fitted to your anatomy. Depending on your medical history, it may not be unusual to lose 1-2 cm. Discuss this in greater detail with Dr. Cornell.

Will anyone notice that I have an implant?

Since the implant is completely placed inside your body, no one will see the implant. In fact, no one will know unless you tell them.

Will I be able to have spontaneous erections with a penile implant?

No. In order to place the implant in the body, the corpora containing the spongy tissue is removed to make room for the cylinders. If you are still able to have erections on your own, which are satisfactory for intercourse, you should consider very carefully whether or not an implant is the right fix for you. However, if you cannot have erections or if they are not satisfactory for intercourse, then an implant will be able to provide you with a more “instant” erection when compared to pills, or vacuum devices.

What makes the Genesis and Titan OTR different?

Both implants provide you with the capability of having an erection satisfactory for intercourse. The main difference is that the Genesis penile implant is a malleable implant consisting of 2 rods that are placed in the corpora cavernosa. There are no further parts to this implant. To have an erection, you only need to hold the penis and move it into the desired position. When you are finished you return the penis to the previous position. With the Titan OTR penile implant, you inflate the cylinders by pressing the pump bulb in the scrotum. You can control the firmness by pumping until you are satisfied with the erection. The best thing is to discuss each implant with your physician to make sure that you are getting the implant that is appropriate for you.

Are there risks associated with the penile implant?

As with any surgery, there are some risks associated with the penile implant procedure including pain, anaesthesia reactions, repeat surgery due to infections, or mechanical problems with the device. Discuss this in greater detail with your physician.

ED Links

Erectile Dysfunction Institute
Prostate Cancer and Intimacy (PCAI) Mailing List
SexHealthMatters.org
American Medical Systems
Coloplast