Most of the men I see with erectile dysfunction (ED) have ED as a result of diabetes and/or hypertension that has slowly caused the small blood vessels to the penis to be compromised, much the same way as the small vessels of the heart get diseased. The result is that the vascular performance of the penis, or the way that the blood flows to it, is abnormal. Abnormal blood flow means abnormal erections. Viagra, Cialis and Levitra all try to stimulate normal blood flow to the penis by relaxing the penile arteries. The side effects of headache and stuffy nose often occur because blood vessels there do the same thing as a result of the medication. When the blood vessels are abnormal as a result of long-term diabetes or hypertension, these medications work poorly. This is called “Organic ED.”
So the question is “what now?” When Viagra doesn’t work, there are a number of options that essentially fall into three main categories:
- Vacuum Erection Devices (VED)
- Penile Injections (Tri-mix)
- Inflatable Penile Prosthesis (IPP)
I like to encourage men who have ED that doesn’t respond to pills to first try the VED. It is relatively inexpensive, most insurances help pay for it, and if it works then it works for a long time without much worry about how the penile blood vessels are working. However, about half of the men who use it don’t like it for one reason or another.
Penile injections are another excellent way to obtain an erection. They work to stimulate the blood vessels of the penis but in a slightly different and in a more direct way than the pills. A special “Tri-mix” is prescribed that compounding pharmacies can fill, and one vial can deliver 20-30 injections so the overall cost is comparatively low. We try it in the office the first time, but then the patient is able to inject himself (or have his partner do it) at home after that. But, again, about half of the men who try this method find that it doesn’t work well or they don’t like the injection process.
If nothing else works or is acceptable to the patient, then the IPP is an excellent choice. I often do this procedure for men who have ED as a result of prostate cancer treatment. In this surgery the patient has two cylinders placed in the penis that replace the spongy tissue that collects blood in a normal erection. A reservoir of water is placed next to the bladder and a little pump is put in the scrotum. When an erection is desired, the patient simply squeezes the pump and an erection is obtained. There is a 2-5% risk of infection, which means that the device would have to be removed or replaced, so there is a significant risk compared to other treatments. But it’s important to note that over 80% of men who get an IPP are extremely satisfied with it.
So if the little blue pill isn’t working like you hoped it would, make an appointment with your doctor and talk about your options.
