I am often asked by patients, “What is the best way to reverse erectile dysfunction?” The short answer: “There isn’t one.”
Erectile dysfunction can be caused by a combination of many factors, including medical issues, medications, lifestyle, blood flow, nerve damage, pelvic muscle weakness, stress and psychological conditions.
Managing any medical problem requires a sensible strategy to try the simplest, safest, and least expensive alternatives first. If unsuccessful, more aggressive, complicated and invasive options can be entertained.
For example, when a patient presents with arthritis, he or she is not offered a total knee replacement from the get-go. Managing knee arthritis can start with rest and anti-inflammatory medications and proceed, if necessary, down the pathway of exercise/physical therapy, arthroscopy, endoscopic knee surgery, and ultimately if all else fails, under the proper circumstances, to prosthetic joint replacement.
The same approach should be applied when managing erectile dysfunction. Unfortunately, however, we are often looking for the quick fix and ignore many other treatments that may help prevent or reverse the condition.
Oral pharmaceuticals are frequently used as the first-line approach to ED. As useful as they are, I believe that ED medications should not be first-line treatment for those with ED, but reserved to be used if the simple and natural first-line interventions fail to work.
Don’t get me wrong, the oral meds for ED (Viagra, Levitra, Cialis and Stendra) were revolutionary additions to the limited resources we once had to treat ED. Far from perfect—expensive, contraindicated with certain cardiac conditions and for those on nitrate medications, associated with some annoying side effects, and not effective in everyo. Nonetheless, for many men they are often highly effective, resulting in a “penetrable” erection.
Since erections are nerve/blood vessel/pelvic skeletal muscle events, optimizing erectile capability involves doing what you can to have healthy nerves, blood vessels and muscles.
How does one keep their tissues and organs healthy? The first-line approach is intuitive and involves achieving the best physical shape possible. This might mean a lifestyle makeover to get down to “fighting” weight, adopting a heart-healthy (and penis-healthy) diet, exercising regularly, drinking alcohol moderately, avoiding tobacco, minimizing stress, getting enough sleep, etc.—all common sense measures to improve health in general and blood vessel health in particular.
Focused pelvic floor muscle exercises improves the strength and endurance of the male “rigidity” muscles that surround the roots of the penis.
Since intact and functioning nerves are fundamental to the erectile process, activation of the nerves via penile vibratory stimulation can be an effective means of resurrecting erectile function.
The vacuum suction device—a.k.a., the penis pump—is a means of drawing blood into the penis to obtain an erection and enable sexual intercourse.
Second-line treatments are the well-established oral medications for ED. Although Viagra, Levitra, Cialis and Stendra all have the same mechanism of action, there are nuanced differences in potency, time to onset, duration of action, side effects, etc., so it may take some trial and error to find out which works best for you. Cialis is uniquely approved for both ED and prostate issues, so it can be an excellent choice if you have both sexual and urinary issues.
Third-line alternatives include urethral suppositories and penile injection therapy. Suppositories are pellets that are placed in the urethra that act to increase penile blood flow. Injections do the same, but require injection directly into the penile erectile chambers.
Fourth-line treatment is the prosthetic penile implant. These are semi-rigid non-inflatable or hydraulic inflatable devices that are implanted surgically within the erectile chambers and can be deployed on demand to enable sexual intercourse. This article in Men’s Health Magazine praised the benefits of the implant. For the right man, under the right circumstances, the penile implant is a magical life changer—as much as a total knee replacement can be—converting a penile “cripple” into a functioning male. However, it is vital to understand that the implant is a fourth-line approach, and less invasive options should be exhausted before its consideration.
Andrew Siegel, M.D., Urologist, Co-founder of The Private Gym, and author of the highly acclaimed book, Male Pelvic Fitness, Optimizing Your Sexual and Urinary Health.
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