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What are the choices for treating erectile impotence?

Treatment depends whether the causes are primarily psychological or physical. For example: a young patient , who experiences erectile impotence, but has normal erections during sleep, most likely has a psychological cause, especially if his physical exam and lab tests do not indicate a problem and the patient is in generally good health. In this case, the most effective treatment may be sexual counseling. The sex therapist may recommend  that the patients sexual partner be included in the sessions.

Erectile impotence of mainly physical cause will be treated differently and depend on the particular problem. In some men with erectile impotence due to pelvic injuries, surgery may be recommended. In others with low testosterone levels, testosterone replacement therapy can be helpful.

However the majority who have mainly physical causes there are three generally accepted treatment options, plus a new option. These include vacuum devices, penile injection therapy , penile prosthesis, and a small pellet place into the urethra called the "Muse" system.

Vacuum constriction devices (VCD) consist of a plastic cylinder, a vacuum pump and an elastic constriction band. The cylinder is placed over the penis, air is pump out of the cylinder to create a vacuum  which causes an erection. The constriction  band mounted on the open end of the cylinder is slid off the cylinder to the base of the penis, creating a constriction and maintaining the erection. The constriction band can be safely left on the penis fro about one half hour.

An Illustration demonstrating Penile Injection Therapy

Penile injection therapy, vasoactive drugs are injected into the erection chambers, the corpora cavernosa, as shown in the above illustration. These drugs work by expanding the arteries and relaxing penile tissue. Blood flow increases into the two erection chambers, causing an erection.

Drugs used can include: Prostaglandin-E1(PGE1) or papaverine/phentolamine, or papaverine/phentolamine, PGE1(known as Super Costs Tri-Mix). The doctor in the office can inject a vasoactive drug  or combination as a diagnostic procedure and if this is chosen as a treatment, the patient will be instructed on how to carry out the injections and manage the medication himself.

An Illustration demonstrating Penile Prosthesis

The penile prosthesis is a biocompatible, in otherwords accepted by the body device, implanted into the penis so the penis can be made rigid. It does not change to ability to urinate, ejaculate , or have orgasm. There are two basic types  of prosthesis, the simpler is a semi-rigid but malleable device, the other type is inflated with fluid to make the penis stiff. The inflatable prosthesis comes in two basic designs, a two piece or a three piece device. For the three piece device, the surgeon implants two paired cylinders, a reservoir and a pump. These are shown in the figure above. These show the prosthesis inflated and then after pressing a valve on the base of the pump the fluid returns to the reservoir and the penis becomes soft.

Implanting a penile prosthesis usually means one day in the hospital and about 7-10 days  before resuming usual activities after surgery and up to 3-4 weeks before engaging in intercourse. One to three follow up office visits are also required.

An Illustration demonstrating the"MUSE" system

The "Muse" system (pellet deposition into the urethra) is relatively new and the passage of time  will indicate how efficient  this option really is. It is believed that although it has many common mechanisms to the needle injection therapy, it is not as efficient in producing erection because the dosages of medication that the penile blood vessels and muscles are exposed to,are less intense and less direct. The medication ,PGE1, is known to produce pain in the penis in some individuals, the other agents known to be effective in producing erection cant be administered similarly through the pellet system. The pellet administration system at this point, per erection is relatively expensive compared to injection therapy, each administration cost is approximately $20-25 and administration may or may not associated with producing an erection. The cost for the "Muse" system ,including medication is not covered by insurance, meaning it will be an out of pocket expense.Yet, this is an attractive alternative for many to treat the problem of penile erection impotence.