Erectile Dysfunction

Erectile Dysfunction

Erectile dysfunction (ED) a man’s lack of ability to achieve or maintain an erection sufficient for his sexual needs or the needs of his partner. Most men experience this at some point in their lives, usually by age 40.

Some men, however, experience constant, complete erectile dysfunction (impotence), and others, partial or brief erections. Frequent erectile dysfunction can cause emotional and relationship problems, and often leads to diminished self-esteem. Erectile dysfunction has many causes, most of which are treatable, and is not an expected consequence of aging.

Do you have to live with ED? NO!

Did you know that nearly every man can be successfully treated?

Call us today at 425-4548016 (Kirkland) or 425-454-8016 (Bellevue) to schedule an appointment or to talk with a Urologist

How Common is ED?

  • 1 in 10 men 1
  • Over 30 million American men 2
  • 90% physical, 10% psychological 3

Physical Causes of Erectile Dysfunction

  • Diabetes
  • Heart disease
  • Surgery (Prostate, Bladder, Colon, Rectal)
  • Medications
  • Spinal injury
  • Hormone Imbalance

Heart Disease and Erectile Dysfunction

Coronary artery risk factors are associated with ED

  • If you have cardiovascular disease, chances are you may be suffering from ED… and vice versa
  • In fact, ED could also stand for endothelial disease

Treatment Options:

Lifestyle Changes

Treatment Options

One way to improve erectile dysfunction is to make some simple lifestyle changes. For some men, adopting a healthier lifestyle, such as quitting smoking, exercising regularly, and reducing stress, may be all that is needed to find relief. For those who require more intensive treatment, adopting these lifestyle changes in addition to other treatments can improve successful outcomes.

Oral Medications

There are only three oral drugs approved by the FDA to treat erectile dysfunction: Cialis, Levitra, and Viagra. They all work by increasing the flow of blood into the penis so that when a man is sexually stimulated, he can get an erection.

Cialis, Levitra, and Viagra work by a similar mechanism to cause erections. There are subtle differences iin how long and quickly the drug works. Levitra works a little longer than Viagra. They both take effect in about 30 minutes. With Levitra, the effects last for about 5 hours. With Viagra, the effects last approximately 4 hours.

Cialis works a bit faster (within about 15 minutes), and the effects last much longer -- up to 36 hours in some cases.

Hormone Replacement

Testosterone is a hormone produced by the testicles and is responsible for the proper development of male sexual characteristics. Inadequate production of testosterone is not a common cause of erectile dysfunction; however, when ED does occur due to decreased testosterone production, testosterone replacement therapy may improve the problem.

As a man ages, the amount of testosterone in his body gradually declines. This natural decline starts after age 30 and continues throughout life. Other causes of lowered testosterone levels include:

  • Injury, infection, or loss of the testicles
  • Chemotherapy or radiation treatment for cancer
  • Genetic abnormalities such as Klinefelter's Syndrome (extra X chromosome)
  • Hemochromatosis (too much iron in the body)
  • Dysfunction of the pituitary gland (a gland in the brain that produces many important hormones)
  • Inflammatory diseases such as sarcoidosis (a condition that causes inflammation of the lungs)
  • Medications, especially hormones used to treat prostate cancer and corticosteroid drugs
  • Chronic illness
  • Chronic kidney failure
  • Liver cirrhosis
  • Stress
  • Alcoholism

Without adequate testosterone a man may lose his sex drive, experience erectile dysfunction, feel depressed, have a decreased sense of well-being, and have difficulty concentrating.

Testosterone deficiency can be treated by:

  • Intramuscular injections, generally every two or three weeks
  • Testosterone patch worn either on the body or on the scrotum (the sac that contains the testicles)
  • Testosterone gel
  • Mucoadhesive material applied above the teeth twice a day
  • Oral tablets

Each of these options provides adequate levels of hormone replacement; however, they all have different advantages and disadvantages. You may talk with our doctors to see which approach may be right for you.

Vacuum Erection Devices

A vacuum constriction device (VCD) is an external pump with a band on it that a man with erectile dysfunction can use to get and maintain an erection. It consists of an acrylic cylinder with a pump that may be attached directly to the end of the penis. A constriction ring or band is placed on the cylinder at the other end, which is applied to the body. The cylinder and pump are used to create a vacuum to help the penis become erect; the band or constriction ring is used to help maintain the erection. The pump helps the penis become erect while the band maintains the erection.

Studies suggest that about 50%-80% of men are satisfied with the results of VCD. As with any other method of treatment for erectile dysfunction (ED), satisfaction rates may decrease with time.

Vacuum constriction devices should not be used by men who may have a significant congenital bleeding disorder or a disorder that predisposes them to a condition called priapism (a prolonged, sometime painful erection lasting over several hours). Examples include sickle cell anemia, some forms of leukemia, and other blood conditions.

Injection Therapy

Alprostadil is the medication and is delivered via the injection method causing an erection firm enough for sexual intercourse in over 80% of men with erectile dysfunction, regardless of their age or the cause of their problem. Alprostadil is also delivered via a suppository but is not as effective as when it is delivered by penile injection. When delivered by suppository, it produces an erection in approximately 30-40% of men with ED. It begins to work in about 5 to 20 minutes. It is advised to use no more than 3 times per week with at least 24 hours between each use.

Penile Implants

A penile prosthesis is another treatment option for men with erectile dysfunction. These devices are either malleable or inflatable. The simplest type of prosthesis consists of a pair of malleable (bendable) rods surgically implanted within the erection chambers of the penis. More recently, many men choose a hydraulic, inflatable prosthesis, which allows a man to have an erection whenever he chooses and is much easier to conceal. It is also more natural. Our physician may recommend a penile implant when there is a clear medical cause for ED and when the problem is unlikely to improve with other medical treatments. The implant works with two cylinders, one a reservoir and one a pump. They are both implanted surgically. To inflate the implant, the man presses on the pump. The pump will then transfer fluid from the reservoir to the cylinders in the penis. This inflation causes an erection. Pressing on the deflation valve returns the fluid to the reservoir and the penis to a flaccid state. About 90-95% of inflatable implants produce erections. Satisfaction rate are very high with 80-90% of men say they would choose the surgery again.

1 Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts male aging study. J Urol Jan 1994; 151: 54-61.

2 Sun P, Seftel A, Swindle R, Ye W, Pohl G. The costs of caring for erectile dysfunction in a managed care setting: evidence from a large national claims database. J Urol Nov 2005; 174: 1948-1952.

3 Mulligan T, Teitelman J. Geriatric Sexual dysfunction. VA Med Q Apr/Jun 1991; 118(2): 97-9.