Treatment Options (Do Not Use) | menMD

Treatments Options

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Treatments Options

  • PDE-5 Inhibitors
  • Intraurethral Gels
  • Injection Therapy
  • Testosterone
  • Vacuum Devices
  • Implants
  • Herbals

PDE-5 Inhibitors

PDE5 inhibitors are drugs like sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). These drugs work by stopping the body from breaking down chemicals that are needed to obtain an erection. Currently, there is insufficient evidence to suggest that any of these drugs work more effectively than the other. They are all oral drugs that need to be taken 30-60 minutes prior to intercourse. Sexual stimulation is still needed to achieve an erection even when taking these medications. The response rate is approximately 65% in men with moderate ED.

PDE5 Inhibitors may fail due to inadequate dosing. Doses higher than 100mg increase the occurrence of side effects; therefore, it is recommended to seek alternative methods of treatment when you reach maximum dosage.
It is not recommended to take PDE-5 Inhibitors if you:

  • Take nitrates
  • Take high blood pressure medications (alpha blockers)
  • Have low blood pressure
  • Have uncontrolled hypertension
  • Have cardiac failure
  • Have angina

The side effects of the three drugs are very similar. Side effects may include facial flushing, nasal congestion, blurred vision, headaches, or heartburn. The monitoring of patients using PDE5 inhibitors should include a follow-up to analyze efficacy, side effects, or changes in health care such as additional medications.

Inefficacy may be the result of hormonal abnormalities, food or drug interactions, timing and frequency of dosing, lack of sexual stimulation, alcohol usage, or partner/relationship issues. If you are not completely satisfied with the results of this treatment, patients are advised to discuss the various alternative therapies available including alprostadil/injection therapy medications, intraurethral gels, vacuum devices, testosterone replacement, and penile prostheses.

Sildenafil citrate was the first oral PDE5 inhibitor for ED approved by the Food and Drug Administration in the United States in March 1998. Since the release, sildenafil has become the first-line therapy for ED with over 12,000 patient-years of experience with sildenafil demonstrating positive safety and efficacy data. Sildenafil use has markedly increased the number of men seeking treatment for ED and has shifted first-line management from the urologist and psychologist to the primary care physician.

How does it help ED?

PDE5 inhibitors work by stopping the body from breaking down chemicals that are needed to obtain an erection.

Available Options

  • Sildenafil

    20mg tablets, $1 /each
    Active ingredient in brand name Viagra

  • Tadalafil

    5mg for $2.50 /lozenge
    20mg for $8 /lozenge
    Active ingredient in brand name Cialis

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Intraurethral Gels

Intraurethral gels are a non-invasive way to treat erectile dysfunction. Gels are formulated with one or two FDA approved ingredients: Alprostadil and Phentolamine. Although not as effective as the injection therapy form of these same ingredients, the gel is inserted into the urethra prior to intercourse or daily for rehabilitation purposes.

How does it help ED?

The medication works to relax smooth muscle in the penis and increase blood flow to the cavernosal chambers. Gel therapy may be an effective choice for patients averse to penile injection therapy.

Instructions

 

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Available Options

  • Intraurethral Gels

    Needless gels that contain the same ingredients as Bimix/Trimix
    Phentolamine / Alprostadil (4mg/1000mcg)/mL
    Phentolamine 10mg/mL

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Injection Therapy

Intracavernousal injection therapy (ICI) is the most effective nonsurgical treatment for ED. Intracavernosal injection therapy has been an effective and reliable ED therapy since 1983. Alprostadil, bi-mix (papaverine and phentolamine), and tri-mix (papaverine, phentolamine, and alprostadil) are all injectable vasodilators used to treat ED. These are injected into the cavernosal tissue of the penis with a very fine needle just before intercourse. The medication works by relaxing the corporal smooth musculature and/or building the adrenergic tone of the corporal smooth muscle (102). As with intraurethral gels, the first dose of injection therapy should be administered under healthcare supervision. A specialized practitioner will be able to instruct patients on proper application in addition to monitoring the efficacy and side effects of the dosing.

How does it help ED?

The medication works by relaxing the cavernosal smooth muscle cells. Injections are one of the most effective forms of ED treatment: up to 92% of patients find it effective. In a study conducted by the British Medical Journal, 88% of patients who failed to respond to PDE5-Inhibitors (Viagra, Cialis, Levitra) were successful with injection therapy. Additionally 48% of men who failed to respond to PDE5-inhibitors responded when used in conjunction with injection therapy.  According to a Continuing Medical Education (CME) Article, of the men who stop using injection therapy, 82% of them would still recommend it to a friend.

