A number of therapeutic options exist for the treatment of Male Sexual Dysfunction. It is not unusual for men to have several contributing factors to their difficulties and/or to have multiple overlapping sexual difficulties. It is therefore not unusual to combine several of the following therapies to help achieve satisfactory sexual performance.
When men (and couples) experience sexual difficulties there can be psychological causes and consequences alone or in combination with recognized physical difficulties. Professional counseling gives both the insight and potential solutions to a difficult problem. It is unusual for men and women in the throughs of sexual dysfunction to not have some primary or secondary emotional/psychological component.
Vacuum Erection Device Therapy
By placing a hollow cylinder connected to a hand held or battery powered pump around the penis, it is possible to create an erection by “pulling” blood into the penis. A constricting band is placed at the base of the penis and the cylinder removed. This can be used alone or in combination with other therapies to enhance erectile response. Vacuum devices mat also be helpful in managing penile curvature (Peyronie’s Disease).
A constriction band is a rubber band-like device that is placed at the base of the penis and is used to prevent blood from escaping from the penis leading to early loss of erection. These bands are sometimes used alone or in combination with other therapies to maintain erections.
5 Phosphodiesterace Inhibitors (e.g. Tadalaphil aka Cialis®, Sildenaphil aka Viagra®, Vardenaphil aka Levitra®)
Taken by mouth, these drugs selectively enhance blood flow in the penis improving erection response to stimulation. These drugs, which first became available in the 1990’s, revolutionized treatment of erectile dysfunction.
Hormones (i.e. Testosterone)
Long recognized as the “predominant male hormone” in men with low testosterone and sexual dysfunction this medication alone or on combination with other sexual dysfunction therapies can restore and enhance sexual activity. The most efficient forms of therapy are by skin application (gel or patch), injection or implant.
Nonselective and Selective Serotonin Reuptake Inhibitors
These oral agents are useful in managing ejaculatory disturbance (e.g. premature ejaculation). Some of these drugs are often considered anti-depressants and/or anti-anxiety medications.
Intracavrenosal Injection Therapy (e.g. Alprostadil, Phentolamine, Papaverine)
These drugs are injected (via a small insulin-type needle and syringe) into the side of the penis creating an improvement in blood flow in the penis. These drugs are sometimes used as single agents or in a “cocktail” with success rates that exceed that of oral drug therapies.
Intraurethral Therapy (e.g. Intraurethral alprostadil aka MUSE®) – These drugs are tiny pellets placed in the male unrine channel (Urethra) with a special applicator. These pellets dissolve and improve penile blood flow when the drug is absorbed into the penis.
Intralesional Therapy (e.g. verapamil, interferon, Xiaflex)
These are injections of medications into the penis with the intent of softening scar tissue (condition called Peyronie’s Disease) and reducing penile curvature that results from the scar tissue in the penis and improving sexual function. This therapy may also be delivered by the use of electrical current (Iontophoresis).
In otherwise healthy individuals, when an isolated injury to the main artery of the penis is discovered, the blood flow to the penis can sometimes be improved by microsurgically attaching a fresh artery to the penis thereby establishing flow.
Penile Plication/Penile Grafting/Reconstruction
When erectile capacity is good and a penile curve/deformity prohibits satisfactory intercourse, the penis can be straightened surgically by placing stitches on the opposite side of the curve, thereby “pulling” the penis straight. In more severe cases, depending on the position, scar tissue can be incised or removed and a tissue graft placed. Depending on each patients ability to initiate and maintain erections and the degree of deformity created by the penile scar both grafting and plication may be employed in combination with treatments for Erectile Function.
For individuals who have responded poorly to the other options and wish to pursue their inability to initiate and/or to maintain erections that are rigid enough for intercourse, implantation of bendable or inflatable rods inside the penis offers and excellent alternative. When surgery is undertaken, the patient “gives up” their own ability to achieve erections but achieves a reliable way to achieve erections on demand. As with any prosthetic there is a risk of infection (necessitating device removal) or mechanical failure. The latter is inevitable with inflatable systems. Penile Prosthetics are constantly being improved with significant reduction in these risks.