- Can erectile dysfunction be reversed?
- Treatment for Erectile Dysfunction
- How will side effects of erectile dysfunction medicines affect me?
- Devices & Surgery for Erectile Dysfunction
- Erectile Dysfunction (ED) Surgical Treatments
- Surgical Treatments for Impotence
- Vascular Reconstructive Surgery
Can erectile dysfunction be reversed?
These can be effective when that cause of ED is physical, and they also work well when the cause is unknown or related to anxiety.
If an underlying condition, such as diabetes, is causing ED, treating it will often reverse ED or prevent it from worsening.
6. Medication changes
Some medications can make ED worse. Blood pressure medication, for example, may lower blood flow to the penis, making it harder to get an erection.
Anyone who suspects that ED is associated with a medication should tell a doctor. Alternative drugs are often available.
7. Mechanical devices
Penis pumps can draw blood into the penis and induce an erection in most men, including those with severe nerve damage. When there is severe nerve or blood vessel damage, using a ring can help to keep blood in the penis.
Even when serious physical health issues are present, a mechanical device can usually help with getting an erection.
If other strategies are ineffective, or when there is an anatomical cause of ED, a doctor may recommend surgery. The procedure involves implanting a device that enables immediate erections. Surgery is effective in most cases, and the rate of complications is less than 5 percent.
Treatment for Erectile Dysfunction
All of these medicines work by relaxing smooth muscles and increasing blood flow in the penis during sexual stimulation. You should not take any of these medicines to treat ED if you are taking nitrates to treat a heart condition. Nitrates widen and relax your blood vessels. The combination can lead to a sudden drop in blood pressure, which may cause you to become faint or dizzy, or fall, leading to possible injuries.
Also talk to your health care professional if you are taking alpha-blockers to treat prostate enlargement. The combination of alpha-blockers and ED medicines also could cause a sudden drop in blood pressure.
A health care professional may prescribe testosterone if you have low levels of this hormone in your blood. Although taking testosterone may help your ED, it is often unhelpful if your ED is caused by circulatory or nerve problems. Taking testosterone also may lead to side effects, including a high red blood cell count and problems urinating.
Testosterone treatment also has not been proven to help ED associated with age-related or late-onset hypogonadism. Do not take testosterone therapy that hasn’t been prescribed by your doctor. Testosterone therapy can affect how your other medicines work and can cause serious side effects.
A health care professional may prescribe you an oral medicine to help you get and maintain an erection.
Prescribe injectable medicines and suppositories
Many men get stronger erections by injecting a medicine called alprostadil into the penis, causing it to become filled with blood. Oral medicines can improve your response to sexual stimulation, but they do not trigger an automatic erection like injectable medicines do.
Instead of injecting a medicine, some men insert a suppository of alprostadil into the urethra. A suppository is a solid piece of medicine that you insert into your body where it dissolves. A health care professional will prescribe a prefilled applicator for you to insert the pellet about an inch into your urethra. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes.
Discuss alternative medicines
Some men say certain alternative medicines taken by mouth can help them get and maintain an erection. However, not all “natural” medicines or supplements are safe. Combinations of certain prescribed and alternative medicines could cause major health problems. To help ensure coordinated and safe care, discuss your use of alternative medicines, including use of vitamin and mineral supplements, with a health care professional. Also, never order a medicine online without talking with your doctor.
To help ensure coordinated and safe care, discuss your use of alternative medicines, including use of vitamin and mineral supplements, with a health care professional.
How will side effects of erectile dysfunction medicines affect me?
ED medicines that you take by mouth, through an injection, or as a pellet in the urethra can have side effects, including a lasting erection known as priapism. Call a health care professional right away if an erection lasts 4 hours or longer.
A small number of men have vision or hearing loss after taking oral ED medicines. Call your health care professional right away if you develop these problems.
Prescribe a vacuum device
A vacuum device causes an erection by pulling blood into the penis. The device has three parts:
- a plastic tube, which you put around your penis
- a pump, which draws air out of the tube, creating a vacuum
- an elastic ring, which you move from the end of the tube to the base of your penis as you remove the tube
The elastic ring maintains the erection during intercourse by preventing blood from flowing back into your body. The elastic ring can remain in place up to 30 minutes. Remove the ring after that time to bring back normal circulation and to prevent skin irritation.
You may find that using a vacuum device requires some practice or adjustment. Using the device may make your penis feel cold or numb and have a purple color. You also may have bruising on your penis. However, the bruises are most often painless and disappear in a few days. Vacuum devices may weaken ejaculation but, in most cases, the devices do not affect the pleasure of climax, or orgasm.
A vacuum device causes an erection by pulling blood into the penis.
