Fast Facts on Erectile Dysfunction and What Are Surgical Treatment Options for ED?

Fast facts on erectile dysfunction:

      • Erectile dysfunction (ED) is defined as persistent difficulty achieving and maintaining an erection sufficient to have sex.
      • Causes are usually medical but can also be psychological.
      • Organic causes are usually the result of an underlying medical condition affecting the blood vessels or nerves supplying the penis.
      • Numerous prescription drugs, recreational drugs, alcohol, and smoking, can all cause ED.

The following list summarizes many of the most common physical or organic causes of ED:

      • heart disease and narrowing of blood vessels
      • diabetes
      • high blood pressure
      • high cholesterol
      • obesity and metabolic syndrome
      • Parkinson’s disease
      • multiple sclerosis
      • hormonal disorders including thyroid conditions and testosterone deficiency
      • structural or anatomical disorder of the penis, such as Peyronie disease
      • smoking, alcoholism, and substance abuse, including cocaine use
      • treatments for prostate disease
      • surgical complications
      • injuries in the pelvic area or spinal cord
      • radiation therapy to the pelvic region

Atherosclerosis is a common cause of blood flow problems. Atherosclerosis causes a narrowing or clogging of arteries in the penis, preventing the necessary blood flow to the penis to produce an erection.

Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.

Having erection trouble from time to time isn’t necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect your self-confidence and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.

If you’re concerned about erectile dysfunction, talk to your doctor — even if you’re embarrassed. Sometimes, treating an underlying condition is enough to reverse erectile dysfunction. In other cases, medications or other direct treatments might be needed.

Inflatable penile prostheses are implanted during outpatient surgery. Once they are part of a man’s body, they enable him to have an erection whenever he desires. The use of a prosthesis preserves penile sensation, orgasm and ejaculation for most men.

The most commonly used penile implant consists of a pair of inflatable cylinders that are surgically implanted in the erection chambers of the penis. The cylinders are connected through tubing to a reservoir of fluid under the lower abdominal muscles, and to a pump inside the scrotal sac.

To inflate the penile prosthesis, the man compresses the pump a number of times to transfer fluid from the reservoir to the cylinders. This causes the penis to become erect. When inflated, the prosthesis makes the penis stiff and thick, which is very similar to a natural erection.

A penile prosthesis does not change the sensation on the skin of the penis or a man’s ability to achieve orgasm or ejaculate. Pressing on a deflation valve attached to the pump returns the fluid to the reservoir, which returns the penis to a flaccid state.

The surgical procedure is performed through one or two small incisions that are generally well hidden. Other people will be unable to tell that a man has an inflatable penile prosthesis. Complications following surgery are not common, but primarily include infection and mechanical device failure.

Approximately 95% of penile implant surgeries are successful in producing erections that enable men to have sexual intercourse. Moreover, patient satisfaction questionnaires show that up to 90% of men who have undergone penile implants say they would choose the surgery again, and overall satisfaction ratings are higher than those reported by men using oral medication or penile injection therapy.

Education and Communication and other Non-surgical Treatments for Erectile Dysfunction (ED)?

Education and communication

Education about sex, sexual behaviors, and sexual responses may help a man overcome his anxieties about sexual dysfunction.

Talking honestly with your partner about your needs and concerns may also help to overcome many barriers to a healthy sex life.

Medication

Medications such as

    • sildenafil (Viagra®),
    • vardenafil (Levitra®),
    • or tadalafil (Cialis®)

may help improve sexual function in men by increasing blood flow to the penis. Men who are on medicines that contain nitrates such as nitroglycerine should not take oral ED medications. The combination of nitrates and these specific medications can cause low blood pressure (hypotension).

The most common side effects of these medications are indigestion, nasal congestion, flushing, headaches and a temporary visual disturbance.

Mechanical aids

Aids such as vacuum devices and penile constriction rings serve as erectile aids for some men.

A vacuum constriction device (above) is a cylinder that is placed over the penis. The air is pumped out of the cylinder, which draws blood into the penis and causes an erection. The erection is maintained by slipping a band off of the base of the cylinder and onto the base of the penis. The band can stay in place for up to 30 minutes. The vacuum device can be safely used to treat most causes of erectile failure. Lack of spontaneity, discomfort, and cumbersomeness of the device seem to be the biggest concerns of patients.

