Erectile Dysfunction: How Surgery Can Help
Posted Mar 29, 2017
by Dr. Alexandre Figueiredo
Medical Content Manager
Erectile Dysfunction (ED) is a condition that involves difficulties in getting and maintaining an erection in order to engage in sexual intercourse. This condition can affect men of any age and can be caused by different factors, both physical and psychological. According to recent data, only a small percentage of men with ED seek for help. Erectile dysfunction can be a sign of an underlying medical condition, so getting effective treatment can also contribute to improving your overall health.
Causes and diagnosis
There are both physical and psychological conditions - or a combination of both - that can cause ED. The most common physical causes comprise high blood pressure, diabetes, heart disease, and physical injury. Psychological issues include anxiety, depression, stress, or fear of sexual failure.
Vasculogenic conditions: they affect the blood flow to the penis. They include: high blood pressure, heart disease, high cholesterol, and diabetes.
Neurogenic conditions: they affect the nervous system and include Parkinson's disease, multiple sclerosis, stroke, and spinal disorder.
Hormonal conditions: they affect the hormones, e.g. hyperthyroidism or hypothyroidism, Cushing's syndrome (high cortisol level), hypogonadism (low testosterone level).
Anatomical conditions: they affect the structure of the penis, e.g. Peyronie's disease.
Surgery and radiation therapy for bladder, rectal, or prostate cancer.
Injury to the penis, spine, or brain.
Side effect of prescription drugs: such as blood pressure medications, antihistamines, antidepressants, or ulcer medications.
Moreover, certain lifestyle choices can lead to ED, such as smoking, using illegal drugs, drinking too much alcohol, being overweight, and not exercising.
Anxiety or depression: mental health problems, including anxiety disorders, panic disorders, or depression may negatively affect sexual functioning.
Stress: stress from work or home can influence the sexual performance.
Relationship problems: these problems underline marital dissatisfaction, sexual boredom, or other problems related to the relationship with the partner.
Fear of intimacy or performance anxiety: fear of performance or failing to sexually satisfy the partner.
In order to help diagnose erectile dysfunction, a doctor usually takes a medical and sexual history of the patient. The doctor will ask the patient to provide information including the patient's medication usage, medical intervention or surgeries, and specific information about his sexual life. A physical exam will then be performed. Other tests that can help diagnose ED include blood tests, a nocturnal erection test, and a mental health exam.
Understanding the causes of erectile dysfunction is the first step towards finding effective treatment. Below a list of treatments that may help treat ED. Your doctor will help you identify the best treatment for your specific case.
Oral medications: these are prescribed drugs that increase the blood flow to the penis. A man needs to be sexually aroused to ensure the erection is achieved. The most commonly prescribed drugs are Viagra, Cialis, Levitra, and Spedra.
Lifestyle changes: lifestyle changes such as stopping smoking, losing weight if overweight, taking exercise and limiting alcohol may contribute not only to solve ED but also to improve you general health.
Sex therapy: sex therapy involves an individual or a couple work with a therapist to identify and tackle relationship or sexual problems. It can be used in combination with other treatments.
Hormone replacement: hormone replacement may be effective for those men who have low testosterone. Other than erectile dysfunction, testosterone deficiency usually has other symptoms such as decreased interest in sex, depression, or difficulty concentrating.
Surgical treatment: there are different types of surgery that can be performed to treat ED.
For the scope of this article, we will be focusing on the types of surgery that are most commonly used to treat ED. This does not indicate that surgery is the recommended treatment for ED. Every patient is strongly encouraged to talk to his doctor to understand what option best works in his case.
What types of surgery are available to treat ED?
Penile prostheses (or implants) and vascular surgery are other treatment options for men with erectile dysfunction. Surgery is usually the last option to consider after other non-surgical treatments have failed to treat erectile dysfunction. A specialist will be able to assess whether surgery is a suitable option on a case-to-case basis.
Penile prostheses can be malleable or inflatable.
Malleable implants consist of a pair of malleable rods that are surgically implanted in the erection chambers of the penis.
Inflatable implants consists of two cylinders, a reservoir, and a pump that are placed surgically in the body. The two cylinders are inserted in the penis and connected by tubing to a separate reservoir of fluid. The reservoir is implanted under the groin muscles. A pump is also connected to the system and is placed between the testicles. In order to inflate the prosthesis, the man needs to press on the pump. The pump transfers fluid from the reservoir to the cylinders in the penis, inflating them. In order to deflate the implant, the man will press on the deflation valve at the base of the pump to let the fluid return to the reservoir.
While malleable implants are always semi-rigid, inflatable prostheses are inflated and deflated only when a man chooses to.
Vascular reconstructive surgery aims at improving blood flow to the penis to help a man get and maintain an erection. There are two main types of vascular reconstructive surgery: penile arterial reconstructive surgery and penile venous reconstructive surgery. Vascular surgery is recommended for those people who have clogged or damaged arteries or veins.
Penile Arterial Reconstructive Surgery
This type of vascular surgery involves bypassing the blocked artery by taking a healthy artery from the abdomen. The arteries in the penis are then dilated to allow the flow of more blood.
Penile Venous Reconstructive Surgery
This type of surgery involves blocking off the veins within the penis to slow down the reverse flow of blood out of it. This system will allow the erection to be maintained for a longer time.
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