Erectile Dysfunction (ED, Impotence) (cont.)

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Surgery for erectile dysfunction

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;
  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 exercising 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.

Inflatable Implant Illustration - Erectile Dysfunction (ED)

Surgery to repair arteries (penile arterial reconstructive surgery) 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 for erectile dysfunction?

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. If these simple behavioral methods at home are ineffective, referral to a sex counselor may be advised.

What will research is being done for erectile dysfunction?

Combination therapy for the treatment of erectile dysfunction has been under investigation. Most of these studies have been small trials, and long-term data regarding their effectiveness and safety are lacking. However, with thorough evaluation and counseling, there may be a use for combination therapy for certain individuals with ED.

Melanocortin receptor agonists are a new set of medications being developed in the field of erectile dysfunction. Their action is on the nervous system rather than the vascular system. PT-141 is a nasal preparation which appears to be effective alone or in combination with PDE5 inhibitors. The main side effects include flushing and nausea. These drugs are currently not approved for commercial use.

Medically reviewed by Michael Wolff, MD; American Board of Urology

Portions of the above information has been provided by the National Institutes of Health (


Brosman, Stanley A. "Erectile Dysfunction." July 22, 2009. <>.

Diamond, L.E., D.C. Earle, W.D. Garcia, and C. Spana. "Co-administration of Low Doses of Intranasal PT-141, a Melanocortin Receptor Agonist, and Sildenafil to Men with Erectile Dysfunction Results in an Enhanced Erectile Response." Urology 65 (2005): 755.

Ellsworth, Pamela, and Eileen M. Kirshenbaum. "Current Concepts in the Evaluation and Management of Erectile Dysfunction." Nov. 26, 2008. <>.

Medically Reviewed by a Doctor on 4/3/2014

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