Dr. Gholami California Urologist

Erectile Dysfunction

Men's Health refers to any aspect of overall health that may affect well-being, energy level, sexual dysfunction or fertility.

Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. Erectile dysfunction is strongly age related and affects as many as 30 million American men. While there is an estimated prevalence across all ages of about 10% (making erectile dysfunction common), the prevalence rises to over 50% in men between 50 and 70 years of age, though it is not an inevitable consequence of normal ageing. While ED is common, only about 5% of men ever discuss this problem with a physician. It is also associated with a number of organic disorders and diseases. In diabetes, for instance, ED occurs in up to 40% of men. But ED may also occur with cardiovascular disorders (especially in men with angina or after myocardial infarction), neurological disorders, after pelvic surgery or trauma, and as a consequence of pharmacological treatments of a number of diseases. Currently, there are a number of lifestyle changes and treatment options available for men with erectile dysfunction. In some cases, the first course of treatment satisfies the patient and his partner. For other patients a number of steps may be taken before one is found satisfactory.

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Erectile Dysfunction

Among the treatment options are:

Changing habits and medications
Quitting smoking can be an important step in reducing the impact of impotence or eliminating it altogether. Small changes in prescription medications may also help improve erectile quality.

Hormone Medications
While only 5% of ED cases are caused by irregular levels of sex hormones (such as low levels of testosterone, excess prolactin and excess estrogen), these conditions are usually treatable with excellent results.

Professional Counseling
Because ED can result from a combination of psychological and physical factors, counseling can lessen anxiety, which in turn may reduce the impact and duration of the condition. This therapy is often used in combination with other treatments directed by a physician.

Vacuum Devices
This treatment involves the use of an external vacuum device and one or more tension rings (basically rubber bands). The device works by inserting the penis into a plastic cylinder, which is then pumped to create a controlled vacuum. Once an adequate erection is produced, a tension band is slipped around the base of the penis to maintain the erection; the vacuum device is then removed. The erection-like state generally lasts long enough for a couple to have intercourse.

Injection Therapy
One of the newest forms of treatment involves the self-injection of medication into the side of the penis. The relatively painless injection produces erections of good quality for about 70-80 percent of patients. There are several injectable medications that, when used alone, help increase blood flow to the penis which promotes an erection. Originally, these medications had been registered and marketed to treat other conditions. Researchers, however, also found them to be effective in treating erectile dysfunction, so doctors began prescribing these medications for their patients.

Penile Prostheses
This treatment involves the surgical placement of a stationary or movable device into the two sides of the penis, allowing erections as often as desired. These implants come in two forms: an inflatable device and semi-rigid rods. This treatment is not recommended until other methods have been considered or tried first.

Oral Therapy
Yohimbine occurs naturally in the bark of evergreen trees and has been used as an aphrodisiac for centuries by Indians and Africans. It is believed the drug works by enhancing nerve sensitivity in the penis. While there have been no large-scale studies to prove the drug's effectiveness, a small percentage of men report it to be helpful for impotence.

Surgical Treatment
This treatment is usually reserved for those patients whose blood flow has been blocked by an injury to the penis or pelvic area. Surgery is also used to correct ED caused by vascular blockages. The goal of this treatment is to correct a blockage of blood flow to the penis so that erections will occur naturally.