Injection therapy treatments should not be used more than once in a 24-hour period. The most common adverse effect is priapism. Priapism is defined as a prolonged erection which lasts for more than four hours. Patients must be cautioned to call their physician if an erection persists for 4 hours or longer. Other reported side effects include hematomas, burning pain after injection, urethral damage, local infections, curvature, and prolonged erections.

Injection Instructions

ICI Instructional Video

 

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Available Options

  • Intracavernosal Injections (ICI)

    15 formulations of Trimix / Bimix in stock
    We provide complimentary patient samples for in office

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Testosterone

Testosterone may induce a noticeable increase in libido without exerting a positive effect on erectile capabilities in patients with ED who do not have an androgen insufficiency. Testosterone can be used to treat erectile dysfunction when the main cause is a decrease in the level of testosterone in the body, also known as hypogonadism or andropause. Testosterone works by increasing libido, and is also necessary to develop an erection.

How does it help ED?

Testosterone reverses the effects of apoptosis (cellular death) in the cavernosal smooth muscle cells. This allows hypogonadal men to improve their sexual function and increase response to ED treatments. According to a study done by Clinical Endocrinology, using testosterone in conjunction with PDE5 Inhibitors can improve the erectile response by increasing blood flow.  Testosterone can be applied topically in a gel, via a patch, or by an intramuscular injection. Testosterone cannot be used by men with prostate cancer.

Available Options

  • Testosterone Injections

    Testosterone Cypionate 200mg/mL
    1cc and 3cc vials in stock

  • Testosterone Gel

    Testosterone topical gel
    (5%) 50mg/mL

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Vacuum Devices

A vacuum is a device which is the least invasive and least expensive treatment for ED. Vacuum constrictive devices are approved by the FDA for over-the-counter distribution. It is a good choice for men who do not want to or cannot take medications due to comorbid conditions such as heart failure or diabetes (96-98). Vacuum therapy devices are available without a prescription.

How does it help ED?

This therapy works by applying negative pressure to the penis. The vacuum produces an erection that can last for up to 30 minutes and is between 70% and 94% effective. The majority of the devices have 3 components – a vacuum chamber, a pump to create the pressure within the pump, and a tension band which is applied at the base of the penis after the erection is achieved.

Complications from these devices have been minor and self-limited (96-98, 100). Common side effects are numbness, pain, and trapped ejaculation. Patient acceptance and satisfaction with vacuum devices in all types of impotence range from 68% to 83%. Reported reasons for discontinuation include premature loss of penile rigidity, penile pain, pain during ejaculation, and inconvenience of usage (101).

Available Options

  • Vacuum Erection Devices (VED)

    VED Vac by Owen Mumford, manual
    VED Vacs by PosTVac, manual and battery options

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Implants

Penile prosthesis is surgically implanted into the corpus cavernosum of the penis. This can be an inflatable implant that can be pumped up to obtain an erection, or a pair of bendable rods. Implants are highly effective with a satisfaction rate of over 85%, but they are not reversible. This treatment is the best solution for patients with severe ED who have failed to respond to multiple forms of treatment. The only minor side effect of the surgery is infection which occurs is approximately 1-5% of patients.

Herbals

Herbal medicine uses supplements derived from plants and plant extracts to treat various medical conditions. Due to the fact that many plants synthesize substances that contribute to the health of humans, herbal supplements can be an alternative to modern medicine to treat your ED.

Common herbal supplements used to treat ED are:

  1. Asian-Ginseng: A root native to Korea and China which has heating properties to increase blood circulation. You should take Asian-ginseng on a continuous basis in order for it to be effective.
  2. Epimedium (Horny Goat Weed): A leafy plant which contains the flavonoid icariin as its active compound ingredient. The plant can be found raw, in tablets, or in capsules. Just as L’Arginine, it increases the levels of nitric oxide to relax the muscles and increase blood flow to the penis.
  3. Gamma – Butyrolactone (GBL): – A hygroscopic liquid found in extracts of unadulterated wines. GBL has been shown to elevate growth in hormone levels to exceedingly unnatural quantities thus making this substance have toxic side-effects.
  4. Gingko: One of the oldest living tree species, Gingko extract is responsible for relaxing smooth muscle in order to increase the blood flow to the penis.
  5. L-Arginine: An amino acid that is found naturally in meat, dairy, poultry, and fish. L’Arginine is available in supplement form and turns into nitric acid in the body. Nitric acid is responsible for dilating your blood vessels to increase blood flow. Taking too much L’Arginine can be harmful as it will increase the amount of stomach acid and may lead to digestive problems.
  6. Yohimbe: An Alkaloid and aphrodisiac derived from plants which is available in both over-the-counter and pure forms to treat sexual dysfunction by improving blood flow.