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Innovators in Comprehensive Urological Care

Innovators in comprehensive urological care

ED – Erectile Dysfunction: Frequently Asked Questions

I ejaculate within minutes of having intercourse. I have no interest in having sex. I cannot reach orgasm. Is this ED?

No! These problems are not ED and they are not treated in the same way. You could be experiencing one of the following:

Premature ejaculation – reaching a climax sooner than desired – this leads to detumescence (erection goes away), but it is not erectile dysfunction. The treatment could involve sexual therapy, possibly the use of drugs that will slow down the time when you ejaculate.

Loss of libido or sex drive – sometimes seen with erectile dysfunction, but not the same. We would check your testosterone and perhaps other hormone levels. We would also explore whether there are psychosocial issues that might be related.

Anorgasmia – inability to reach orgasm – can be caused by medical problems, pelvic surgery, genital trauma, psychological issues – but it is not ED.

If I keep my diabetes in the best control possible, will my ED go away?

Probably not, since the ED is probably related to neurovascular disease already caused by the diabetes. Nevertheless, it’s important to manage your diabetes carefully to prevent other serious vascular events like a stroke or heart attack.

I get a headache when I use Viagra or Levitra or Cialis. What can I do about it?

If the headache is mild, ignore it. If it is annoying, take Tylenol when you take the drug for ED to pre-treat for possible headache.

I get a good erection if I inject my penis with Papaverine (common trade names, EDEX or Caverject). So can I give myself a big dose to last even longer?

Your urologist will help you find the dose that gives you an erection that lasts 30-60 minutes. Injecting even more drug may cause a prolonged erection that will become painful. If the erection does not come down, you will have to see your urologist or an emergency room doctor to have another penile injection of saline or phenylephrine, a drug that reverses the one that caused the erection. Prolonged erections lead to scarring within the penis. Future efforts to inject the penis may be less effective.

Is sensation and ejaculation the same when I have a penile implant placed?

Yes – the surgery does not affect nerves that go to the penis, so penile sensation and ejaculation are unchanged. Men who have had prostate surgery have either limited or no ejaculation, but this is not improved or made worse by placing a penile implant.

I had a penile implant and my erection is not as large as I am used to! Is this expected?

Your urologist should tell you that a penile implant provides rigidity to the shaft of the penis, but the head of the penis remain soft even when you are using the penile prosthesis to have sex. The erection won’t be as large as you had at age 18, but the erection is quite serviceable!

If I don’t like my penile prosthesis, can I go back to the other therapies?

Not easily. Applying a vacuum pump or doing penile injections may damage the cylinders or cause an infection. If the cylinders are removed, there may be scarring that prevents the other therapies from improving any blood flow to the penis. It’s best to try any of the other therapies before choosing to have surgery to place a penile prosthesis.