Erectile Dysfunction (ED) is the inability to achieve or maintain an erection that lasts long enough or is rigid enough for satisfying sexual intercourse.

It is also referred to as impotence. If you feel that you have this difficulty, you are not alone. It is estimated that about half of all men 40 to 70 suffer from some degree of impotence. However ED, or impotence as it is sometimes called, is not only a problem of older men. Overall, approximately thirty million men in the United States are believed to have some degree of impotency. (It is hard to know exactly how many men suffer from this condition because so many men are reluctant to discuss the problem.)

What causes Erectile Dysfunction (ED)?

Impotency has many causes. It may have a psychological cause, such as depression, stress, or anxiety, or it may have a physical cause. The Center for Sexual Medicine specializes in the treatment of physical impotency. Physical causes include blood flow disorders due to diabetes, cigarette smoking, or general hardening of the arteries. They also include nerve injury as the result of strokes, multiple sclerosis, or pelvic surgery for prostate, colon, or bladder cancer. In addition, heavy alcohol consumption, opiates, or various prescription drugs can impair erectile functioning.

Because there are so many causes of impotency, there should be no shame in seeking help. Without medical help, it is almost impossible to determine the cause of impotency and treat it. With medical help, impotence is almost always treatable.

When Should I Seek Treatment?

If you have been having trouble for the last six months or longer in achieving satisfying intercourse because of erectile difficulties, then it is time to seek help.

An occasional problem is nothing to get alarmed about. Most men experience an occasional erectile failure. However, if problems occur more than half the time, then it is time to make an appointment for a medical evaluation. Persistent problems with impotency will not go away on their own, but with treatment impotency is reversible.

Age should not be a factor in deciding to seek treatment. Although impotency is more common in older men, it is not an inevitable part of aging. Treatment of older men can be just as effective as treatment of younger men.

What Can I Expect if I Seek Treatment?

Treatment for impotency begins with a visit to the doctor's office for a diagnostic evaluation. You will be asked to give a full medical history and a sexual history. You will also have a physical examination and a urinalysis.

In addition, almost all men will require blood to be drawn for a PSA test and a testosterone test. The PSA test screens for prostate disorders often linked to impotence. The testosterone test checks for an abnormally low hormone level, which may affect sexual desire and performance. If you have not had a general physical recently, further blood tests will be done to ensure that you have no other health problems.

If these tests are all normal, the next step in an impotence evaluation usually is nocturnal penile tumescence monitoring or NPT test, where you take home a device that will measure the quantity and quality of your night-time erections. (A sexually healthy man will have spontaneous night time erections of good quality and quantity.) When you return the NPT device to our office, it is hooked up to a computer to print out a bar graph of your erections for the doctor to review.

Depending on the results of this test, you may then undergo any or all three other tests:

1. vasodilator injection testing - This involves a medication being injected into the penis that stimulates an increase in blood flow and an erection. It is often combined with one of the other tests.
2. ultrasound Doppler Penile artery scanning - The Doppler ultrasound measures the speed of the blood flowing into the penis to determine if there is a blood inflow problem, or if an outflow or leakage problem is suspected.
3. and/or oral vasodilator trials - e.g. taking Viagra to test the result

As you can see, quite a few tests may be necessary to determine the causes of an erectile problem. Without these tests, you and your urologist would not be able to choose the most effective treatment options for you.

What are the Current Medical Treatments for Erectile Dysfunction?

In the vast majority of cases, physical impotence can be treated by non-surgical means. These treatment options include:

• Oral Prescription Medicine. Viagra works by improving blood flow to the penis. When taken approximately one hour before sexual activity, in combination with sexual stimulation, these pills help the body's own natural mechanisms to produce an erection. It is often given as a first line of therapy. Some prescription medications (ex. High Blood pressure medications) have side effects that can cause impotence. Also medications that contain nitrates, (ex. Nitroglycerine) taken with Viagra can drop blood pressure to a dangerously low level. If you are on nitrates, Viagra will not be an option unless your primary physician considers changing your medication. We do not recommend changing your medications without consulting your doctor. Viagra is not suitable for men with complicated heart conditions. This is why a complete medical history is so important.

• External Vacuum Therapy. The vacuum system consists of a clear plastic cylinder, hand pump and a tension ring. Basically, it is used to create a partial vacuum around the penis that assists the blood flow into the penis, much like in a natural erection. There are few side effects with this treatment, but many men do not like the lack of rigidity at the base of the penis or lack of spontaneity caused by the use of this equipment.

• Penile Injection Therapy. Certain medications, when injected directly into the penis, will produce a good erection in a few minutes. Unlike the vacuum device, these injections produce good rigidity at the base of the penis. Many men find self-injection less cumbersome or inhibiting than vacuum therapy. However, there are possible side effects. One is priapism, a prolonged erection, that does not go down. It must be treated promptly with Sudafed so as not to do damage to the penile arteries. Another is scarring or fibrosis in the penis due to repeated injections. To lessen the chance of this occurring, men are advised to use the injections no more than once a week or 5 times a month. Injection therapy may be difficult for frequent travelers, since some medication must be kept refrigerated because of short shelf life.

• Intra-urethral Suppositories. Muse is a suppository, or tiny pellet, that is gently inserted into the urethral opening using a small applicator. This pellet contains the same medication as injection therapy. The medication is absorbed through the surrounding erectile tissue, causing increased blood flow and resulting in an erection after 10-15 minutes. A prolonged erection that does not go down, also known as priapism, is a side effect to this therapy as well. Some men experience a burning sensation which will lessen with successive use. This medication must also be kept refrigerated.

• Hormone Replacement. If your testosterone level has been found to be low, then you may be a candidate for hormone replacement. You may get regular injections and then move to wearing a patch that delivers a small amount of testosterone directly into the bloodstream through the skin. This may improve sex drive, and erections. This therapy may produce unwanted side effects however, and should not be used by men with an enlarged prostate, prostate cancer, or who have kidney, liver, heart, or breast disease.

• Penile Implants. Almost all men can successfully use at least one of the above non-surgical treatment options. However, the side effects or other drawbacks of these treatment options lead many men to eventually consider surgical implantation of a penile prosthesis. A penile prosthesis is the only cure for impotence. This is a permanent, long term treatment. Over 250,000 men have received implants to return to an active sex life. Studies show implants provide our highest level of satisfaction among both patients and their partners. All prostheses are inserted in the spongy area of the penis and are completely concealed within the body. They require manipulation to initiate a natural erection. The penis looks normal, and the implant permits more spontaneous lovemaking. If you decide to have the procedure you can choose either same-day surgery or a 23-hour admission for your convenience.

  While durability is good, these devices can occasionally malfunction. Because both insertion and replacement require surgery, there are the usual risks associated with surgery. While these risks are low, because of them, all men are not eligible for a penile implant.

This is a brief overview of the main medical treatments for impotence. If you seek treatment you will be given more information about your treatment option.

Who Would Treat Me?

The Center for Sexual Medicine has a staff that has been specially trained to assist in the diagnosis and evaluation of erectile difficulties. They will treat the information you provide with the utmost confidentiality. They understand your problem and can answer your questions.

Abraham Hawatmeh, M.D., F.A.C.S. and his associate, Frederick Walters, M.D. are both board-certified urologists and are experienced in the diagnosis and treatment of impotence or erectile dysfunction.

For us to treat the problem, You must take the first step . . .

Make an appointment for a diagnostic evaluation. Call 314.843.0835.

The Center for Sexual Medicine is conveniently located in the:
St. Anthony's Medical Office Building
10004 Kennerly Road Suite 174B
St. Louis, Missouri 63128