Figure 3. Choosing an injection site

Penile injection therapy (intracavernosal injection therapy)

Men are taught how to inject medications directly into the erection chambers of the penis to create an erection. Injection therapy is effective in treating a wide variety of erection issues caused by blood vessel, nerve and psychological conditions.

The tissue that causes you to get an erection (erectile tissue) is a muscle. Going long periods of time without an erection is unhealthy for erectile tissue and may damage it.

We believe that having erections keeps erectile tissue healthy. A penile injection helps you have an erection. It works best if it’s given about 5 to 15 minutes before you want an erection.

Using a tiny needle and syringe, the man injects a small amount of medicine into the side of his penis. The medicine relaxes the blood vessels, allowing blood to flow into the penis. This treatment has been widely used and accepted since the early 1980s. The three most common medicines are prostaglandin E1 (alprostadil), papaverine (Papacon®), and phentolamine (Regitine®).

The most common side effects are pain and penile scarring (fibrosis). In extremely rare cases, patients with cerebral and vascular disease or severe cardiovascular diseases might not be able to tolerate the dizziness and high blood pressure occasionally caused by injection therapy.

A painful erection that lasts longer than two to three hours is called priapism and may occur with injection therapy. This can be lessened with proper dosing and by following the treatment guidelines.

The 3 most commonly used medications for injection therapy are Trimix, Bimix, and Papaverine. Most men begin injection therapy with Trimix, which is a mixture of 3 ingredients: alprostadil, phentolamine, and papaverine. These ingredients work by relaxing the smooth muscle and opening the blood vessels in your penis, causing an erection. Your APP will decide whether Trimix or a different medication is best for you.

 

Psychology and sex therapies

Psychological causes may contribute to erectile failure even when there is a clear organic cause.

Therapy with a trained counselor can help a person address feelings of anxiety, fear or guilt that may have an impact on sexual dysfunction.

Sex therapy can be beneficial to most men when counseling is provided by a skilled sex therapist. Sex therapy also helps a man’s partner accept and cope with the problems.

A patient whose ED has a clear psychological cause should receive sex therapy counseling before any invasive treatments are pursued.

When you seek out sex therapy, you need to look for a relationship or marriage counsellor, psychotherapist or psychologist who uses specialised clinical skills and theoretical knowledge about human sexuality. In addition to having post-graduate training in couples and marriage counselling, we get specific sex therapy training to help you deal with your sexual difficulties or concerns.

Sex therapists are qualified counsellors or healthcare professionals who have had extensive training in human sexuality, in addition to being well-trained couples and marriage counsellors and therapists.

Sexual issues can often cause distress and conflict in relationships and sex therapists can assist you with these difficulties.

Some sexual concerns include:

      • Lack of sexual knowledge or education
      • Believing wrong/harmful information about sex from the media or religious institutions
      • Struggle to understand sex, desire, eroticism, privacy versus secrecy
      • Erectile and/or ejaculation difficulties
      • Performance anxiety and lack of confidence
      • Problems reaching orgasm
      • Low sexual desire concerns for both men and women
      • Intimacy problems
      • Relationship and marriage difficulties
      • Painful sex or intercourse
      • Sexual problems or changes due to illness, ageing, surgery or stress
      • Compulsive sexual behaviours, or out of control sexual behaviours (wrongly called sexual addiction)
      • Sexual trauma
      • Questioning your sexual identity, orientation or preferences
      • LGBTQI issues
      • Gender identity issues
      • Interest in kink
      • Cross dressing or other fetishes

Hormone

Low hormone levels may play a role in ED. Hormone replacement in the form of topical gels, creams, patches, injections and pellets are only used after physician evaluation.

Which Drugs are Good for Erectile Dysfunction?

What are the differences between erectile dysfunction drugs? About half of men ages 40 to 70 have erectile dysfunction (ED) to some degree, although only one in 10 report a complete inability to have erections. Taking an ED drug produces an erection sufficient to start intercourse in about 70% of otherwise healthy men.

