Treatment of Erectile Dysfunction

Treatments 

The management of erectile dysfunction requires expert diagnosis and treatment. 

Diagnosis includes sexual function history, general medical history, psychosocial history, medication history, physical examination, and appropriate laboratory testing. 

Treatment follows diagnosis, and we provide a range of treatment options through the Clinic. Minimally invasive treatment options range from oral medications to medications administered directly to the penis to a mechanical vacuum device applied to the penis. Invasive treatments include implants or vascular surgery. We are particularly expert in the surgical treatment of patients with erectile dysfunction. The range of conditions we manage include penile prosthesis complications, penile vascular abnormalities, penile curvature, and abnormally prolonged erection consequences.

Psychological treatment is an important adjunct to managing erectile dysfunction. If our diagnosis suggests a psychological association with your erectile dysfunction, we may recommend that you pursue counseling with a qualified psychologist available through the Clinic.
For instance, there may be relationship problems that negatively affect sexual functioning with your partner. Referrals can be made to the Johns Hopkins' noted Sexual Behaviors Consultation Unit.

Types of RX	Advantages	Disadvantages
Sex therapy/ counseling	-Non-invasive (not surgery or drugs) -Addresses psychological condition -May benefit regardless of the cause of ED	-May be required for an indefinite time -May be costly -Success rates vary and depend on cooperation of patient (and partner)
Oral medications, including Viagra, Levitra, Cialis	-Non surgical, painless -The new generation of pills may be more successful than those in the past	-Variable effectiveness-treatment may not always work "on demand" -Possible side effects: headaches, indigestion, facial flushing -May be costly
Intraurethral medications (penile suppository)	-Minimally invasive -Moderate effectiveness -Likely to work "on demand"	-Requires training to master technique -Possible side effects: penile pain and Urethral injury -May be costly
Hormone replacement (preferred therapy includes patches and injections)	-Minimally invasive -May improve libido	-Applies only to patients with testosterone deficiency -May promote prostate disease
Vacuum constriction devices	-Relatively safe -Creates a highly successful erection-like state -Works "on demand"	-Requires training to master technique -Equipment can be cumbersome -Possible side effect: local bruising
Penile injection therapy	-Very effective, mimics a natural erection response -Less cumbersome than vacuum devices -Works "on demand" -Erection lasts for one to two hours	-Requires training to master technique and a clinical visit to determine dosage, than follow-up -Limited to two uses per week -Possible side effects: prolonged erection, scarring -May be costly
Penile prostheses (malleable and inflatable)	-Extremely effective -Generally simple to use, works "on demand"	-Invasive  -Significant cost -Subject to complications and risks of surgery
Penile vascular surgery	-Corrects "discrete" vascular lesions, such as a rupture, injury or tear -May preserve natural erections	-Invasive -Significant cost -Subject to complications and risks of surgery