What is erectile dysfunction and how is it treated?

Underlying condition:

Erectile dysfunction (ED) is an issue with the arousal or excitement phase of sexual activity. It is an inability to get and/or keep an erection to satisfy yourself and/or partner.

Risk factors:

Age, smoking, diabetes, high blood pressure, high cholesterol, depression, obesity, sedentary lifestyle.

What you should know:

ED can be a sign of heart disease and other conditions.  If you have ED, you should work with your family doctor to treat these issues (e.g. improve blood pressure, cholesterol, blood sugar).

Treatment options:

·         Lifestyle modifications – Improve diet, increase physical activity, stop smoking.

·         Sexual counselling – Men with ED often benefit from sexual counselling to improve communication with their partner and to overcome performance anxiety.

·         Phosphodiesterase type 5 inhibitors (PDE5i) – E.g. sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra). May be combined with testosterone if testosterone levels are proven to be low/borderline low. A common issue that can decrease the effectiveness of these pills is improper use – see the chart at the end of this post.

·         Vacuum erection device (VED) – Cumbersome, but a decent low-cost option as you should only need to purchase one: https://www.remingtonmedical.com/product-category/pelvic-health-products/vacuum-erection-pumps/

·         Intraurethral suppository (IU) – No needle, but can be painful in its own way. Most patients won’t pursue this option.

·         Intracavernosal injection (ICI) – Often involves a combination of alprostadil, papaverine and phentolamine which is self-administered. Not as painful as you would think. Follow this link for an instructional video: https://www.dylanhoaremd.ca/videos/trimix

·         Penile prosthesis implantation – Often a last resort, it is a very effective and safe surgical treatment. I typically implant the AMS 700 inflatable penile prosthesis.

·         Low-intensity extracorporeal shock wave therapy (ESWT) – Non-invasive, pain free option. Will not work for everyone, but is an excellent option for many men.