ED Treatment Options — A New Perspective

Shawn Blick, MD , Men’s Sexual Health Expert & Penile Implant Specialist

Interestingly, after a careful consideration of the reversible causes of ED (i.e. Low T, Low Thyroid, High Cholesterol and Triglycerides, Diabetes, Blood pressure meds, Antidepressant meds, etc.), urologists actually only have 5 treatment options to offer to their patients. During our training, we are taught “goal-oriented therapy”, starting with the simplest treatment and progressing towards the relatively more complicated therapies. In this paradigm, a urologist may decide to avoid performing any diagnostic tests because the same five treatment options exist regardless of the test results. In my practice, I have a different perspective, and I prefer to pursue “cause-oriented therapy”. In other words, I offer diagnostic testing in order to confirm the medical cause of the ED before I recommend any treatment options. In my experience, men want to know why they have ED before they accept any long term treatment options. On the contrary, when a patient has normal testing, it suggests the problem is psychological, prompting a referral to the sexual therapist in our office. This allows a patient to avoid any unnecessary treatments or surgery, and it usually cures the ED. Basically, the cause-oriented approach allows me to advocate the best treatment option for each individual patient.

So…What are the 5 treatment options for ED? They are Pills, Injections, Urethral Suppositories, Vacuum Erection Devices, and Penile Implants. The first four treatment options are all long term medical therapies that can help manage the problem, but none of them actually provide a cure for erectile dysfunction. Although we have patients that utilize all of these medical treatments successfully, approximately 70% of patients discontinue their therapy within one year of follow-up due to the lack of spontaneity and reliability, and the presence of ongoing side effects and cost.

Fortunately, when medical treatments fail, there is Hope!!! The single best treatment for erectile dysfunction is the Penile Implant. It has the highest patient satisfaction rate compared to any other treatments available. As opposed to the medical therapies listed above, the Penile Implant is the only treatment that definitively cures your ED. Simply, it’s a 30 minute… minimally invasive… outpatient procedure that fixes the problem. The Penile Implant is a water filled device that is placed through a 1-inch incision located just above the penis in the midline. It consists of a pump in the scrotum, a reservoir behind the pubic bone, and 2 cylinders that fill the 2 chambers that normally fill with blood during a normal erection. So, when you squeeze the pump, the fluid (salt water) moves from the reservoir into the cylinders, creating a rock hard erection that lasts for as long as you want…whenever you want. The placement of the implant does not affect your penile sensations, ejaculations or orgasms. The device is completely invisible and inside you, and it’s very discrete. In fact, a new partner may not be able to notice that you have an implant, and it will not be detected in the airport. The implant is hard when you want to be hard and it’s soft when you want to be soft. When its inflated, it will feel natural, and it will feel good for both you and your partner. The implant is very durable with 90% success at 10 years. In other words, if you are 65 years old, you will have a functioning implant at 75 years old, 90% of the time. Many patients actually have their implants for as long as 12-15 years. If the implant breaks, it’s very easy to remove the old product and replace it with a new device. Because of all of these features, 96% of patients are highly satisfied with their implant. Furthermore, the recovery is modest. Patients are sent home the same day as the procedure. After one week of recovery, most of the discomfort and swelling is over and 95% of patients are free of pain medications. At 3 weeks, patients are completely healed, and they are ready to be trained on inflating the device. At 4 weeks, patients are safe to proceed with normal sexual intercourse. So, the penile implant is a transformational life changing procedure with a modest and quick recovery, and it is usually covered by insurance!!!!

While the penile implant is often the best solution for men who have failed other conservative therapies, it still remains a relative secret to the community at-large due to a lack of education and marketing. For many years, penile implants have been misunderstood, and physicians (both primary care physicians and urologists) have failed to educate their patients about this highly successful solution. Despite the scary image, the penile implant is clearly quick and easy to perform, and it has a modest recovery with patients being completely healed in only 3 weeks. Importantly, only a small percentage of urologists perform penile implants in high volume. Therefore, it is very important to find a urologist who specializes in Men’s Health and Penile Implants (Prosthetic Urologist) in order to obtain the most comprehensive evaluation and effective treatment for your ED.