Erectile Dysfunction

  • Definition
  • Treatment Options
  • Oral Mediciations
  • VED's
  • Penile Injections
  • Penile Implants

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.    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.

Also see: Nine Effective Treatments for Erectile Dysfunction

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:

Pick the perfect pill

Drugs like Viagra, Cialis, and Levitra all boost nitric oxide availability, sending more blood to the penis. But they're formulated differently, so ask your doctor which is best for you. "Cialis tends to last 24 to 48 hours, versus about 4 hours for Viagra or Levitra," says Tobias S. Kohler, MD, associate professor of urology at Southern Illinois University School of Medicine and a spokesperson for the American Urological Association. "But you take Viagra and Levitra an hour before sex and Cialis at least 2 hours before." Some men find that a new version of Levitra called Staxyn, which dissolves on the tongue, takes effect faster than pills. "These drugs work in about two-thirds of men with ED," says Dr. Kohler.


  • 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 heart 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.

Evidence showing similarities between coronary artery disease and erectile dysfunction causes and potential treatment: Click here for more information

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.  PDE5Is taken daily can also significantly improve urinary tract symptoms.

Evidence linking prostate problems to erectile dysfunction: click here

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”. In addition, use of the VED prior to penile implant surgery likely increases safety of the surgery and improves penile aesthetics. 

Evidence that use of the VED after prostate removal preserves penile length and function: more info...

Penile injections are one of the most effective treatments for erectile dysfunction with some studies estimating a 93% success rate. This technique is reserved for patients who fail (or are unable to use) other erectile aides such as pills, pellets into the urethra, or vacuum erection devices. Self-injection is straight forward but does carry some risks, such as dizziness, penile curvature, pain and priapism (an erection lasting longer than 4 hours). Remember that although many men utilize injections, only commercial formulations such as Edex or Caverject are FDA approved.

The generic versions of medications often contain the same medicines or more potent medications and by using them you assume the risks.

Penile Implant

Dr. Köhler is a world class, expert surgeon in penile implants.  His minimally invasive technique is extremely fast and safe.  Dr Köhler has performed over 200 implants and is a physician trainer for other doctors wishing to learn this surgery in both the United States and Germany. 
Penile implants are often selected by men who do not respond to simpler treatments such as pills, vacuum devices, and shots. Inflatable implants give a natural-appearing erection which is completely invisible. After you have healed, the penis and scrotum look normal. These implants give a stiff, reliable erection when inflated, and a natural-appearing penis when deflated. With a penile implant, you can have sex as often as you like, and for as long as you wish. An implant not only restores erections, it can also restore a man’s sexual confidence, which is a tremendous benefit. Most insurance plans and medicare covers the cost of penile implant procedure. Potential advantages of a penile implant include the following:

    1. Implants have been available for >30 years
    2. Are a permanent solution for erectile dysfunction regardless of reason for erection problems (diabetes, prostate treatments, medications etc.)
    3. Are usually inserted through a small incision
    4. Usually an outpatient procedure
    5. Allow an erection at any time, in a few seconds
    6. Erection lasts indefinitely
    7. You control the erection hardness
    8. You can have an erection as often as you want
    9. Does not interfere with penile sensation, ejaculation, or orgasm
    10. Erection does not go down after climax
    11. Cost Effective as it is covered by most insurance plans and medicare
    12. Avoids ongoing costs of pills & injections, which are frequently not covered by prescription plans
    13. FDA-approved
    14. Recently upgraded with infection-resistant coatings
    15. Have high published satisfaction rates (much higher than pills, pumps or shots), and low complication rates
    16. Are undetectable by most women
    17. Are easy to operate
    18. With an implant, you know you will be able to obtain and maintain a hard erection indefinitely. When you are using pills, shots, or other treatments, you are never sure if you will get an erection, how hard the erection will be, or how long it will last. A tremendous advantage of an implant is that it can restore your sexual confidence!

Penile Implant Websites:

Articles on Penile Implants: