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The good news is that effective treatments exist. Once not easily talked about, ED is now openly discussed by health care providers and the general population. Successful advertising campaigns for oral therapies have also led to more openness and knowledge about this concern.
To understand ED, it helps to know how erections work. When a man is sexually stimulated, usually with arou sing thoughts and/or sexual touching, blood flow to the penis increases. Increased blood makes the penis firm, called an erection. Most cases of ED can be described in one of two ways. Some men notice it is more difficult to get an erection when they want one. Others are able to get a firm erection but find it difficult to maintain for as long as they want. In some men the two problems are combined.
Diabetes is a known risk factor for ED. One study showed that men with diabetes are three times more likely to experience it, possibly because diabetes affects blood vessels and nerves responsible for erections.
Diabetes is not the only risk factor for ED. Cardiovascular (heart) disease, high blood pressure, high cholesterol, smoking, and certain medications can all influence erections. As well, certain surgeries, such as prostate cancer surgery, may also cause ED. It can be a symptom of an existing health problem. It is very important to discuss this concern with your family doctor or your diabetes education team.
Treatments for ED are available and can be very helpful. Therapy can be divided into the following categories: oral medications, self-injection, intra urethral therapy, vacuum devices and surgical options.
Three oral medications are now available by prescription in Canada - Viagra™ (sildenafil), Cialis™ (tada lafil), and Levitra™ (vardenafil). They all work in a similar way, boosting natural erectile function by improving blood flow to the penis and allowing blood to stay longer.
One advantage with these treatments is they only work when the man is sexually stimulated. Both mental and physical sexual stimulation are needed. In other words, if a man takes the medication and decides not to have sex, he will not get an erection.
Table 1 shows some key differences among the three medications. The costs of the three are very similar and are not typically covered by drug benefit plans. Any man taking nitrate medications, such as nitroglycerin tablets or patches (even if they are only taken occasionally) should not use these medications. The combination may cause a serious drop in blood pressure. Other medications can affect how well these oral therapies are absorbed by the body. Be sure to discuss your current medications with the doctor or pharmacist.
In general, the oral therapies work better if you can get some erection on your own. They will not work for all men with ED. You can try other ED therapies if these medications are not effective for you.
Self-injection therapy involves using a little needle to inject a small amount of medication into the side of the shaft of the penis. The same type of needle is used to inject insulin. Once the medication is injected, it helps directly increase blood flow in the penis, usually starting to work within 10 to 20 minutes.
This treatment is usually effective regardless of the cause of ED, and may work when oral medications do not. Although there is a possibility of priapism (an erection lasting more than three hours), this risk is low especially with careful dosing. The key to success with this technique is understanding how and where to inject. Urologists, some family doctors, and specially trained nurses can teach the technique, and therapy may be covered by your drug benefit plan.
Intraurethral therapy is similar to the self-injection method in that the medication works locally to increase blood flow in the penis. Rather than injecting medication, a special applicator is inserted into the urethra (the tube that drains urine from the bladder). The applicator then inserts a pellet of medication smaller than a grain of rice. Once absorbed into the penis, the medication increases blood flow. Some men may experience some burning sensation as the medication is absorbed. This therapy is not usually covered by drug benefit plans.
Vacuum device therapy is the one option for ED that does not involve medi cation. This therapy involves placing the penis into a cylindrical tube that is attached to either a manual or battery-operated vacuum device. When activated, suction brings blood into the penis. Once the penis is erect, a constrictor band placed at the base of the penis maintains the erection for as long as the band is in place. It should not be left on for longer than 30 minutes at a time. Some men who are able to get a full erection but have difficulty maintaining it may use the constrictor band on its own.
Penile implants are usually only considered once all other therapies have been tried. Surgery is required to place an implant, either inflatable or bend able, in the penis. A urologist can help explore this option.
Choosing a therapy for ED is a very personal decision that should be discussed with your health care provider. The type of ED, personal preference and financial considerations will influence your decision. Including your partner can help reduce stress and allow closer involvement. Since partners may blame themselves, it is important for both of you to understand the cause of the ED.
Certain basics can help promote sexual closeness. The availability of therapies has made ED very manageable. However, many couples find a sexual therapist or counsellor helpful. In counselling, suggestions can be offered on how to incorporate treatments along with ideas and activities to increase intimacy.
FAMILY HEALTH is written with the assistance of |
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