Erectile Dysfunction Treatment in Los Angeles, CA
Back in my father’s and grandfather’s time, the problem of erectile dysfunction was very hush-hush. It was a different world then, not like today where ads for prescriptions and natural supplements that promise quick erections are so common most people start to tune them out. If you commute to work and listen to the news and weather, you are almost certain to hear a radio ad having to do with “performance in the bedroom.” My grandfather would have been shocked! Yet even with all this public advertising, ED is still a very private matter.
The problem with ads that promise an easy solution is this: if it sounds too good to be true, it probably is. First of all, because ED is a sensitive subject, many men and their partners have a hard time talking about it and live with it while suffering in silence. They want to grasp at the hope offered by ads, without getting correct information about what may be causing or contributing to ED. Do the pills work? Yes, of course-for the right conditions.
Another problem is what happens if the pills don’t work-and for many men, they don’t. Why? Because ED can be caused by a variety of issues, including cardiovascular problems (the most common), neurological conditions, substance use or abuse, psychological and emotional issues, relationship problems, and unhealthy lifestyles. Prescriptions won’t do it for many of these conditions.
More importantly, ED is often an “early warning sign” of a deeper problem, such as cardiovascular disease. Ignoring ED, or wishing it would go away, won’t help an underlying medical condition. Neither will taking a pill if it’s not the right pill. Knowing that ED is treatable, and that diagnosing what’s causing it could save your life, should be reason enough to see a urologist who specializes in ED treatment.
In my practice, our mission is to give hope to men who experience erectile dysfunction, and to their partners. Once we diagnose the cause of an individual’s ED, we provide a full range of treatments. If the first one or two interventions are not effective, we have a progression that we follow, alone or in combination, until we find what works.
Treatment Options for Erectile Dysfunction
There are a variety of methods for treating erectile dysfunction (ED). Your doctor can discuss all of these options with you in more detail. All decisions regarding your best option for treating ED should be made between you and your physician, with consideration given to your individual needs and the risks and benefits of each treatment option.
There is a range of ED treatments and interventions available, including:
- Oral medication (such as Viagra®)
- Transurethral delivery of alprostadil (MUSE®)
- Vacuum Erection Devices (such as the VED®)
- Compounded drugs inserted into the penis
- Penile implants
Dr. Alarcon typically suggests that treatment proceed along a path moving from least invasive (like oral medications) to the most invasive (like penile implants). It’s important that you talk to Dr. Alarcon about which ED treatment or combination of treatments is right for you.
Drugs for treating erectile dysfunction can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis. The most commonly known drugs on the market today are Viagra®, Cialis® and Levitra®.
Oral medications for erectile dysfunction include, sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). All of these medications work to relax the muscles in the penis, allowing blood to rapidly flow in. On average, the drugs take about an hour to begin working. Sildenafil and vardenafil tend to last for about 8 hours while tadalafil can last up to 36 hours. While oral medications work for some people they are not effective for everyone. Examples include men who you have cardiovascular disease or take nitrates for chest pain, men who are diabetic or take high blood pressure medication, men who have had a radical prostatectomy or other pelvic surgery. Additionally, oral medications take time to work and can have side effects such as headaches, flushing, upset stomach and blurred vision. Finally they are expensive and must be continually replaced.
There are several prescription medications that claim to help patients. These pills may help achieve erections in response to sexual stimulation:
- Pills can help you achieve an erection quickly and may have an effect on sexual intimacy.
- Do not provide automatic erections like injection drugs
- Not effective in approximately 30% of cases1
- Must take at least ½ hour to one hour before anticipated sexual activity2
Some patients may experience side effects, including:
- Facial blushing
- Upset stomach
- Mild and temporary visual effects
Local medication delivered directly into the penis may be a good choice for men with ED due to neurogenic (nerve) damage, low hormone levels, or psychogenic causes. It is also a good option for men who can’t take oral medication. There are two delivery systems: injections and urethral suppositories, also called MUSE (Medicated Urethral System for Erection)… Both deliver the a drug or combination of drugs that relax smooth muscle tissue to allow sufficient blood flow for erection. The most common approved drug is alprostadil (a form of prostaglandin). Other effective drug combinations may include various formulations of papaverine, phentolamine, and protastaglandin.
Injections for ED are given directly into the penis with a very fine-gauge needle. The idea may pose a psychological hurdle, but the method is virtually painless and is easily learned under supervision of a clinical professional. Erection begins in 5-20 minutes and lasts 30-90 minutes. They may be prescribed for penile rehabilitation after prostate cancer surgery as well as for chronic ED from other causes. However, in cases where the blood supply is compromised, or there is venous leakage whereby an erection can’t be sustained, injections are unlikely to help.
Advantages of injection therapy:
- It can easily be self-administered
- On-set of erection within 5-20 minutes3
- Injections are shown to have a long-term dropout rate of 37% – 76%.4
Reasons for dropping out of drug therapy include:
- Desire for a permanent treatment alternative
- Inadequate response
- Fear of needles
- Side effects
Non-Drug Treatment Options
Penile Pumps (Vacuum Devices)
Also called vacuum constriction devices, penile pumps are devices that are placed over the penis to draw blood into the shaft. Once the vacuum creates an erection, the retaining band is slid down to the lower end of the penis and the pump is removed. You can leave the band on for up to 30 minutes.
- On-demand use
- Drug Free
- Erection is not warm to the touch
- Learning curve
- Delayed ejaculation
A penile implant is a device that is placed into a man’s body and is designed to help him get an erection. A penile implant is a long-term treatment, that is covered by many insurance plans, which allows an erection as often as you like, for as long as you wish.
- Easy to use
- Totally concealed in the body
- Erections when desired
- Surgical Procedure
- No longer able to get natural erections
Other Treatment Options
Your doctor can provide you with specific details about the pros and cons of each of the following treatments:
- Lifestyle changes like stopping smoking, losing weight and eating healthier
- Oral testosterone
- Intraurethral suppositories (ex. MUSE®)
MUSE (Medicated Urethral System for Erection)
The MUSE treatment involves using an applicator to insert a very small, medicated suppository into the urethra at the tip of the penis. Effectiveness ranges from 30-58% for all types of ED, and may not be equally effective each time a man uses it. Erection begins in 5-10 minutes and usually lasts for 30 to 60 minutes. It can be used daily and may be prescribed for penile rehabilitation.
- Applicator makes insertion easy
- May be more acceptable for some men than injections
- May be used with a VED for penile rehabilitation
- Can be used daily, but never more than twice in a 24-hour period
- Less effective than injections and results may be inconsistent
- At higher doses, men may experience pain or burning
- Expensive (MUSE is not typically covered by insurance)
Side effects are relatively rare for both MUSE and injections. However, never use either except as instructed and never increase the dose or frequency without Dr. Alarcon’s supervision. There is a risk of an erection lasting too long (priapism). IMPORTANT: Any erection that lasts beyond 4 hours requires emergency treatment.