Erectile Dysfunction (ED, Impotence) (cont.)

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Avanafil (Stendra)

Avanafil was recently FDA approved to treat erectile dysfunction. Common side effects may include headache, flushing, sore throat, stuffy and/or runny nose, and back pain. The drug is not recommended for patients with cardiac problems (in the last six months), hypotension or hypertension, unstable angina or congestive heart failure.

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 (alprostadil) 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 in the management of erectile dysfunction (success rate of around 80%), they are not widely used because of their potential complications. These injections are painful, can cause scarring of the penis, and lead to a higher risk of developing priapism.

What are intraurethral suppositories?

Prostaglandin E1 (intraurethral alprostadil or MUSE) 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. This drug is now rarely used since the introduction of oral medications, however, it may play a role in management of erectile dysfunction in those who are not a candidate for oral PDE5 medications.

How effective is testosterone in treating erectile dysfunction?

In patients with hypogonadism, testosterone treatment can improve libido and erectile dysfunction, but the response of erectile dysfunction in men with hypogonadism to testosterone is not complete; many men still may need additional oral medications such as sildenafil, vardenafil, or tadalafil.

In men 40 years of age or older, a breast examination, digital examination of the prostate, and a PSA level (prostate specific antigen) blood test should be done to exclude breast and prostate cancer before starting testosterone treatment since testosterone can aggravate breast and prostate cancers. Patients who have breast and prostate cancers or are suspected of having them should not use testosterone.

Blood testosterone levels can be measured to detect deficiency. Although, there is no clear-cut testosterone level to define hypogonadism, levels lower than 250 nanograms per deciliter are considered low, and levels of greater than 350 nanograms per deciliter are considered normal. Testosterone levels in between these numbers may be labeled indeterminate.

Certain medications can alter the gonadal function, including thiazide diuretics, some seizure medications, long-acting oral opiate pain medications, antipsychotic medications, and oral steroids.

Medically Reviewed by a Doctor on 4/23/2015

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