Erectile Dysfunction

Overview of Erectile Dysfunction

Understanding Erectile Dysfunction

During male sexual arousal, blood goes into the penis, causing it to stretch. Smooth muscles relax and compress blood in the veins, trapping blood inside the penis, which makes it grow firm and erect. After ejaculation, these veins reopen, and blood exits the penis, causing it to soften.

The body needs five elements to achieve a healthy erection:

1. The correct hormone stimulation
2. A healthy, intact nervous system to begin arousal
3. Healthy arteries to carry blood into the penis
4. Healthy veins to trap blood in the penis
5. Healthy erectile tissue

A problem in any one of these areas can cause ED. Risk factors for ED include diabetes, tobacco use, cardiovascular disease, high blood pressure, high cholesterol, history of chemotherapy or radiation treatment, low testosterone, sleep apnea and prior surgeries, like a prostatectomy or bladder cancer removal.

Diagnosis

To determine the cause of your erectile dysfunction, you’ll meet with our experienced and fellowship-trained specialists who will talk with you about your individual concerns and perform a detailed history and examination. Together, you will create a personalized treatment plan to rebuild your intimacy and confidence and restore your relationship with your partner.

During your appointment, your doctor will ask you a lot of questions to get know you and understand your concerns. They will help you feel comfortable talking about these issues and work with you to find a solution. In addition to taking a detailed health history and a physical exam, your doctor will ask you about your:

• Relationship status
• Symptoms
• Current medications
• Injuries or prior surgeries in this area
• Recent changes in health, behavior or relationship status
• Previous care for this condition
• Expectations of care
• Current erection firmness

Treatments for Erectile Dysfunction

There are several options to treat ED, depending on its cause:

• Medications. ED is commonly treated using oral medications, which work by increasing blood flow into the penis and protecting the endothelial lining of its blood vessels. ED medications are only effective with intact nerves and healthy penile tissue. Since these pills increase blood flow into the body, they can sometimes cause facial flushing, nasal congestion, blue-tinted vision, headaches and acid reflux.
  
• Penile Doppler Ultrasound. This ultrasound test can be used to help diagnose and determine the cause of your ED. This is often used when medications no longer work or to evaluate a curvature in the penis during erections known as Peyronie’s disease. This test can be diagnostic as well as therapeutic in determining how you will respond to intracavernosal injections.
  
• Intracavernosal injection (ICI) therapy. A common treatment for ED, ICI involves a painless injection directly into the side of the penis to create a natural, spontaneous erection. During an office visit, your doctor teaches you how to self-administer the injection using a small, diabetic needle. Your doctor will also go over all the safety information for using this medication to minimize the risk of priapism (prolonged erections lasting longer than four hours). You can only inject once every 24 hours and must abstain from taking other erectogenic medications or drugs.
  
• Vacuum erection device. This hollow tube is placed over the the penis to suction blood into the penis and create a natural erection. Once an erection is achieved, a small band slides down to the base of the penis to trap the blood and maintain the erection. Vacuum pumps can only be worn for 30 minutes before you must allow the blood to flow back into the penis. This is not an option for patients using blood thinners. The vacuumed blood is deoxygenated, so it may make the penis appear cold or blue tinted. Your doctor will teach you how to use a vacuum device to ensure it is painless.
  
• Intraurethral suppositories. These medications are inserted into the urethra and dissolved by rubbing the penis. After 10 minutes, the suppository creates a natural erection. These can cause a burning sensation or pain.
  
• Penile implant. In an outpatient surgery that takes less than an hour, your doctor can implant a prosthetic device into the penis to create an erection. A pump is concealed within the scrotum and connected to two cylinders within the penis. By pressing a button in the scrotum, you can achieve a natural, spontaneous erection using your own anatomy. The erection is deflated by pressing the same button. Implants are effective in about 98% of patients. You will have presurgical testing to ensure you are healthy enough to undergo surgery.
• Shockwave therapy. This option for mild to moderate ED is currently offered in clinical trials at IU Health through the Male Sexual and Reproductive Medicine Program. Shockwave therapy is delivered in your doctor’s office in series of six weekly treatments. Through little shockwaves of energy directed into the penis or perineum, this treatment regenerates blood flow through the recruitment of stem cells. By restoring blood flow, shockwave therapy may help men for whom ED pills no longer work. This therapy is not an option for men with severe ED or those whose ED isn’t caused by related blood vessel issues.
  
• Penile rehabilitation. The Male Sexual and Reproductive Medicine Program at IU has a strong penile rehab program for men who undergo radical prostatectomy, cystectomy or bowel surgeries to help recover and restore your erections, continence and intimacy with your partner. We work together with you, your surgeon, pelvic floor physical therapists, sexual counselors and your partner to provide you with the best care to improve your quality of life after cancer surgery. During the penile rehab program, you will be closely followed for one to two years after your surgery and may be may be instructed to take medications after surgery to help maintain healthy penile tissue, recover nerves and preserve erections.

Research

Our partners at IU School of Medicine offers the only Male Sexual and Reproductive Medicine Program in the state with a fellowship to train the next generation of physician leaders in novel and innovative treatments for ED, Peyronie’s Disease, sexual dysfunctions and male Infertility. Researchers are conducting ground-breaking studies on improvement in sexual and reproductive health and quality of life for our patients.

Physicians at the IU Health Male Sexual and Reproductive Medicine Program are performing research examining:

• Treatments for ED and its relationship to cardiovascular disease and preventative health
• Shockwave therapy for ED
• Erectile function recovery and penile rehabilitation programs following prostate cancer patients by exploring a large database of prostate cancer patient data
• Post-prostate cancer testosterone therapy and nerve-sparing surgery
• Surgical outcome and quality improvement studies to make penile implant surgery safer and last longer with fewer risks
• Using PET scans to predict how to map out prostate cancer surgery to preserve nerves during radical prostatectomies and follow-up care using erectile function recovery (penile rehabilitation therapy)
• Novel research on improving treatment and outcomes for Peyronie’s Disease

Wellness and Support

IU Health’s Male Sexual and Reproductive Medicine Program offers quarterly webinars to discuss treatment options and support for ED, sexual dysfunctions, Peyronie’s disease, prostate cancer and penile rehab, including topics such as how implants work. We also have a prostate cancer support group that meets monthly.