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Erectile Dysfunction-Questions & Answers

Howard B. Abromowitz, MD, FACS








Erectile Dysfunction (ED) is the inability to obtain and maintain an erection that is adequate for sexual activity.  There are many causes for ED.  Most common causes include Diabetes, vascular disease, low testosterone levels, and obesity.  Many causes are medically induced as a side effect of certain medication such as blood pressure medication, psychological medications and GI medications. Treatment for cancer is another potential cause of erectile dysfunction.  One of the biggest side effects of prostate cancer intervention is ED.

Radical prostate surgery is associated with a 50% risk of ED, surgical techniques such as Robotic assisted approaches and nerve-sparing techniques have helped significantly.   Patients under 60 tend to do better.

Radiation Therapy also has an increased risk of erectile dysfunction at about 30% with Intensity Modulated Radiation Therapy or IMRT external beam radiation therapy.  Prostate seed implantation has a much higher rate of ED at a 70-80% rate.  Cryosurgery as a prostate cancer treatment also has a very high rate of ED.

When a physician treats cancer the prime objective is to cure the patient. The side effects are dealt with later, though ED concerns are taken into consideration when choosing intervention modalities.  The prime objective is always control of the cancer but quality of life is also extremely important.

Erectile dysfunction can be managed quite well.  Treatment can be very easy or much more involved.

Initial treatment is frequently with oral medication such as Viagra, Cialis, Levitra or Stendra. This is a class of medication known as PDE5 inhibitors.  These medicines are very effective.

If the medications fail, the next option is that of a vacuum device; a non-invasive mechanical device that will induce an erection.

Another option is self-injection therapy which involves injecting a vasodilating medication directly into the penis.  While this sounds terrible it actually works extremely well and with very high patient satisfaction.

The most invasive option (which is considered last choice) is the insertion of a penile prosthesis.  This requires surgery and a 6-week recovery.  In the right individual this is an excellent choice with a long-term solution.

Erectile dysfunction can almost always be treated, the question is to what extent is the patient willing to pursue treatment..

Please do not hesitate to talk to your physician, as we’re here to help guide you thru these difficult times.  For more information and educational resources, please visit The Urology Care Foundation.