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Improving Your Erections:
Current Medical Treatments

by Stanley Ducharme, Ph.D.

(Q) I am a student researching male sexuality and the latest treatments for erection problems. I read one of your previous articles in which you seemed quite optimistic about the new oral medications to treat men with this problem. Have you found that oral medications have been as successful as you had hoped? If not, have alternative therapies such as injections, MUSE and implants become more common? Finally, do you think the new technology for implants will make that therapy more acceptable for men?

(A) You are correct. When the oral medications were first introduced back in the late 1990's and in the early 2000s, I was very optimistic about the tremendous positive impact they would have on men who have erection problems. As the dust has settled and these drugs have gained acceptance, I have come to realize a number of different factors. First of all, these drugs have been remarkably successful and have drastically increased the number of men who seek professional help for these problems. The popularity of these medications cannot be overstated. I still believe that their introduction was nothing shy of a sexual revolution in our society. The success rate of these medications is different depending on the cause of the erection problem. Generally all three drugs have demonstrated similar success rates although, by and large, Cialis seems to be preferred, by younger men, because of its longer half-life. (Cialis, as many men know, can be effective up to 36 hours.) Viagra continues to remain the number one seller but the other medications, Levitra and Cialis, continue to eat away at the market share enjoyed by Pfizer and Viagra. As expected, the oral medications work best with younger men who have little systemic cardiovascular disease. They also have been very helpful for men who have erection problems as a result of anxiety. These medications can help a man to feel successful and to gain confidence in the bedroom.

CoupleThe safety of these medications has been well established in spite of the early over reactions about their adverse reactions among men. We all heard those early allegations about blindness or even death. Such wildly exaggerated talk has finally ceased. The reality remains that headaches, blue vision and a stuffy nose are about the worse side effects that most of us will ever experience from erection pills. Most men deal with the headaches, stuffy nose or muscle ache by simply taking a couple of Tylenol or Advil at the same time they take a Viagra, Cialis or Lavitra.

Another fact that I have learned over the years is that alternative therapies still have a place in treating erectile dysfunction. They are still commonly used when pills are not successful. For example, older men who have alcohol, smoking and substance abuse histories tend not to respond well to oral medications. Men with diabetes, high blood pressure and elevated cholesterol don't respond well either. For them, injections remain the most preferred and effective treatment. They are safe, reliable and easy to learn. Vacuum devises and MUSE have all but disappeared from Urology and Sexual Medicine clinics throughout the country. There was just no good reason for people to make use of these therapies.

Personally, I wouldn't waste my money on either a vacuum devise or MUSE. They both seem risky. There's too much at stake! Over the years, I've heard too many people discuss their dislike and the pain associated with using MUSE. It seldom works either.

As for vacuum devises, I personally think they are dangerous and have heard too many nightmares about men causing permanent damage to their penises. Many times these devises are incorrectly used in an attempt to enlarge the penis or men leave the penile rings on for too long a time causing blood clots in the penis. Vacuum devises are also awkward, un-natural and require a degree in engineering to use them effectively. Who needs that?

As for penile implants, that's another story. Penile implants are enjoying great success in our country today and the new technology has made them extremely popular. I know many older men who speak very highly of the devises. Surprisingly, I know many young men who ultimately feel positive about an implant as well. For many men, especially younger ones, there is an emotional adjustment in accepting the fact that an implant is the only remaining solution to restore an erection. This emotional process can take some time!

The concept of a penile implant may sound a little strange initially but these devises are highly effective. The individual however needs to be realistic and know what to expect. An implant will not return the sexual functioning of your youth nor will it increase genital length... An informed and properly informed individual however knows what to expect and is most often quite satisfied with the results.

CoupleEven today, an implant remains the last resort in restoring sexual functioning. The insertion of an implant is final and there is no going back after the surgery. It's a big decision and should never be taken lightly. It should only be done after talking with your partner and your doctor. Take your time on this decision and make sure that you feel good about the choice. A second opinion is not a bad idea either. Ultimately however the decision is between you and your partner.

There are two types of implants on the market today. These include the bendable and the inflatable prostheses. The bendable implants seem to be less popular since the man has a permanent erection. This type of implant consists of two plastic rods that are placed in the erection chambers of the penis. These are the spaces that would normally fill with blood during an erection.

One of the main advantages of the bendable implant is for men who have disabilities. These men often use condom drainage for urination and the prosthesis helps to keep a condom in place. The big disadvantage for the bendable implant however is the fact that the man has a permanent erection. This can be embarrassing at a gym, the beach or when wearing tight clothing.

The inflatable implant consists of a pair of inflatable cylinders that are surgically implanted into the penis. A pump for the implant is also surgically inserted into the scrotum. When a man wants to get an erection, he squeezes the pump, which moves fluid (usually saline) into the inflatable cylinders and makes the cylinders rigid. When deflated the penis returns to a normal flaccid size.

As you mentioned in your letter, the technology for implants has dramatically improved over the last decade. Today, there is much less danger of mechanical failure and the life expectancy of these devises is usually in excess of 10 years. The biggest problem is often minimizing or eliminating any infection at the time of surgery.

In conclusion, oral medications have been remarkably successful however there is still a place for the various other erection treatments. There will never be a single treatment that will work for every man. There are just too many factors that determine the quality of a man's erection. Yet, with today's technology, there is a solution for every man who wants to have an erection. The biggest challenge may be in getting the courage to speak to your doctor.

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