Does it make any difference which of the four drugs for erectile dysfunction you take? “Yes, there can be differences,” says Dr. Louis Liou, chief of urology at Harvard-affiliated Cambridge Health Alliance in Boston. “For new patients, I have them try different ones to see what works best.”

Sildenafil (Viagra) is often the first drug your doctor offers. It’s been on the market longest and its side effects and the medications and foods it interacts with are well known.

But the main challenge to finding the best ED drug for you may turn out to be health insurance rules—not biochemistry. It’s a common practice among insurers to limit the number of pills you can obtain per month. After you hit your limit, the out-of-pocket cost for a single pill can be very high. “The main obstacle in my practice is the cost,” Dr. Liou says. You’ll need to work with your doctor to get the pill you need at a price you can afford.

What erectile dysfunction pills are available?

In addition to Viagra, other ED drugs available in the United States include avanafil (Stendra), tadalafil (Cialis) and vardenafil (Levitra). These all improve blood supply to the penis. In combination with sexual stimulation, the drugs can produce an erection sufficient to initiate and complete intercourse.

There is also a fast-dissolving form of Levitra, called Staxyn, that you put under your tongue.

  • Viagra
  • Cialis
  • Levitra

One ED drug, Cialis, is FDA-approved for use daily in a dose of 2.5 or 5 milligrams. This helps to produce erections on demand and may also help relieve urinary problems, like difficulty starting urination, that result from an enlarged prostate.

 

How well do ED pills work?

ED drugs produce an erection sufficient for intercourse in about 70% of men. But the results vary quite a bit from one individual to another. A man with nerves or arteries damaged by prostate surgery, diabetes, or cardiovascular disease will not respond as strongly to ED drugs. “There are some men in whom none of these drugs work,” Dr. Liou says.

 

How quickly do ED pills work?

How soon the drugs start working ranges from 15 to 60 minutes. Neither Viagra nor Levitra will work if you take them after a meal, which blocks their absorption. However, neither Cialis nor Stendra interact with food this way. The onset time determines how soon you can engage in intercourse. Stendra and daily-use Cialis are closest to being an “on demand” erectile drug; using the others requires more planning.

 

How to use ED pills properly

Dr. Liou says that some men come to him after getting a prescription from their primary care doctors, claiming that the drug doesn’t work. Sometimes it’s because they used it incorrectly. “The biggest misconception is that these drugs are an on/off switch for erections,” Dr. Liou says. But the drugs don’t work well without sexual stimulation. “During that time, you need to be with your partner and have foreplay,” Dr. Liou says. “Don’t take it, do the taxes or the dishes, and then meet at the bedroom thinking you’ll be ready to go. It’s not like that.”

 

How long do ED pills last?

The ED drugs break down at different rates in the body. The durations of action range from four hours to more than a day (for Cialis in the higher doses). Each dose should be sufficient to provide a full cycle of intercourse, from erection to climax.

“Will it last through another cycle? It’s not guaranteed,” Dr. Liou says. To have sex more than once a day, Cialis is your best bet.

 

What are the side effects of ED pills?

The most common side effects of ED drugs, in order of most to least common are headache, flushing, upset stomach, nasal congestion, vision problems, diarrhea, dizziness, and rash. A man who has an erection that lasts four hours or more needs to get to a hospital or risk permanent damage.

None of the ED drugs is safe to take with cardiac drugs called nitrates because it could cause a dangerous drop in blood pressure. Drugs that many men take for urinary symptoms, called alpha blockers, can also lower blood pressure, so take them at least four hours apart from ED drugs. Your doctor may start you on a smaller dose of the ED drug if you already take an alpha blocker or may recommend the alpha blocker tamsulosin (Flomax), which affects blood pressure less.

 

Heart health and erectile dysfunction

ED is often an early warning sign of underlying cardiovascular disease, such as clogged arteries (atherosclerosis). “It can predate a diagnosis of cardiovascular disease by at least a few years,” Dr. Liou says. We don’t have strong proof yet that starting to live a healthier lifestyle can reverse erectile problems, but it can’t hurt.

