Erectile dysfunction (ED)
Erectile dysfunction is defined as the inability to achieve an erection or maintain an erection satisfactory to have sexual intercourse. It is one of the most common complaints of men (and their partners!) affecting at least 30 million American men. It can happen at an increasing rate with age but is not a normal part of aging. Many men in their 80’s-90’s have no problems with erections. Dr. Shaba treats men of all ages and has effective treatments to solve this issue for most men.
Symptoms:
- Inability to get an erection hard enough for penetration
- Inability to maintain an erection for sexual activity
- If you have no interest in sex along with this, then this may be a symptom of low testosterone (hypogonadism)
Causes:
There are many causes of erectile dysfunction. These are mainly related to poor blood flow to the pelvic area and penis or damage to the nerves in the area. Sometimes ED can be a sign of a serious medical condition and an early sign of neurologic disease or coronary artery disease- higher risk of heart attack.
- Pelvic surgery- prostatectomy, bowel resections, etc
- Pelvic radiation
- Hypertension (high blood pressure)- and the medication used to treat this
- Diabetes
- Peripheral vascular disease- poor blood flow
- Neurologic diseases- Alzheimer’s, Parkinson’s, Multiple sclerosis, stroke, spinal cord injury
- Medications- SSRI’s (used for anxiety and depression) and beta blockers (used for high blood pressure and cardiac issues)
- High cholesterol
- Renal failure or other kidney issues
- Anxiety, stress, depression and relationship issues
- Trauma to the pelvis
Evaluation and Treatment:
Dr. Shaba will start with a history and physical and most of the time can diagnose the cause at that point. Sometimes testing will be ordered such as blood work, ultrasounds, or even referrals to cardiology, vascular, or even counsellors to help with the mental side of things. Some physicians use a doppler for flow and other tests. For some people the treatment can be as simple as changing a medication, losing some weight and exercise, or talking to a counsellor or their partner.
Generally, there are a few options that work well.
- PDE-5 inhibitors- these medications increase blood flow to the penis. Viagra, Cialis, Levitra are the most common medications. They are now generic so that instead of $40 a pill, most times they are under a $1. For most people this is the preferred choice for treatment.
- Vacuum erection device- this is a hand-held mini vacuum that brings blood to the penis to help with erections
- Intracavernosal injections- small injection to the penis that works to achieve an erection without the side effects of oral medications
- Penile implant– surgical procedure to place an inflatable implant that gives a good erection and deflates when not in use.
- Less commonly used- intraurethral suppository (small pill pushed into the penis). Shockwave or E-wave technology (from my experience does not work as well as advertised).
Dr. Shaba did a webinar on ED- Please click here to listen and watch. https://bit.ly/ShabaEDwebinar
For more information please visit: https://www.urologyhealth.org/urology-a-z/e/erectile-dysfunction-(ed)
