Erectile Dysfunction ED

Erectile dysfunction, a man's inability to maintain an erection sufficient for satisfactory sexual intercourse, is much more common than once thought. Erectile dysfunction affects about 10 to 20 million men, and as many as 30 million men suffer at least partial erectile dysfunction. Eighty percent of all erectile dysfunction has a physiological component or cause, and is not psychological. It is age-related, chronic, progressive, and greatly under-treated.

Compared to many other societies, America is still embarrassed and bashful about sex—but that is changing. Sex is more openly discussed on television, in the movies, on the Internet, and in private. This new-found openness, coupled with the introduction of medications such as Viagra, is encouraging more and more men to seek medical treatment for erectile dysfunction. Between 5% and 25% of men with the condition now see a doctor for help.

Doctors at Columbia University Department of Urology at NewYork-Presbyterian Hospital offer men with erectile dysfunction the full range of available treatments. Columbia Urology's Dr. Peter Stahl, a specialist in sexual dysfunction, has developed a program for men with erectile dysfunction that combines oral and injection therapy. He also has particular expertise in penile rehabilitation after prostate surgery, and spent a year training specifically in complex penile implant surgery.

Causes of Erectile Dysfunction

In the last decades doctors have recognized that impotence can be caused by a variety of physical conditions, as well as by psychological factors. By some estimates 90% of all impotence is linked to:

  • Medications: Medications including antidepressants, blood pressure medicines, and drugs used to treat hypertension, cardiac disease, and psychiatric disorders.
  • Nerve damage: Nerve damage from prostate cancer, pelvic trauma, radical pelvic surgery, diabetes, spinal injury, or multiple sclerosis, which can damage the nerves that travel from the brain to the penis.
  • Performance anxiety: Relationship problems, depression, stress, or other psychological disturbances, which can interfere with sexual performance.
  • Testosterone deficiency: Testosterone deficiency while rare, can cause or contribute to impotence.
  • Other causes: Other causes such as smoking, high blood pressure, heart disease, and fluctuations in cholesterol levels can all reduce blood flow to the penis.

Because erectile dysfunction is often a symptom of a more serious physical problem, it is extremely important for any man who has trouble achieving or maintaining an erection to see his physician.

Treatment for Erectile Dysfunction

Given the large number of treatment options now available—with more on the way—virtually all men can be successfully treated, regardless of how long they have been sexually inactive.

Before initiating medical or surgical therapy, doctors here explore aspects of a man's lifestyle that may be contributing to erectile dysfunction including physical exercise, weight, blood lipids (fats, cholesterol), smoking, alcohol consumption, and stress, fatigue, and a busy schedule. We also address potentially reversible causes of erectile dysfunction such as hormonal (testosterone) deficiency and medications that can cause erectile dysfunction as a side effect.

Doctors at Columbia Urology begin treatment with the simple, inexpensive, and reversible approaches first. If these are not successful we move to the more complex, expensive, and non-reversible treatments.

Oral medications for Erectile Dysfunction

Oral medications are usually the first option doctors use to treat erectile dysfunction. Viagra and the related drugs Cialis and Vardenafil, are generally successful drugs for many men. These medications are taken by mouth, are usually less expensive, and can be used more discreetly and spontaneously than some other therapies.

Sex counseling and sex therapy for Erectile Dysfunction

Counseling and therapy with a qualified counselor/psychologist can help the man and his partner identify, understand, and cope with their sexual concerns. Sex therapy also incorporates specific techniques to remove the stressful element from lovemaking, increasing sexual stimulation, and enabling the man to focus on sensual pleasure and intimacy.

Penile injection of Alpostradil for Erectile Dysfunction

Alpostradil, which is injected into the side of the penis, is very effective, safe, and reliable. Caverject, the first drug approved by the FDA as a treatment for impotence, relaxes the smooth muscles surrounding the penile arteries, causing them to dilate and permit an increased flow of blood. A related but generally less effective treatment, intraurethral therapy, works in much the same way, but men insert pellets of alpostradil into the urethra.

Vacuum erection devices for Erectile Dysfunction

These devices offer a treatment option without the need for medication. The devices work by creating an artificial erection using vacuum suction on the penis itself. While the devices are well-tolerated they may not offer the same benefits of other therapies in terms of spontaneity and being discreet. These devices are a suitable option in select men such as those who cannot tolerate medications, do not respond to medical therapy, and/or are not interested in penile prosthesis.

Penile implants for Erectile Dysfunction

Implants are highly reliable and allow a degree of spontaneity that makes them a very satisfactory option for men with erectile dysfunction. Most insurance providers cover the cost of the procedure. The risk of surgical complications or subsequent infection or mechanical failure has decreased significantly through improvements in the implants in recent years. Overall, penile prosthesis surgery offers the highest satisfaction rates of any treatment for ED for both the patient and his partner. Different types of penile prostheses are available and we can help you decide which device is right for you.