Q: I am having erection problems. What are my options?
Dr. Know replies:
I heard once in a lecture on erectile dysfunction that the penis is nothing more than a glorified vein. After I stopped laughing, I had to agree with the speaker. Basic penile anatomy is two corpus cavernosa, large vascular tubes that fill with blood. Erections are mediated by the release of nitrous oxide into the corpus cavernosa, which leads to smooth muscle relaxation, allowing inflow of blood.
Treatment of erectile dysfunction can be chemical, surgical, or mechanical. There are three oral drugs available: Viagra, Levitra, and Cialis. These medications work by inhibiting a chemical called phosphodiesterase type 5, which makes the nitrous oxide more effective. All of these medications are most effective when taken on an empty stomach, which is one hour before food, or two hours after food. Viagra and Levitra should be taken up to one hour before anticipated sexual activity, and are effective for up to four hours. Some of my patients report some effect from these medications for up to twenty-four hours. Cialis is the 36 hour pill. I call it the weekend party drug: good from Friday night until Sunday morning. There is now daily Cialis as well, allowing you to always be ready for sex.
Muse is a urethral suppository. You insert the suppository into the urethra, massage the penis, and you achieve an erection in 5 to 10 minutes that will last 30 to 60 minutes.
Caverject is an injectible medication. It is injected directly into the base of the penis, producing an erection that can last up to 60 minutes.
An erection that lasts more than four hours as a consequence of using any of the above treatment modalities is an emergency. You should get to an emergency room as soon as possible, or permanent damage to the penis can occur. This condition is called priapism, and can be very painful. The treatment is drainage of the corpus cavernosa with large bore needles.
Surgical treatment is an implant, some permanently firm, some inflatable. Two implants are required, one for each side of the penis. Complications can include infection, and erosion of the implants through the head of the penis.
Mechanical treatment is the vacuum pump device. A cylinder is placed around the penis, and a vacuum is created which causes the penis to fill with blood. Usually, a ring of some kind is used at the base of the penis to keep the blood in place. These devices are frequently used by men who do not have erectile dysfunction.
Send your questions to Dr. Know to men@men4men.com
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