Erectile dysfunction is a condition characterized by inability to attain or maintain penile erections sufficient for sexual satisfaction.
It affects about 50% of men older than 40 years of age.
Many cases of erectile dysfunction result from organic diseases, such as cardiovascular disease, diabetes mellitus, hyperlipidemia, and high blood pressure.
Regardless of the underlying cause, erectile dysfunction can have a significant effect on a person’s relationships and overall quality of life.
Treatment options for erectile dysfunction include the following.
Sexual counselling if no other co-morbidities present.
Oral medications.
Injected, implanted, or topically applied medications.
External vacuum and constriction devices.
And surgery.
Many patients with erectile dysfunction have co-existing cardiovascular disease.
Therefore, treatment should consider that as well.
Oral phosphodiesterase-5 inhibitors are the first-line therapy unless contraindicated.
These include, sildenafil, vardenafil, and tadalafil.
If these medications fail to achieve sufficient erections, one of these agents can be combined with an injection of prostaglandin E1.
Hormone replacement with testosterone may be beneficial for individuals with low androgen levels.
They are available as oral tablets, injections, transdermal patches, and topical gel form.
In addition, implantation of long-acting testosterone pellets has also become increasingly popular.
Intra-cavernosal injection of vasodilators such as alprostadil is another effective way of treating erectile dysfunction.
Some common adverse effects of alprostadil include painful erections, priapism, and scarring of the injection site.
Implantation of intra-urethral prostaglandin E1 pellets is also a beneficial option for individuals who are unable to attain sufficient erections with medications, or they are refusing injections.
They are particularly effective in individuals with vascular diseases, diabetes, or have undergone prostate surgery.
External erection facilitating devices are another option.
These include constriction devices such as penile tourniquet, and vacuum devices.
Penile tourniquet is placed at the base of the penis to maintain erections.
It is more effective when used in combination with a phosphodiesterase inhibitor.
Vacuum devices sustain erection by draining blood into the penis.
Finally, if all these methods fail to give sufficient erections for the individual, surgical care may be indicated.

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