If oral PDE-5 inhibitors such as Viagra do not significantly impact the erectile dysfunction or perhaps the PDE-5 inhibitors can’t be taken for medical reasons, then Alprostadil is usually recommended.
It is a powerful vasodilator that triggers an erection within minutes and typically the erections last about an hour. Alprostadil only works if the blood flow is intact, however.
Alprostadil is given in two different ways:
- Intracavernous injection, whereas a solution of Alprostadil is injected directly into the base of the penis. You can use it only three times per week. And of course, after the patient learns how to do it he is expected to do himself each time he is interested in having sex up to a maximum of three times per week. There is an increased risk of damage, scarring and priapism which is prolonged and painful erections typically lasting more than four to five hours.
- Another way of taking Alprostadil is via intraurethral suppository. In this case, pellets are placed into the urethra at the tip of the penis. This method is typically less successful compared to injections. Although the side effects are also less.
Testosterone is a male hormone (androgen), which produced mainly in the testicles but also in the adrenal glands. It helps maintain bone density, fat distribution, muscle strength and mass, red blood cell production, sex drive or libido and also sperm production. The hormone peaks during adolescence and early adulthood and then gradually decline about 1 percent per year beyond the age of 30. About 25 percent of men over the age of 70 don’t produce enough testosterone.
Testosterone therapy, which can occur via injection or gel, is only recommended as a treatment for ED , when the levels are low. But again, slightly lower testosterone levels do not necessarily mean there is going to be reduced libido or erectile dysfunction. The best time to test the blood for testosterone levels is usually in the morning between the hours of 7 and 10 a.m. because testosterone levels are known to fluctuate quite significantly according to you mood and dietary factors throughout the day.
Surgery for erectile dysfunction
Surgical procedures are usually only recommended if the ED is severe enough or complete and there is no response from psychological, natural or pharmaceutical treatments. It is a last resort.
Erectile dysfunction surgery falls into two categories:
- Placement of an implant, which is either inflatable or semi-rigid. This usually happens on both sides of the penis.
- Vascular reconstruction surgery to improve blood flow or to reduce blood leakage from the penis and surrounding structures.
As noted there are two types of penile implants: inflatable and semi-rigid rods.
Inflatable types are the most common in the United States, and there are more natural in the sense that they can be inflated to create an erection just prior to having sex and then deflated afterwards. The picture is an example of this three-piece inflatable implant.
The pump is within the scrotum. Sometimes to fit the pump within the scrotum a testicle has to be removed, but that is not normally the case. There is also a fairly large fluid reservoir inserted into the lower abdomen. And of course, the two inflatables are inserted on either side of the penis.
The two-piece inflatable model works in a similar way to the three-piece, but the fluid reservoir is part of the pump implanted in the scrotum. The advantage of having a three piece is that there is more fluid to pump into the penis which can give a more firm erection. In contrast, semi-rigid rods are always firm but the surgery is less complicated and prone to failure.
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