Erectile Dysfunction (ED)

Dr Kohler has highly specialized training dedicated to the diagnosis and treatment of erectile dysfunction (ED). We encourage men and their partners to schedule an appointment, as there are excellent, affordable treatments available for all men.  For more information on treatments, click on the links below.  To learn more about Dr Kohler’s research dealing with ED click here.

Erectile Dysfunction Definition

Erectile dysfunction is the inability to get and keep an erection firm enough for sex. Half of all men above age 50 have erectile dysfunction.  Having erection trouble from time to time isn't necessarily a cause for concern. But if erectile dysfunction is an ongoing problem, it may cause stress, cause relationship problems or affect your self-confidence.
Even though it may seem awkward to talk with your doctor about erectile dysfunction, go in for an evaluation. Problems getting or keeping an erection can be a sign of a health condition that needs treatment, such as heart disease or poorly controlled diabetes.  To learn more about the connection between ED and heart disease click here.  Treating an underlying problem may be enough to reverse your erectile dysfunction. If treating an underlying condition doesn't help your erectile dysfunction, several alternative treatments are available.
ED Causes

Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. In most cases, erectile dysfunction is caused by something physical. Common causes include:

• Heart disease
• Clogged blood vessels (atherosclerosis)
• High blood pressure
• Diabetes
• Obesity
• Metabolic syndrome, a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol
• Parkinson's disease
• Multiple sclerosis
• Low testosterone
• Peyronie's disease, development of scar tissue inside the penis
• Certain prescription medications
• Tobacco use
• Alcoholism and other forms of substance abuse
• Treatments for prostate cancer or enlarged prostate
• Surgeries or injuries that affect the pelvic area or spinal cord

Treatments options for ED
A variety of options exist for treating erectile dysfunction. Surprising to most patients and other doctors is that most are covered by insurance or are more affordable than pills.  The cause and severity of your condition, and underlying health problems, are important factors in your doctor's recommending the best treatment or treatments for you. Your doctor can explain the risks and benefits of each treatment, and will consider your preferences.  

Life Style Modification

A heath healthy life style is a penis healthy lifestyle. Proper exercise, diet high in fruits and vegetables, and decreased stress levels all significantly affect erectile function. Smoking cessation, normal cholesterol levels and tight diabetes control all have profound effects on the penis, and even small improvements in these can positively affect erectile function.  Most men do not know that ED is often the first sign of impending heart disease (predating the first heart attack by 3-5 years) as the blood vessels to the penis are about half the size of those in the heart.

Oral Medications

Phosphodiesterase inhibitors (PDE5Is) are the first line treatment of ED after lifestyle modification no longer works.  Drugs such as Viagra, Levitra or Cialis all work equally well but typically only continue working for 3-5 years.  Of all men who try pills, only 2/3 of men will get the desired effect, with 1/3 of men failing them entirely.  Choosing between PDE5Is often comes down to side effects and how long the medications last in the blood stream.  Most men need to try these drugs at least 3-4 times before they know if they will work.

Vacuum Erection Devices

The vacuum erection device is great by itself or used in conjunction with oral medications. The pump draws blood down into the penis resulting in an erection. When a constrictive band is applied, the erection may be used for sexual intercourse. The pump may also be used for penile rehabilitation before and after prostate surgery. Preoperative use of the pump increases blood flow to the area. Increased blood flow may assist in the healing process, decreasing length of healing time. Use postoperatively decreases scar tissue formation. With prostate surgery, scar tissue may form resulting in “shrinkage” of the penile shaft. As this is an unwanted side effect of surgery, exercising the penis with the vacuum device may reduce the amount of scar tissue formed, preventing “shrinkage”.

Penile Injections
Penile Implant

To request an appointment with Dr.Köhler click here