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Conditions: Erectile Dysfunction

Treating Erectile Dysfunction

What factors determine which treatment a doctor recommends for ED patients?

Erectile dysfunction has many causes, both physical and psychological. Initial management for ED depends on the possible cause of the disorder in each individual patient. Treatment options for ED have significantly improved over the past few years and new research and medications continue to increase treatment choices. Treatments offered depend on the expertise of the physician you see. For example, a urologist may offer you a greater scope of treatments than a family physician.

Deciding which treatment is best depends on a number of factors, including:

  • Whether the cause of a patient's ED is physical, psychological or both
  • The presence of other medical conditions
  • The possibility of interaction with other medications
  • Which option is most likely to be effective for a particular patient
  • The preferences of the man and his partner

Physical issues that may cause varying degrees of sexual dysfunction include: injury or surgery; underlying medical conditions, such as diabetes and/or cardiovascular disease; lifestyle issues, such as smoking and the use of alcohol or other substances; and side effects of medications used to treat other conditions. Psychological issues that can lead to ED include performance anxiety, stress or secondary sexual dysfunctions (premature, delayed and/or retrograde ejaculation).

While the first step of good medical practice is to alter controllable risk factors (such as smoking, obesity, and alcohol abuse; stress, fatigue, depression; the adjustment of prescription medications etc.), most patients with ED will need an additional form of treatment. Therapies currently available include: sexual counseling and education, oral medications, injection therapy, vacuum devices and surgical treatments.

To determine an optimal treatment plan, physicians, patients and partners must have open and honest discussions of all available options. The process of care model outlines the general approach to treatment. First-line therapy includes (1) an attempt to correct controllable risk factors (2) addressing overt psychological issues (For example, if ED commences during the first relationship after a divorce, after being widowed or where obvious confidence issues are not being helped by medical therapies, such as a sex psychologist) (3) oral therapy (pills), which at this time is limited to the use of PDE5 inhibitors, such as sildenafil citrate (Viagra®), vardenafil hydrochloride (Levitra®) and tadalafil (Cialis®).

Second-line treatment includes the use of vacuum devices, intra-urethral (urine channel) suppositories and penile injection (intracavernosal) therapy and is typically reserved for men who have failed pills or have significant side effects and cannot tolerate these medications. Third-line therapy is for patients who have explored first- and second-line therapy and includes vascular surgery for very specific populations of men and penile implant (prosthesis) surgery.

Is treatment for ED covered by insurance? Are the medicines covered?

Treatment and medicine coverage by healthcare insurance varies from one insurance provider to the next, as well as from one plan to the next. It is best to contact the individual provider in order to determine whether the prescribed treatment(s) for ED is covered by insurance.

What non-surgical treatments are available for ED?

The most common non-surgical treatments for ED include:

  • Counseling/Psychotherapy/Sex Therapy
  • Oral medications
  • Penile (intracavernosal) injections
  • Vacuum devices
  • Intra-urethral suppositories

What is involved in Counseling/Psychotherapy/Sex Therapy?

Seeking psychological treatment is very common in the treatment of ED since ED can be both due to, and the cause of, psychological stress, sexual anxiety and/or other mental health and personal issues.

Psychological treatments often involve counseling or talk therapy and include talking about relationships and experiences with a mental or sexual health professional. Therapists can help find effective ways of coping with many of these problems. Therapists can offer practical strategies that can help reduce sexual anxiety and encourage communication around sexual issues. Often, meeting with a therapist, as few as three or four times, can be very helpful. For many couples affected by ED, talking with a therapist together may produce the best results, as good communication among partners can also help solve problems in an intimate relationship that might be contributing to ED and increasing sexual anxiety.

The risks and benefits of all treatment options should be discussed with a doctor before any mode of treatment is chosen, as patient and partner satisfaction is the primary goal.

Does taking vitamins or other dietary supplements help treat or prevent ED?

Many dietary supplements, such as herbs, vitamins, and minerals, have become increasingly popular as ways to treat medical conditions and improve health. Some are even labeled and marketed as promoting sexual health and improving ED. Don't assume "natural" products are safe and effective to use, as they are not usually reviewed and/or approved by regulatory health agencies such as the U.S. Food and Drug Administration (FDA). There is very little clinical evidence to determine whether dietary supplements provide benefits to people with ED. It is best to discuss the individual risks and benefits of any dietary supplements with your physician before taking them, as some may interact with current prescriptions or complicate current medical conditions.

It is worth noting that in ED drug trials, there is a 30% placebo response rate, meaning that 30% of men on a placebo (sugar pill) claim an improvement in their erectile function. Two important caveats: first, some male health supplements contain androgens (testosterone, DHEA, androstenedione), which may be inappropriate for some men, and second, it has been shown that some of these "all natural" supplements actually contain drugs such as sildenafil citrate (Viagra®) and tadalafil (Cialis®). One of the reasons many men choose to try such supplements is that they are not permitted to use the prescription medications sildenafil citrate (Viagra®), vardenafil hydrochloride (Levitra®) and tadalafil (Cialis®), because they use or possess nitroglycerin-containing medications. Combining these two types of medications may result in life-threatening blood pressure changes. So be cautious when purchasing or using 'all natural' supplements, as they may actually not be 'all natural.'

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