Choosing ED treatment

It is important to realize that only a few of the available treatment options can fully restore natural erections. Often, a therapeutic modality will help a man with ED achieve firm erections for successful intercourse, but without addressing the root cause(s) of his sexual dysfunction or providing a permanent solution. Moreover, those erections may not totally resemble his normal erections in their quality, spontaneity, degree of rigidity, and duration. The PDE-5 inhibitors, for example, are sexual enhancers, not promoters; as such, they have no effect at all in producing an erection without sexual stimulation, and they do not increase sexual desire.

But this does not imply that ED is incurable or that "once impotent, always impotent," as some therapists erroneously suggest. In fact, for about 30% of carefully selected patients, simple behavioral measures such as smoking cessation, daily exercise, a balanced diet, reduced obesity and serum cholesterol, moderated alcohol intake, avoidance of illicit drugs and steroids, discontinuation of some medications, relief of anxiety and stress, or even knowledge of proper sex techniques may be sufficient to recover normal sexual functioning, without the need for further treatment.

A recent study covering 401 men with ED in the Massachusetts Longitudinal Aging Study revealed some interesting and unexpected findings. While about 33% of men with minimal or moderate ED exhibited ED progression, about 32%, 14%, and 31% of men with minimal, moderate, and complete ED, respectively, recovered full sexual potency. Weight loss, cessation of smoking, and improvement of overall health were the most important factors involved in the remission of ED and/or delaying its progression. In certain other cases, specific medical measures, such as supplementing low hormone levels, repairing a herniated disk, or bypassing an arterial occlusion, may restore normal erections.

As you can see, it is extremely important for the patient to look at his own case for reversible factors, which, if corrected with professional help and personal willpower, may help him regain full sexual ability without the need for artificial and expensive therapeutic interventions. All treatment options and their success rates, risks, benefits, possible complications, and cost should be explained to him (and his partner) by the treating physician.

Treatment with PDE-5 inhibitors is generally effective in about 70% of patients with ED. If it is not, the patient is usually referred to a urologist, who will assess the cause of the failure and likely prescribe other non-aggressive options such as a vacuum device, intraurethral inserts, or intracorporeal injections. If all of these options are unsuccessful, and after obtaining the patient's approval, the urologist proceeds with surgical insertion of a penile prosthesis, unless the patient's choice and/or other medical considerations indicate a different course of treatment. It is important to understand that surgery solely for restoring sexual function is elective and not a matter of life or death.

No treatment for ED, conservative or aggressive, should be undertaken if the patient is not fully convinced of its necessity and efficacy. If he is not ready to accept all the potential side effects or complications of any recommended form of treatment, or if the treating physician or therapist cannot reasonably assure his expectations of the anticipated results, he should not proceed with it.

It is also highly desirable that the selected treatment be fully acceptable to the patient's partner, with whom he should candidly and objectively discuss any proposed treatment beforehand. A man should never, under any circumstance, hide his treatment from his partner, especially if he has chosen injections, a vacuum device, or a penile prosthesis. The later surprise may only aggravate any existing sexual and relationship problems and compound the man's (or couple's) dysfunction.