Impotence in men (Part two)

Treatments and medications

Impotence is treated in various ways including: oral medications, sex therapy, injections into the penis, vacuum devices, the use of medications within the urethra, and surgical intervention. Each method has its pros and cons.

The first thing done is the discovery and appropriate treatment of any underlying pathology that has caused the impotence.

Non-surgical treatments

Education and communication about sex, sexual behaviors, and sexual reactions can help overcome anxiety related to sexual disorders.

Oral medications for the treatment of impotence are successful in many men. These include:

• Viagra (Sildenafil)
• Cialis (Tadalafil)
• Levitra, Staxyn (Vardenafil)

All three medications work in the same way by helping male sexual function through increasing blood flow to the penis. They enhance the effects of nitric oxide, a natural chemical substance that the body produces which relaxes the muscles of the penis. Men who take medications containing nitrates, such as nitroglycerine, should not use the above medications. The combination of nitrates with these medications can cause a drop in blood pressure.

The most common side effects of these medications are stomach upset, nasal congestion, headache, and temporary visual disturbances.

Mechanical devices

This is a vacuum device along with a ring that helps some men to have and maintain an erection. It consists of a cylinder into which the penis is inserted. Using a pump, a vacuum is created which allows blood to increase in the penis thereby facilitating its strengthening. This device yields results in many cases, but patients feel bothered by its not easy use.

Injection therapy with medication into the penis

This therapy is effective in a large number of patients in whom the difficulty of erection is a result of blood vessels, nerves, and some psychological circumstances.

The patient uses a syringe with a very thin needle by which he injects a quantity of medication alongside the penis. The medication relaxes the blood vessels allowing an increased blood supply to the penis.

The most common side effects are pain and localized fibrosis at the injection site. Another side effect is what is called Priapism, which means a painful erection lasting over two, three hours. In these cases, the injection dose should be reduced and there are special procedures for its recovery.

Transurethral therapy

This method consists of using a medication in suppository form that is inserted into the urethra (intraurethral). The suppository contains the medication alprostadil (MUSE) which is absorbed into the blood. It relaxes the blood vessels allowing an increased amount of blood in the penis.

MUSE is less effective than vacuum or injection, however, it is used in a series of erection disorders.

Psychology and sex therapy

Psychological causes can play a part in impotence even if an organic cause is clear.

Consultation with a psychologist can help a person who has anxiety or fear conditions that may influence impotence.

Sex therapy can be beneficial if given by a person trained in this field.

If a patient has a clear psychological cause, he should be treated with sex therapy before undergoing invasive treatments.

Hormones

Men with low levels of testosterone may benefit from supplemental testosterone. It is used in various ways such as: injections, skin patches, gel, etc.

SURGICAL TREATMENT

Penile prostheses

These are devices made of a pair of inflatable cylinders that are inserted into the penis. They are connected by two thin tubes to a water-filled reservoir placed at the end of the abdomen, and a pump placed inside the scrotum. To inflate the prostheses, the pump is pressed several times and the fluid moves from the reservoir into the cylinders.

This makes the penis firm resembling its natural appearance. The penile prosthesis does not alter skin sensitivity and the man can have orgasms and ejaculation. To deflate the prosthesis, a valve attached to the pump is pressed making the fluid return to the reservoir, as a result, the cylinders deflate.

95% of the interventions are successful enabling the performance of sexual intercourse. According to statistics, the level of satisfaction in men with prostheses is higher than those who use oral medications or injections.