Male Impotence Treatment

Gladly I think of the days
When all my members were limber, all except one.
Those days are certainly gone.
Now all my members are stiff, all except one. —Goethe

Male Impotence Treatments

Treatments for male impotence can be arranged on a continuum by the level of intrusiveness they impose as well as the level of effectiveness they provide. The least intrusive ED Treatments are counseling and vacuum ed devices. Vacuum Therapy Devices are external to the body and have few side effects or contraindications. The most intrusive are penile implants followed by penile injections.

The most effective impotence treatment involves surgery to implant a penile prosthesis, offering 70 to 89% effectiveness. Vacuum ED Pumps are a very close second, providing 65 to 90% effectiveness. Vacuum therapy pumps are significantly less intrusive and are most often recommended by physicians as the first line of therapy after counseling. Some who use vacuum therapy find its effectiveness decreases over time and is likely to migrate to ED medications as an alternative.

Male Impotence Treatment Selection Continuum

Counseling Therapy is the least invasive treatment for ED and is helpful for impotence patients that experience erectile dysfunction due to psychological reasons. Patient or couple counseling may help reduce anxiety and overcome this medical condition. Counseling therapy is sometimes used in combination with other treatments as directed by the doctor.

Vacuum Therapy offers high effectiveness and low invasion. Approved by the FDA, vacuum ED pumps are growing as a treatment for erectile dysfunction. Since vacuum therapy is an external procedure that is easily performed at home and has few side effects, it is often recommended after counseling has proven ineffective. Physicians often refer ED patients who have undergone certain medical procedures to vacuum therapy as a way to restore lost erectile performance due to surgery side effects. The growth of this ED therapy is expected to continue to grow.

Natural ED Remedies or Impotence Supplements are oral or skin therapies in which the ED patient doses by a capsule or lotion. ED remedies often take the form of Herbs for ED or Vitamins for ED and can be helpful to some. These Natural Remedies for ED were often used years ago but are found to be harmful to some with certain medical conditions. Since there are no viable studies to substantiate the claims of natural ED remedies, physicians do not recommend these as a therapy choice.

ED Medications with brand names like Viagra and Cialis have been heavily promoted in advertisements. Currently, five medications have been approved by the FDA for treating erectile dysfunction which include sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra). These medications are convenient therapies that are taken orally prior to sexual intercourse. These medications are phosphodiesterase-5 inhibitors and are often prescribed by physicians. Although these medications are associated with numerous side effects, most of them have minimal impact. Two other medications that are used but do not receive as much advertising are Yohimbine, an atagonist of a2 receptors, and Apomorphine, a non-ergoline dopamine agonist.

Hormone Therapy or Testosterone Therapy is available in three different delivery devices--intramuscular injection (testosterone enanthate or cypionate), orally (testosterone undecanoate), or by dermal patch. Testosterone should only be used for patients with hypogonadism. Although testosterone augmentation is associated with enhanced libido which may improve erectile status by restoring interest and desire, it remains an inappropriate therapy to restore erectile dysfunction.

Intracavernosal Injection Therapy should be considered when vacuum therapy and oral medications appear to be ineffective. This injection is given directly into the corpus cavernosum through the side of the penis. The success rate is high, but problems include pain, prolonged erections, and penile fibrosis.

Penile Implants are considered by most to be the last line of therapy after all other measures have failed. Penile implant surgery is a very successful therapy but should be reserved for patients who have tried other therapies and did not find them effective. Penile implants involve invasive surgery that is irreversible, destroying the normal function of the corpus cavernosa.

Male Impotence and ED Treatment Citations

1Lakin, Milton and Wood, Hadley. “Erectile Dysfunction." Cleveland Clinic.
2Yuan, J., Hoang, A.N., Romero, C.A., Lin, H.,Dai, Y., and Wang, R. VT in Erectile Dysfunction–VCD. Int J Impot Res. 2010;22(4):211–219.
3Turner LA, Althof SE, Levine SB, et al. Treating erectile dysfunction with external vacuum devices: Impact upon sexual, psychological and marital function. The Journal of Urology. 1990;144(July):79-82.
4Guay, A.T.; Spark, R.F.; Jacobson, J.; Murray, F.T.; Geisser, M.E. Yohimbine treatment of organic erectile dysfunction in a dose-escalation trail. International Journal of Impotence Research. February 2002, Volume 14, Number 1, Pages 25-31.
5Perimenis P., Markou S., Gyftopoulos K., Giannitsas K., Athanasopoulos A., Liatsikos E. and Barbalias, G. Efficacy of apomorphine and sildenafil in men with nonarteriogenic erectile dysfunction. A comparative crossover study. Andrologia. 2004 Jun;36(3):106-10.
6Perimenis, P., Gyftopoulos, K., Giannitsas, K., Markou, S.A., Tsota, I., Chrysanthopoulou, A., Athanasopoulos, A. and Barbalias, G. A comparative, crossover study of the efficacy and safety of sildenafil and apomorphine in men with evidence of arteriogenic erectile dysfunction. International Journal of Impotence Research (2004) 16, 2–7. doi:10.1038/sj.ijir.3901119.
7Burke, Ryan M. and Evans, Jeffrey D. Avanafil for treatment of erectile dysfunction: a review of its potential. Vasc Health Risk Manag. 2012; 8 : 517–523.
8Rajfer, Jacob, MD, Relationship Between Testosterone and Erectile Dysfunction. Rev Urol. 2000 Spring; 2(2): 122–128.
9Eid, J. Francois, Testosterone Therapy: A Misguided Approach to Erectile Dysfunction (ED), PRNewswire, New York, June 19, 2012.
10Penile Injection Therapy, Advanced Urological Care P.C. Male Urinary and Sexual Dysfunction.
11Penile Implant Surgery, Weill Cornell Medical College.

Male Impotence Treatments and ED Cures Additional Information

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Goldstein I et al. Safety and efficacy outcome of mentor alpha-1 inflatable penile prosthesis implantation for impotence treatment. Journal of Urology, 157:833.1997.

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