Category Archives: Erectile Dysfunction
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.
Many men come to our office deeply concerned about ED or erectile dysfunction – something we also call impotence. After all, a man’s erectile function is often psychologically linked to their virility and is physically critical to their sexual enjoyment. This is especially true if the man is dating and meeting new people. Unfortunately, too many men believe that erectile dysfunction is simply a natural part of aging and there’s not much they can do to prevent it or slow its progression. That is simply not true. We are told that there are a host of non-modifiable factors that will lead to ED and while some of them may hold water, many can be addressed without the need for medication or further treatment. At very least, a man’s sexual function may improve with lifestyle changes.