What are nonsurgical treatments for erectile dysfunction?
There are many nonsurgical treatments available for erectile dysfunction.
Oral pharmacological treatment
The first line of pharmacological treatment is a class of medication called phosphodiesterase (PDE-5) inhibitors. This class includes sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). They will improve the ability to attain and maintain the erection, but sexual stimulation is still required for this medication to work. It should be taken some time before the sexual act is planned, but has a long timeframe of action. Side effects include visual disturbances, flushing, back pain, and muscle pain. Most side effects will abate with time. Usually, there will be no side effects at all. If you are taking nitrates, phosphodiesterase inhibitors are not recommended since both medications taken simultaneously could cause severe hypotension (excessive low blood pressure).
Other types of oral medication are available. Apomorphine will enhance penile erection. And there are others. You should ask your doctor for other types of medication if the first one didn't work. Other treatment options should also be discussed.
Transurethral therapy
Another type of pharmacological solution is a liquid that can be applied in the urethra that manages to improve erection. The erection can be maintained by applying an elastic band at the base of the penis.
Intracavernous injection
Injections at the base of the penis (intracavernous) can help attain and maintain an erection. There are various types of solutions that can be injected -- papaverine, alprostadil, and drug combinations. These injections are considered the most effective treatments for erectile dysfunction. They are also convenient for the patients who don't tolerate the oral therapies.
Side effects include priapism (prolonged and painful erection) and fibrosis (scarring) but they are rare. There are ways to prevent these side effects (especially the prolonged and painful erection). The patient must follow the training and recommendations given at the beginning of this type of therapy. Contraindications for intracavernous injections include sickle cell anemia, schizophrenia, and severe psychiatric disorder.
Vacuum constriction device
This is a plastic cylinder connected to a vacuum-generating source that creates a negative pressure that draws the blood to the penis and makes way for an erection. An elastic band must be placed at the base of the penis to maintain the rigidity. The base of the penis will stay flaccid which might make the genitalia pivot. Side effects include ejaculatory problems, penile pain, and blood pooling because of ruptured blood vessels (ecchymosis or petechiae).
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