What are my ED treatment options?
With the proliferation of oral medications such as Viagra and other similar drugs (PDE-5 inhibitors), the public awareness and treatment options for erectile dysfunction have increased significantly. Although ED pills have proved very successful in helping millions of men overcome their erections issues, the reality is that taking a pill before sex only treats the symptom but not the underlying cause of the disease. As such, many men with ED remain under-treated since the health issues causing their ED are not identified or addressed.
With that in mind, the aim of any treatment plan should not only be to allow men to enhance their erections during sex (with on demand treatments) but most importantly heal their damaged erection mechanism and prevent further deterioration, address the underlying causes of their ED and help them adopt a healthy lifestyle that will improve both their erections and their overall health and quality of life!
Rejuvenating the Erection Mechanism
As discussed in a previous blog, for the majority of men with organic ED, the main reason for their issues is the fact that their erection mechanism is compromised because of endothelium/smooth muscle dysfunction. It is also likely that there is some fibrosis (scarring) in the corpora cavernosa because of a reduction in their night erections. Unfortunately, ED medications before sex might help temporarily achieve better erections but do not really heal the diseased erection mechanism.
Fortunately, there are various treatments modalities that have the potential to rejuvenate the erection mechanism, including:
- Extra-corporeal Shock-wave Therapy
- Platelet Rich Plasma (PRP) Injections
- Stem Cell Injections
All of these options seem to be quite well tolerated and safe to administer but in terms of efficacy, only shockwave therapy has enough scientific evidence to suggest that it can lead to actual erection rejuvenation. This is why it is our mission here at AndroWave to popularise this revolutionary treatment. This does not mean that PRP or stem cell injections do not work but that the necessary research to evaluate their therapeutic effects has not been carried out yet.
On demand treatments
The first ED pill, Viagra, was introduced in 1998 and it is not an exaggeration to say that ED pills are one of the most successful – commercially and in terms of results - drugs, ever!
Because of ED pills, hundreds of millions of men have been able to regain their erections and salvage their sex lives.
How do ED pills work?
As explained previously, erections are caused by increased penile blood flow resulting from the relaxation of penile arteries and the smooth muscle cells.
This process involves a few steps; following sexual stimulation the local nerves and the endothelial cells in the penis release nitric oxide, which in turn increases the production of a chemical called cGMP (cyclic guanosine monophosphate), which relaxes the smooth muscles and increases blood flow. Another chemical, found in the erection mechanism, called phosphodiesterase type 5 (PDE5) breaks down cGMP and reduces its concentration. ED pills, effectively block PDE5 (that is why they are called PDE5 inhibitors), thus allowing more cGMP to form and act on the erection mechanism smooth muscle, which in turn improves erections.
This means that ED pills only enhance erections, rather that induce erections (like penile injections do), when a man is sexually stimulated. After orgasm or when there is no sexual stimulation, the penis returns to the normal flaccid state even if you have taken a pill.
Penile Injections and other on demand treatment options
The first successful pharmacological treatment of erectile dysfunction was through penile injections of papaverine and phenoxybenzamine. To date, a number of medications have been used for this purpose, most commonly papaverine, phentolamine and alprostadil in isolation or as a mix.
Penile injections are administered by the patient himself just before sexual intercourse and they induce an erection within 5 minutes. The use of an injection mechanism similar to that for insulin injections makes administration easy and painless.
In most cases, penile injections will be recommended to patients as an erection enhancer when ED pills do not work (around 30% of men suffering from ED) or as a booster for patients taking daily tadalafil and suffer from severe erectile dysfunction.
Penile injections do not require any sexual stimulation to work (this means that erections will be achieved irrespective of sexual desire) and their efficacy rate is significantly higher than PDE-5 inhibitors. On the other hand, taking an oral pill as opposed to administering an injection before intercourse is more acceptable for most patients.
The type and dosage of injection therapy that will result in maximum responses is patient specific and will thus need to be evaluated during a consultation with your doctor.
Beyond ED pills and penile injections, other topical treatments that can help induce erections are MUSE pellets (inserted in the urethra) and a topical cream called Vitaros. Unfortunately, although these treatment options sound appealing and might play a role for men who do not respond to ED pills and do not want to inject themselves, the reality is that they are rarely used and treatment satisfaction is significantly lower than ED pills or injection therapy.
Beyond AndroWave and on-demand treatments explained in this post, there are other treatment options which will be explored in subsequent posts. Stay Tuned!