Treatment Sex Therapy
- A significant number of men develop
impotence from psychological causes that can be overcome. When a
physiological cause is treated, subsequent self-esteem problems
may continue to impair normal function and performance.
Qualified therapists (e.g., sex counselors, psychotherapists)
work with couples to reduce tension, improve sexual
communication, and create realistic expectations for sex, all of
which can improve erectile function.
- Psychological therapy may be effective in conjunction with
medical or surgical treatment. Sex therapists emphasize the need
for men and their partners to be motivated and willing to adapt
to psychological and behavioral modifications, including those
that result from medical or surgical treatment.
- Oral medications used to treat erectile
dysfunction include selective enzyme inhibitors (e.g., sildenafil [Viagra®], vardenafil HCl [Levitra®], tadalafil [Cialis®])
and yohimbine (Yohimbine®, Yocon®).
- Selective enzyme inhibitors are available by prescription and
may be taken up to once a day to treat ED. They improve partial
erections by inhibiting the enzyme that facilitates their
reduction and increase levels of cyclic guanosine monophosphate
(cGMP, a chemical factor in metabolism), which causes the smooth
muscles of the penis to relax, enabling blood to flow into the
- Patients taking nitrate drugs (used to treat chest pain) and
those taking alpha-blockers (used to treat high blood pressure
and benign prostatic hyperplasia should not take selective
- Men who have had a heart attack or stroke within the past 6
months and those with certain medical conditions (e.g.,
uncontrolled high blood pressure, severe low blood pressure or
liver disease, unstable angina) that make sexual activity
inadvisable should not take Cialis®. Dosages of the drug should
be limited in patients with kidney or liver disorders.
- Viagra® is absorbed and processed rapidly by the body and is
usually taken 30 minutes to 1 hour before intercourse. Results
vary depending on the cause of erectile dysfunction, but studies
have shown that Viagra is effective in 75% of cases. It helps
men with erectile dysfunction associated with diabetes mellitus
(57%), spinal cord injuries (83%), and radical prostatectomy
- In clinical studies, Levitra® has been shown to work quickly,
provide consistent results, and improve sexual function in most
men the first time they take the drug. It also has shown to be
effective in men of all ages, in patients with diabetes
mellitus, and in men who have undergone radical prostatectomy.
Cialis® has been shown in clinical trials to stay in the body
longer than the other selective enzyme inhibitors. It promotes
erection within 30 minutes and enhances the ability to achieve
erection for up to 36 hours.
- Common side effects of selective enzyme inhibitors include
headache, reddening of the face and neck (flushing),
indigestion, and nasal congestion. Cialis® may cause muscle
aches and back pain, which usually resolve on their own within
- Yohimbine improves erections for a small percentage of men. It
stimulates the parasympathetic nervous system, which is linked
to erection, and may increase libido. It is necessary to take
the medication for 6 to 8 weeks before determining whether it
will work or not.
- Yohimbine has a stimulatory effect and side effects include
elevated heart rate and blood pressure, mild dizziness,
nervousness, and irritability. Yohimbine's effects have not been
studied thoroughly, but some studies suggest that 10% to 20% of
men respond to treatment with the drug.
- Ease of administration makes oral medication advantageous. Some
drugs, however, are suitable for only a relatively small group
of men, and in many cases, oral medications may by less
effective than other treatments.
- Self-injection involves using a short needle to
inject medication through the side of the penis directly into
the corpus cavernosum, which produces an erection that lasts
from 30 minutes to several hours. Prostaglandin (alprostadil,
Caverject®, Edex®), and phentolamine (Regitine®) produce results
similar to Viagra but are localized in the penis after
injection. They cause vascular dilation and a relaxation of
smooth muscle. Prostaglandin is the only substance currently
approved for erectile dysfunction treatment. Phentolamine is a
heart medication with similar effects used by some physicians to
- These drugs have been shown to produce erections in 80% of men
who inject them. Some men claim that they produce erections that
feel natural and improve sex. The injections are relatively
painless and create an erection that begins about 5 to 15
minutes after the injection. It is recommended that
self-injection be performed no more than once every 4 to 7 days.
Side effects include infection, bleeding, and bruising at the
injection site, dizziness, heart palpitations, and flushing.
There is a small risk for priapism (an erection that lasts for
more than 6 hours and requires medical relief). Repeated
injection may cause scarring of erectile tissue, which can
further impair erection.
- containing prostaglandin (aprostadil),
like Muse® (Medicated Urethral System for Erections), may be an
alternative to injection. Using a hand-held delivery device, a
man inserts a prostaglandin pellet through the meatus (penis
opening) into the urethra. Prostaglandin is absorbed through the
urethral mucosa and into the surrounding erectile tissue. It is
available with a prescription, is well tolerated, and may
improve erections in 60% of men who use it.
- In addition to the side effects associated with injecting
aprostadil, pain in the penis and perineum (area between scrotum
and rectum) may occur with suppository use.
- Vacuum devices work by manually creating an
erection. The penis is inserted into a plastic tube, which is
pressed against the body to form a seal. A hand pump attached to
the tube is used to create a vacuum that draws blood into the
penis, causing the penis to become engorged. After 1 to 3
minutes in the vacuum, an adequate erection is created. The
penis is removed from the tube and a soft rubber O-ring is
placed around the base of the penis to trap blood and maintain
the erection until removed. The ring can be left in place for 25
to 30 minutes.
- Vacuum devices work best in men who are able to achieve partial
erections on their own. They are easy to use at home, require no
other procedure, and typically improve erections regardless of
the cause of impotence. Some men experience a numbing feeling
after placing the O-ring. Since the penis is flaccid between the
ring and the body, the erection may be somewhat floppy.
Erectile Dysfunction Causes
Erectile Dysfunction Diagnosis