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    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

    Wiles PG. Successful non-invasive management of erectile impotence in diabetic men. British Medical Journal. 1988;296:161-162.
    Korenman SG, Viosca SP, Kaiser FE, et al. Use of a vacuum tumescence device in the management of impotence. Journal of the American Geriatrics Society. 1990;38:217-220.
    Lloyd EE, Toth LL, Perkash I. Vacuum Tumescence: An option of spinal cord injured males w/ erectile dysfunction. SCI Nursing. 1989;6(2):25-28.
    Boloña ER, Uraga MV, Haddad RM, Tracz MJ, Sideras K, Kennedy CC, et al. Testosterone use in men with sexual dysfunction: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clin Proc. 2007 Jan;82(1):20-8.
    Dong JY, Zhang YH, Qin LQ. Erectile dysfunction and risk of cardiovascular disease: meta-analysis of prospective cohort studies. J Am Coll Cardiol. 2011 Sep 20;58(13):1378-85.
    Gupta BP, Murad MH, Clifton MM, Prokop L, Nehra A, Kopecky SL. The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis. Arch Intern Med. 2011 Nov 14;171(20):1797-803. Epub 2011 Sep 12.
    Bella AJ, Lue TF (2008). Male sexual dysfunction. In EA Tanagho, JW McAninch, eds., Smith's General Urology, 17th ed., pp. 589–610. New York: McGraw-Hill.
    Babaei AR, Safarinejad MR, Kolahi AA. Penile revascularization for erectile dysfunction: a systematic review and meta-analysis of effectiveness and complications. Urol J. 2009 Winter;6(1):1-7.
    Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010 Jun;95(6):2536-59.
    Heidelbaugh JJ. Management of erectile dysfunction. Am Fam Physician. 2010 Feb 1;81(3):305-12.
    Jena AB, Goldman DP, Kamdar A, Lakdawalla DN, Lu Y. Sexually transmitted diseases among users of erectile dysfunction drugs: analysis of claims data. Ann Intern Med. 2010 Jul 6;153(1):1-7.
    Lindau ST, Schumm LP, Laumann EO, Levinson W, O'Muircheartaigh CA, Waite LJ. A study of sexuality and health among older adults in the United States. N Engl J Med. 2007 Aug 23;357(8):762-74.
    McVary, K. T. Clinical practice. Erectile dysfunction. N Engl J Med. 2007 Dec; 357(24): 2472-81.
    Govier FE et al. Mechanical reliability, surgical complications, and patient and partner satisfaction of the modern three-piece inflatable penile prosthesis. Urology 52:282.1998.
    McLaren RH et al. Patient and partner satisfaction with the AMS 700 penile prosthesis. Journal of Urology 147:62-65.1992.
    Mulhall JP et al. Serial assessment of efficacy and satisfaction profiles following penile prosthesis insertion. Journal of Urology165(5):1042A, 2001.
    Qaseem A, Snow V, Denberg TD, Casey DE Jr, Forciea MA, Owens DK, Shekelle P, Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Hormonal testing and pharmacologic treatment of erectile dysfunction: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2009 Nov 3;151(9):639-49.
    Melnik T, Soares BG, Nasselo AG. Psychosocial interventions for erectile dysfunction. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004825.
    Miles CL, Candy B, Jones L, Williams R, Tookman A, King M. Interventions for sexual dysfunction following treatments for cancer. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005540.
    Nehra A. Erectile dysfunction and cardiovascular disease: efficacy and safety of phosphodiesterase type 5 inhibitors in men with both conditions. Mayo Clin Proc. 2009 Feb;84(2):139-48.
    Qaseem A, Snow V, Denberg TD, Casey DE Jr, Forciea MA, Owens DK, et al. Hormonal testing and pharmacologic treatment of erectile dysfunction: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2009 Nov 3;151(9):639-49.
    Selvin E, Burnett AL, Platz EA. Prevalence and risk factors for erectile dysfunction in the US. Am J Med. 2007 Feb;120(2):151-7.
    Tsertsvadze A, Fink HA, Yazdi F, MacDonald R, Bella AJ, Ansari MT, et al. Oral phosphodiesterase-5 inhibitors and hormonal treatments for erectile dysfunction: a systematic review and meta-analysis. Ann Intern Med. 2009 Nov 3;151(9):650-61.
    Tsertsvadze A, Yazdi F, Fink HA, MacDonald R, Wilt TJ, Bella AJ, et al. Oral sildenafil citrate (viagra) for erectile dysfunction: a systematic review and meta-analysis of harms. Urology. 2009 Oct;74(4):831-836.e8. Epub 2009 Jul 9.
    Furlow WL et al: Implantation of Model AMS 700 penile prosthesis. Journal of Urology 139:741-742.1988.
    Wilson SK et al. Comparison of mechanical reliability of original and enhanced Mentor Alpha I penile prosthesis. Journal of Urology, 715-8.1999.
    Montorsi F et al. AMS three-piece inflatable implants for erectile dysfunction: a long-term multi-institutional study in 200 consecutive patients. European Urology, 37:50-55.2000.
    Carson CC. Penile prosthesis implantation in the treatment of Peyronie's disease. International Journal Of Impotence Research, 10:125-8.1998.
    Daitch JA et al. Long-term mechanical reliability of AMS 700 series inflatable penile prostheses: Comparison of CX/CXM and Ultrex cylinders. Journal of Urology, 158:1400.1997.
    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.