 

ED drugs: How soon they start working and how long they last

Medication Onset Duration
avanafil (Stendra) 15-30 minutes 6-12 hours
sildenafil (Viagra) 30-60 minutes 4-5 hours
tadalafil (Cialis) 30-45 minutes 24-36 hours
tadalafil (Cialis) daily continuous continuous
vardenafil (Levitra) 30-60 minutes 4-5 hours

Looking for natural solutions to ED?

What is Erectile Dysfunction and Why I Get ED ?

Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.

Having erection trouble from time to time isn’t necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect your self-confidence and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.

If you’re concerned about erectile dysfunction, talk to your doctor — even if you’re embarrassed. Sometimes, treating an underlying condition is enough to reverse erectile dysfunction. In other cases, medications or other direct treatments might be needed.

Flaccid and erect penis

 

Symptoms

Erectile dysfunction symptoms might include persistent:

  • Trouble getting an erection
  • Trouble keeping an erection
  • Reduced sexual desire

 

Why I get Erectile Dysfunction ?

Depression – The brain is an often-overlooked erogenous zone. Sexual excitement starts in your head and works its way down. Depression can dampen your desire and can lead to erectile dysfunction. Ironically, many of the drugs used to treat depression can also suppress your sex drive and make it harder to get an erection, and they can cause a delay in your orgasm.

Alcohol – You might consider having a few drinks to get in the mood, but overindulging could make it harder for you to finish the act. Heavy alcohol use can interfere with erections, but the effects are usually temporary. The good news is that moderate drinking — one or two drinks a day — might have health benefits like reducing heart disease risks. And those risks are similar to erectile dysfunction risks.

Medications – The contents of your medicine cabinet could affect your performance in the bedroom. A long list of common drugs can cause ED, including certain blood pressure drugs, pain medications, and antidepressants. But do not stop taking any medicines without talking to your doctor first. Street drugs like amphetamines, cocaine, and marijuana can cause sexual problems in men, too.

Stress – It’s not easy to get in the mood when you’re overwhelmed by responsibilities at work and home. Stress can take its toll on many different parts of your body, including your penis. Deal with stress by making lifestyle changes that promote well-being and relaxation, such as exercising regularly, getting enough sleep, and seeking professional help when appropriate.

Anger – Anger can make the blood rush to your face, but not to the one place you need it when you want to have sex. It’s not easy to feel romantic when you’re raging, whether your anger is directed at your partner or not. Unexpressed anger or improperly expressed anger can contribute to performance problems in the bedroom.

Anxiety – Worrying that you won’t be able to perform in bed can make it harder for you to do just that. Anxiety from other parts of your life can also spill over into the bedroom. All that worry can make you fear and avoid intimacy, which can spiral into a vicious cycle that puts a big strain on your sex life — and relationship.

Middle-Aged Spread – Carrying extra pounds can impact your sexual performance, and not just by lowering your self-esteem. Obese men have lower levels of the male hormone testosterone, which is important for sexual desire and producing an erection. Being overweight is also linked to high blood pressure and hardening of the arteries, which can reduce blood flow to the penis.

Self-Image – When you don’t like what you see in the mirror, it’s easy to assume your partner isn’t going to like the view, either. A negative self-image can make you worry not only about how you look, but also how well you’re going to perform in bed. That performance anxiety can make you too anxious to even attempt sex.

Low Libido – Low libido isn’t the same as erectile dysfunction, but a lot of the same factors that stifle an erection can also dampen your interest in sex. Low self-esteem, stress, anxiety, and certain medications can all reduce your sex drive. When all those worries are tied up with making love, your interest in sex can take a nosedive.

Your Health – Many different health conditions can affect the nerves, muscles, or blood flow that is needed to have an erection. Diabetes, high blood pressure, hardening of the arteries, spinal cord injuries, and multiple sclerosis can contribute to ED. Surgery to treat prostate or bladder problems can also affect the nerves and blood vessels that control an erection.

 

Causes of Erectile Dysfunction

Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Likewise, stress and mental health concerns can cause or worsen erectile dysfunction.

Sometimes a combination of physical and psychological issues causes erectile dysfunction. For instance, a minor physical condition that slows your sexual response might cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen erectile dysfunction.

