By Alvaro Lucioni, MD, Virginia Mason-Federal Way
Erectile dysfunction (ED) or impotence is a common condition.
More than 30 million men in America experience ED. Unfortunately, many think the cause is “all in their head.”
There is a medical or physiological cause for the condition in up to 90 percent of cases. Psychological causes are not common. After an appropriate evaluation, most men can undergo successful treatment.
However, many do not want to talk about the issue, and some are even embarrassed to bring it up with their physician. Physicians can also be uncomfortable managing ED, and thus many men do not undergo evaluation and treatment.
The most common reason for impotence is an alteration in the normal physiology of erection. There are four main steps in the process of achieving an erection:
1. Desire for an erection
2. Signals from the brain to the pelvis urging an erection
3. Increased blood flow to the penis
4. Blood stasis in the penis to maintain an erection
ED can result due to a problem at any one of these steps. When I evaluate a patient experiencing impotence, I check each of these steps to ensure the treatment is targeted appropriately. The evaluation also includes obtaining a detailed medical history, conducting a thorough examination, performing blood tests (such as checking testosterone levels), and recommending radiological tests as needed (for instance, penile color Doppler ultrasound).
Treatment depends on the cause of the condition. Some men can have a reversible cause, such as low testosterone. Replenishing testosterone can help.
For those who experience ED due to a vascular or neurological issue, the initial treatment involves the use of a medication such as Viagra, Cialis or Levitra. Men who do not respond to these medications, or who do not wish or cannot take these medications, have other options that include:
1. Vacuum Erection Device: a manually or battery operated pump that helps increase blood flow to the penis.
2. Muse (alprostadil): a small suppository placed into the urethra that is rapidly absorbed and increases blood flow to the penis.
3. Penile injections (alprostadil, Bimix, Trimix, Quadmix): a small quantity of medication is injected into the penis to increase blood flow.
4. Penile prosthesis (IPP): surgical procedure involving placement of a penile implant with a pump. While this treatment does involve surgery, it is highly successful and more than 90 percent of patients are satisfied with the outcome. IPP restores spontaneity to sexual encounters.
Erectile dysfunction affects quality of life. Importantly, the condition is treatable.
About the writer: Urologist Alvaro Lucioni, MD, treats patients at the Virginia Mason Clinic in Federal Way. He will speak about impotence at a free men’s health event at 6 p.m. Wednesday, Sept. 11, at the clinic. To register, call (253) 874-1604, then press 0, between 8 a.m. and 5 p.m. Monday-Friday, or email: firstname.lastname@example.org.