Category Archives: Erectile Dysfunction
Erectile dysfunction is a ubiquitous part of aging and is closely related, in most patients, to the efficiency of the blood flow to the penis. Just as with other parts of the body, the penis has arteries that supply it with oxygenated blood. Differently from most other structures in the body, the penis retains some of that blood to create an erection. If this blood does not or cannot reach the penis, an erection may be soft or not last long enough for proper sexual contact. While blood flow issues are the most common cause of erectile dysfunction, there are other considerations, including the fact that some patients have psychogenic causes of their ED. This means that they have essentially psyched themselves out of sex either due to prior poor performance or other psychological concerns.
When a man first sees that his penis is curved, it can be a very concerning, even panic-inducing situation. Peyronie’s disease is caused by plaque buildup on the penile structures, leading to curvature in any direction. Eventually, this curvature can begin to be problematic: it can be mild or serious enough to interfere with proper sex and even cause significant pain with an erection. When the penile curvature is relatively mild, patients are often hesitant to go to their urologist or men’s health specialist because they’re unsure if the degree of curvature requires medical or surgical care. However, looking only at the curvature does not paint the whole picture, and patients who have Peyronie’s disease should change how they think about the condition. Most importantly, it’s not so much about the degree to which the penis is curved but rather whether the curvature is interfering with life in some way or another.
P-shots or Priapus shots, aptly named after the Greek god of fertility, have become popular in recent years as some in the medical community turn their minds toward biohacking or improving the function of the body. From online resources to doctors and men’s health clinics, P-shots are being advertised as a way to get many benefits from platelet-rich plasma, or PRP, specifically as it relates to the penis. Let’s see what the most common claims are. P-shots can improve erectile function. P-shots can increase the girth and or length of the penis. P-shots can improve the health of the penis.
Of the most common and debilitating male sexual function concerns that Dr. Engel treats, erectile dysfunction, and Peyronie’s disease are at the top of the list, both in incidence and in the desire for the patient to have them treated. When discussing these two conditions with patients, they are often seen as having separate and distinct treatment protocols. To some degree, this is true if they occur individually. However, Peyronie’s disease and ED often co-occur. One may cause the other, or they may both be present independently. In this article, we will discuss when a penile implant may be appropriate to treat both conditions, giving patients a one-stop option for handling two significant concerns.
Priapism is a greatly misunderstood concern. Many people call priapism the four-hour erection and think that it is alternately a good thing – a sign of masculinity or amusing; however, the exact opposite is true. Yes, we all want strong, prolonged, lasting erections, but when they begin to damage penile tissue, often permanently, we need to stop them in their tracks. In this article, we discuss the primary non-surgical ED treatments, whether they could cause priapism, and what to do about it. Before we continue, however, it must be said that priapism is very rare, and while you should know about it, you don’t necessarily need to actively worry about it. Remember, a satisfying sex life is also psychological, and you do not need any impediments to that. You should also know that several medications can cause priapism, and as such, you should speak to your urologist to understand more about possible causes.
Erectile dysfunction, or ED, is a problem as old as humanity and remains virtually inevitable as we age. No matter how healthy we are, the heart and blood vessels, especially those arteries feeding oxygen to the penis, eventually lose their ability to transmit blood to the body as effectively as before. The best analogy involves our capacity to exercise as we age. No matter how in shape we are for our age, our bodies lose some ability with time. As it relates to erectile function, this aging process leads to weaker erections over time and, eventually, the inability to enjoy one’s sex life.
As we age, there is an inevitable decline in the ability to achieve an erection. This is simply because erectile function depends on blood flow to the penis, and as a man ages, the circulatory system becomes less efficient. This is also why we can’t perform in sports or endurance in our later years the same way we did in our teens, 20s, or 30s. With that said, some men begin to lose their erectile function earlier, and we see patients as young as 30 or 40 who have concerns about their ability to achieve and maintain an erection during sex. At this point, there is a continuum of care that almost every ED patient will follow. This begins with an evaluation of the root cause of the problem, and the answer may include any combination of psychological therapy (for a small number of patients), lifestyle change, and ED medications like Sildenafil and Tadalafil. If these options fail, we move on to injection therapy or a penile implant for severe cases of ED.
Erectile dysfunction most often has a slow progression, where patients initially have occasional trouble achieving or maintaining an erection, followed by subsequent difficulty finishing. Eventually, the condition becomes troublesome enough that without intervention, a satisfying, sex life is not possible. Of course, once the patient first realizes they have a problem, the psychological effects are often as problematic as the physical ones. While the prospect of taking medication to achieve an erection can be dispiriting, patients need to know that they are not alone. Around 50% of all men over 60 have trouble attaining or maintaining their erection, and those that opt for medical therapy as a front-line attack on the condition can often regain a satisfying sex life immediately. Further, with generics like sildenafil and tadalafil on the market, the cost of this improvement in sexual function is minimal when compared to when these drugs were on-patent (Viagra and Cialis).
When patients come to us looking for relief from their erectile dysfunction, they are faced with a preliminary decision of which medication, tadalafil or sildenafil, is better. Back in the day, when these medications were still on patent AND named Cialis and Viagra, respectively, they were very costly. These were the days of fighting with and often losing to insurance companies. Now that generics are available, so many more people can take advantage of these great, highly effective drugs. We often suggest that patients taking ED medications for the first time try both separately to see which works best for them with the fewest side effects. Ultimately, with prices as low as they are, there’s little financial risk in seeing which is best for our patient’s unique circumstances.
Dr. Engel joined “Great Day Washington” on WUSA 9 to discuss erectile dysfunction (ED) and treatment options including inflatable penile prostheses. Dr. Engel told viewers about the distinction between ED caused by prostate cancer surgery and radiation, for which medication is relatively ineffective; and ED caused by other problems and/or aging. For patients recovering from prostate surgery or radiation, an inflatable penile prosthesis is often an excellent option, allowing them to have natural, relatively spontaneous erections using a device that is completely hidden within the anatomy.