CURRENT TREATMENT OPTIONS FOR IMPOTENCE

A Self-Injection Kit Erections obtained by injection usually last 30-60 minutes and may not subside when a man has an orgasm or ejaculates, and may interfere with the patient's social/business agenda. An overdose can cause a prolonged and painful erection that may require medical or surgical intervention. Frequent use may lead to the build-up of scar tissue in the penis, further complicating the process of erection.       Sexual Counselling

Counseling and sex therapy are sometimes effective in helping patients with minor sexual problems, especially when these are caused by sexual ignorance and psychological factors.

Oral Medication

The introduction of Viagra by Pfizer in March, 1998,, marked the beginning of a revolution in the oral medical management of erectile dysfunction (ED, E.D., impotence). The launch of Viagra was soon followed by that of Levitra and Cialis. Other (even better) drugs are in the pipeline.
Effective oral medication has re-written the management of ED and is effective in nearly 70 - 75 % of cases. Several internet resources are available for more detailed information about these drugs and these will not be discussed in detail here.

Hormone Replacement Therapy

Testosterone is the major male hormone that gives men their sexual characteristics (deep voice, beard, chest hair). As men age, their level of testosterone decreases (andropause) and this may have an adverse effect on sexual performance. In proven cases of andropause, testosterone preparations may enhance potency and improve sex drive. However, this therapy must be only offered under expert medical supervision because many side effects can occur. Other endocrine disorders causing low testosterone, elevated prolactin, and other abnormal hormonal states, will require specialist endocrinologist attention.

External Vacuum Devices

Vacuum therapy involves the use of an external vacuum device, and one or more tension rings. This therapy is purported to be effective for over 90% of the men who use it. In fact, most can technically master its use in one day, and can use it to maintain erections for up to 30 minutes, even after ejaculation and/or orgasm.

Side effects, include petechiae (reddish, pinpoint-size dots) and ecchymoses (bruising). These conditions are not painful or serious and generally occur only during an initial learning period. Penile temperature may decrease 1-2 degrees during use. Vacuum devices are generally favoured by elderly patients with erectile dysfunction.

Penile Injections

The need for the use of injections has declined enormously since the advent of orally effective drugs like Viagra for ED. Papaverine, phentolamine, prostaglandin E1, and combinations of these drugs may be self-injected into the penis with a fine, small gauge hypodermic needle. Men must first be taught the procedure in the physician's office. These drugs produce erections of good quality for about 75-85% of patients who select this option. Some patients combine this method with the use of an external vacuum device. Not too many injections are used nowadays.

Penile Implants

A penile prosthesis (implant) is a fixed or mechanical device surgically implanted within the two corpora cavernosa of the penis, allowing erection as often as desired. Penile prosthetic implantation surgery gives good results and high satisfaction ratios with low complication rates when performed at centers of excellence. The incidence of side effects is low. Penile prostheses are available in semi-rigid, self-contained 2-piece inflatable, and 3-piece inflatable models. Newer advances in implant design have reduced the complication rates and increased satisfaction rates further.

Microsurgery

Penile revascularisation and venous ligation are microsurgical procedures similar in technical complexity to a heart by-pass operation although they clearly do not carry anywhere near the same risk to the life of the patient. ! With the advent of oral drugs, the need for microsurgical intervention nowadays is not frequent. Some patients, however, will request a microsurgical cure rather than have silastic devices inserted into their penises. They would prefer that implantable penile prostheses be tried only as a last resort.