What are intracavernosal injections?
Medications can be injected directly into the corpora cavernosa to attain and maintain erections. Medications such as papaverine hydrochloride, phentolamine, and prostaglandin E1 can be used alone or in combinations to attain erections. Combining small amounts of each drug is preferred over using a single drug because of increased efficacy and fewer side effects. Even though such injections can be effective, they are not widely used because the injections are painful, there may be scarring of the penis, and there is a risk of developing priapism.
What are intraurethral suppositories?
Prostaglandin E1 can be inserted in a pellet (suppository) form into the urethra to attain erections. This technique also is not popular because of occasional side effects of pain in the penis and sometimes in the testicles, mild urethral bleeding, dizziness, and vaginal itching in the sex partner. Men also need to remain standing after inserting the pellet in order to increase blood flow to the penis, and it may take 15-30 minutes to attain an erection. Prostaglandin can cause uterine contractions and should not be used by men having intercourse with pregnant women unless condoms or other barrier devices are used.
What are vacuum devices?
Mechanical vacuum devices cause an erection by creating a vacuum around the penis that draws blood into the penis, engorging it and expanding it. The devices have three components:
1. A plastic cylinder, in which the penis is placed;
2. A pump, which draws air out of the cylinder; and
3. An elastic band, which is placed around the base of the penis, to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back into the body
One variation of the vacuum device involves a semirigid rubber sheath that is placed on the penis and remains there after attaining erection and during intercourse
Surgery for erectile dysfunction may have as its goal:
1. To implant a device that causes the penis to become erect;
2. To reconstruct arteries in order to increase the flow of blood to the penis, or
3. To block veins that drain blood from the penis.
Implantable devices, known as prostheses, can cause erections in many men with impotence.
Malleable implants usually consist of paired rods, which are inserted surgically into the corpora cavernosa, the twin chambers running the length of the penis. The user manually adjusts the position of the penis and, therefore, the rods. Adjustment does not affect the width or length of the penis.
Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid (see figure 3). Tubes connect the cylinders to a fluid reservoir and pump, which also are surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis somewhat. They also leave the penis in a more natural state when not inflated.
Possible problems with prostheses include mechanical breakdown and infection. Mechanical problems have diminished in recent years because of technological advances.
Surgery to repair arteries can reduce impotence caused by obstructions that block the flow of blood to the penis. The best candidates for such surgery are young men with discrete blockage of an artery because of a physical injury to the pubic area or a fracture of the pelvis. The procedure is less successful in older men with widespread blockage of arteries.
1. A plastic cylinder, in which the penis is placed;
2. A pump, which draws air out of the cylinder; and
3. An elastic band, which is placed around the base of the penis, to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back into the body
One variation of the vacuum device involves a semirigid rubber sheath that is placed on the penis and remains there after attaining erection and during intercourse
Surgery for erectile dysfunction may have as its goal:
1. To implant a device that causes the penis to become erect;
2. To reconstruct arteries in order to increase the flow of blood to the penis, or
3. To block veins that drain blood from the penis.
Implantable devices, known as prostheses, can cause erections in many men with impotence.
Malleable implants usually consist of paired rods, which are inserted surgically into the corpora cavernosa, the twin chambers running the length of the penis. The user manually adjusts the position of the penis and, therefore, the rods. Adjustment does not affect the width or length of the penis.
Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid (see figure 3). Tubes connect the cylinders to a fluid reservoir and pump, which also are surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis somewhat. They also leave the penis in a more natural state when not inflated.
Possible problems with prostheses include mechanical breakdown and infection. Mechanical problems have diminished in recent years because of technological advances.
Surgery to repair arteries can reduce impotence caused by obstructions that block the flow of blood to the penis. The best candidates for such surgery are young men with discrete blockage of an artery because of a physical injury to the pubic area or a fracture of the pelvis. The procedure is less successful in older men with widespread blockage of arteries.
What about psychological therapy?
Experts often treat psychologically based impotence using techniques that decrease anxiety associated with intercourse. The patient's partner can help apply the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when physical impotence is being treated.
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