For most men, surgery should be a last resort. Talk with your doctor about whether surgery is right for you. A urologist performs surgery at a surgical center or hospital to
- implant a device to make the penis erect
- rebuild arteries to increase blood flow to the penis
Implanted devices. Implanted devices, known as prostheses, can help many men with ED have an erection. Implants are typically placed by a urologist. The two types of devices are
- inflatable implants, which make your penis longer and wider using a pump in the scrotum
- malleable implants, which are rods that allow you to manually adjust the position of your penis
You usually can leave the hospital the day of or day after the surgery. You should be able to use the implant 4 to 6 weeks after the surgery.
Once you have either implant, you must use the device to get an erection. Possible problems with implants include breaking and infection.
Artery reconstruction. Surgery to repair arteries can reverse ED caused by blockages that stop blood flow to the penis. Usually men younger than 30 are the best candidates for this type of surgery.
Devices & Surgery for Erectile Dysfunction
A penile prosthesis can be implanted in men with erectile dysfunction related to the symptoms of diabetes, vascular disease, and spinal cord injuries. There are two types of implants, neither of which change sensation in the skin of the penis or negatively affect a man’s ability to orgasm or ejaculate.
Malleable penile implants are mechanical devices that are surgically implanted in the penis to provide permanent firmness. A surgeon makes an incision near the base of the penis and creates an opening in the two long tubes of spongy tissue of the shaft. One semi-rigid rod is placed in each opening. The procedure, performed with anesthesia in the hospital, takes 30 to 60 minutes. Often, you can leave the hospital the day of surgery.
Following surgery, your doctor may advise you to avoid sexual activity for at least six weeks and may also prescribe pain medication as needed. These implants are always firm, making them more detectable in clothing than inflatable implants. This can be concealed by manually bending the implanted rods downward.
Inflatable penile implants can be inflated to create an erection-like state and then deflated after sexual intercourse, allowing for reliable, rigid, and spontaneous erections. In a one- to two-hour procedure, a surgeon installs the implant—which includes two inflatable cylinders, a reservoir, and a pump unit—into the penis and scrotum. Pressing on the area of the scrotum where the pump portion of the device is embedded allows fluid to flow from the reservoir implanted near the bladder, inflating the prosthesis and creating an erection-like state.
The surgical procedure to install the penile prosthesis requires anesthesia and four to six weeks of recuperation, during which your doctor may advise you to avoid sexual activity. Some men go home the day of surgery, although some may require extra monitoring and return home the next day. Pain medicine is prescribed as needed after the surgery.
Inflatable implants are mechanical devices and, as such, can break down eventually. If this occurs, surgery may be required to remove, repair, or replace them.
Erectile Dysfunction (ED) Surgical Treatments
Surgical Treatments for Impotence
Penile implants involve surgical insertion of malleable or inflatable rods or tubes into the penis. A semi-rigid prosthesis is a silicon-covered flexible metal rod. Once inserted, it provides the rigidity necessary for intercourse and can be curved slightly for concealment. It requires the simplest surgical procedure of all the prostheses. Its main disadvantage is that concealment can be difficult with certain types of clothing.
An inflatable penile prosthesis consists of two soft silicone or bioflex (plastic) tubes inserted in the penis, a small reservoir implanted in the abdomen, and a small pump implanted in the scrotum. To produce an erection, a man pumps sterile liquid from the reservoir into the tubes by squeezing the pump in the scrotum.
The tubes act as erectile tissue and expand to form an erection. When the erection is no longer desired, a valve allows the fluid to return to the reservoir. Inflatable prostheses are the most natural feeling of the penile implants and they allow for control of rigidity and size.
The surgical procedure to implant the inflatable prosthesis is slightly more complicated than for a semi-rigid implant. Also, because there are more mechanical parts, there is a higher risk for mechanical failure requiring repair or adjustment.
A self-contained inflatable prosthesis is similar but has fewer parts. It consists of a pair of inflatable tubes in the penis with a pump attached directly to the end of the implant. The reservoir is also located in the shaft of the penis. Its compact design allows for simpler implantation, but because it takes up more space in the penis, there is less room for expansion.
Vascular Reconstructive Surgery
A small percentage of men undergo vascular reconstructive surgery to improve blood flow to the penis. Revascularization involves bypassing blocked veins or arteries by transferring a vein from the leg and attaching it so that it creates a path to the penis that bypasses the area of blockage. Young men with only local arterial blockage are the best candidates for this procedure. It may restore function in 50 to 75 percent of men.
Venous ligation is performed to prevent venous leak. Problematic veins are bound (ligated) or removed, which allows an adequate amount of blood to remain in the penis. It may improve function in 40 to 50 percent of men, but some men may experience problems over the long term.
Vascular surgery for erectile dysfunction is rarely performed and is generally considered experimental. Risks include nerve damage and the creation of scar tissue, both of which are causes of impotence. Surgeons experienced with these procedures may be difficult to find.
Publication Review By: David M. Kaufman, M.D., Stanley J. Swierzewski, III, M.D.
Published: 09 Jun 1998
Last Modified: 14 Sep 2015