The approach to Erectile Dysfunction
Erectile Dysfunction (ED) affects men of all ages and is an important issue at the men’s health clinic.
There are two important questions in this order of priority for men:
- What can I do about it? Treatments usually work whatever the cause!
- What is the Cause of The ED?
The causes of Erectile Dysfunction
An underlying disease process is found in only a small proportion of men with erectile dysfunction. However, the underlying problem may be significant and therefore a blood test is usually indicated.
Performance anxiety often contributes to erectile dysfunction. Unfortunately, worrying about losing an erection will often cause that feared outcome. General anxiety, stress or depression may occasionally be the cause of the problem.
Low Testosterone may cause a low libido and occasionally erectile dysfunction.
Erectile dysfunction in older guys is often linked to narrowing of the the penile arteries caused by atherosclerososis (furring of arteries caused by fatty plaques). Erectile dysfunction is linked to the causes of atherosclerosis:
Older men with erectile dysfunction are at higher risk of cardiovascular events than men without ED. Cardiovascular risk factors may of course be managed or treated.
Which routine tests might be needed?
The following blood tests may be indicated:
- Testosterone (Other hormone tests may be indicated when there are other pointers to a hormonal problem)
- Fasting lipids, Glucose, Full Blood Count
- Routine biochemistry
What can be done about my erectile dysfunction?
This is the whole point of the exercise! Thankfully there are some very effective treatments.
Treatments for erectile dysfunction involve taking a tablet, using a gel or self-administering an injection. The doctor wants you to get good results and will help you to choose the most cost-effective option.
Underlying causes will need treatment. Testosterone replacement therapy is indicated in only a small number of men with ED.
Which tablets used to treat Erectile Dysfunction?
You have heard of heard Viagra which is a class of medication called a ‘PDE5 inhibitors’ and works by relaxing the blood vessels in the penis. Other brands include ®Levitra and ®Cialis. These treatments are a good starting point because they are safe & usually well tolerated.
The brands differ in:
- Cost (generic viagra is the cheapest)
- Speed of onset (®Levitra / Vardenafil is probably the fastest acting commercially available in Australia)
- How long they last for (®Cialis lasts the longest)
Viagra is available as affordable generic sildenafil. ®Cialis is soon to be released in Australia as generic Tadalfil.
The main issue with Sildenafil (®Viagra) is that it needs to be taken a full hour before sex for it to work properly.
Dr Beatty is able to offer scripts for a variety of compounded PDE5 inhibitors. These are available through specialized pharmacies and offer the following advantages:
- Cost per dose is often considerably cheaper – even down to around $4 per dose
- Avanafil is not available any other way in Australia
- Combination of PDE5 inhibitors that optimize both speed of onset with length of action
The compounded versions are made in Australia and should be of a very high quality. Having said that, some guys prefer the factory-made TGA-approved products such as ®Cialis.
What about Gel?
Gel or injections contain Vasodilators which work by opening up the blood vessels in the penis. The Gels are a great alternative to those who are not willing to injection the medication with a needle. Gels are, however, a little less effective in men with more severe ED.
The Gels are inserted into the tip of the penis with an applicator. The Gel package consists of 10 x pre-filled tapered syringes. Insert the blunt tip of the syringe into the opening of the penis and gently depress the plunger. Keep the tip of the penis closed off with your thumb/index finger or the syringe to keep the medication inside the urethra. Use your other hand to squeeze and relax the whole penis repeatedly over 2-3 minutes. This will spread the medicine around the inside of the urethra and encourage absorption of the medication into the Corpus Cavernosa.
An erection follow after around 15 minutes.
What about injections?
Most guys are understandably reluctant to embark on this treatment option. However, this form of treatment is usually very rewarding. Injection therapy is the most successful non-surgical treatment of erectile dysfunction. After all, if injections didn’t work then there would be no demand for them!
You give yourself the injection directly into the side of the penis with an ultrafine needle. You probably won’t even feel the needle, so just ‘forget’ that a needle is involved!
Erection follows within around 15 minutes of the injection – voila!
The ‘upside’ of the injections usually outweigh the risks which include:
- Fibrosis (hardening just under the skin) occurs in around 1 in 20 men after prolonged therapy.
- A Prolonged erection (Priapism) lasting 4 hours or more is an emergency. Priapism is most likely to occur when the dose is too high and occurs also in around 1 in 20 men. A normal erection will not last more than 1 hour.
®Caverject is the branded injection of Prostaglandin E1. Caverject impulse is an all-in-one syringe which does not require separate mixing.
There is also a whole range of compounded injections available through the clinic. Dr Beatty prescribes the medication which you obtain through a compounding pharmacy. You draw up the dose through the vial with a 1ml insulin syringe. The typical vial of 5mls to 6 mls will last for 10 or more injections. This may be a very a cost-effective option. Ingredients are varied to keep side effects, particularly pain, to a minimum. The strength of the vials may also be increased according to response.
The compounded injections may include Phentolamine, Papaverine, Prostaglandin (PGE1), occasionally Atropine or Aviptadil. Men who have not had good results with ®Caverject may get good results with the stronger compounded injections. Men who experience burning or pain as a side effect may be fine with the non-prostaglandin injections.
Instruction in the use of injections is available at the clinic under direct supervision with Dr Beatty. Don’t worry – the dose is small enough to not cause embarrassment when you leave the clinic! You’ll titrate up the dose yourself at home. Just remember that you should not increase beyond that required for an erection lasting up to 1 hour.