ED is not the same as premature ejaculation.

The major causes of ED include:

  • Vascular (blood vessel) disease — Erections happen when blood collects in the shaft of the penis. Vascular disease can limit the amount of blood flowing to or staying in the penis. Both can result in problems with erections.
  • Vascular disease is the most common medical cause of impotence.
  • Nerve damage — Nerves must be working normally for a man to get and keep an erection. Nerves can be damaged by diabetes, multiple sclerosis, prostate surgery or damage to the spinal cord.
  • Psychological factors — Psychological issues such as depression, anxiety, guilt or fear can sometimes cause sexual problems. At one time, these factors were thought to be the major cause of impotence. Doctors now know that physical factors cause impotence in most men with the problem. However, embarrassment or “performance anxiety” can make a physical problem worse.
  • Medications — Many medications cause problems with sexual function. These include drugs for high blood pressure, depression, heart disease and prostate cancer.
  • Hormonal problems — Abnormal levels of certain hormones can interfere with erections and sex drive. Hormonal problems, such as a low testosterone level, are an uncommon cause of impotence.

 

Physical causes of Erectile Dysfunction

In many cases, erectile dysfunction is caused by something physical. Common causes include:

  • Heart disease
  • Clogged blood vessels (atherosclerosis)
  • High cholesterol
  • High blood pressure
  • Diabetes
  • Obesity
  • Metabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol
  • Parkinson’s disease
  • Multiple sclerosis
  • Certain prescription medications
  • Tobacco use
  • Peyronie’s disease — development of scar tissue inside the penis
  • Alcoholism and other forms of substance abuse
  • Sleep disorders
  • Treatments for prostate cancer or enlarged prostate
  • Surgeries or injuries that affect the pelvic area or spinal cord
  • Low testosterone

Psychological causes of erectile dysfunction

The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:

  • Depression, anxiety or other mental health conditions
  • Stress
  • Relationship problems due to stress, poor communication or other concerns

Risk factors

As you get older, erections might take longer to develop and might not be as firm. You might need more direct touch to your penis to get and keep an erection.

Various risk factors can contribute to erectile dysfunction, including:

  • Medical conditions, particularly diabetes or heart conditions
  • Tobacco use, which restricts blood flow to veins and arteries, can — over time — cause chronic health conditions that lead to erectile dysfunction
  • Being overweight, especially if you’re obese
  • Certain medical treatments, such as prostate surgery or radiation treatment for cancer
  • Injuries, particularly if they damage the nerves or arteries that control erections
  • Medications, including antidepressants, antihistamines and medications to treat high blood pressure, pain or prostate conditions
  • Psychological conditions, such as stress, anxiety or depression
  • Drug and alcohol use, especially if you’re a long-term drug user or heavy drinker

Complications

Complications resulting from erectile dysfunction can include:

  • An unsatisfactory sex life
  • Stress or anxiety
  • Embarrassment or low self-esteem
  • Relationship problems
  • The inability to get your partner pregnant

Prevention

The best way to prevent erectile dysfunction is to make healthy lifestyle choices and to manage any existing health conditions. For example:

  • Work with your doctor to manage diabetes, heart disease or other chronic health conditions.
  • See your doctor for regular checkups and medical screening tests.
  • Stop smoking, limit or avoid alcohol, and don’t use illegal drugs.
  • Exercise regularly.
  • Take steps to reduce stress.
  • Get help for anxiety, depression or other mental health concerns.

Diagnosis

For many people, a physical exam and answering questions (medical history) are all that’s needed for a doctor to diagnose erectile dysfunction and recommend a treatment. If you have chronic health conditions or your doctor suspects that an underlying condition might be involved, you might need further tests or a consultation with a specialist.

Tests for underlying conditions might include:

  • Physical exam. This might include careful examination of your penis and testicles and checking your nerves for sensation.
  • Blood tests. A sample of your blood might be sent to a lab to check for signs of heart disease, diabetes, low testosterone levels and other health conditions.
  • Urine tests (urinalysis). Like blood tests, urine tests are used to look for signs of diabetes and other underlying health conditions.
  • Ultrasound. This test is usually performed by a specialist in an office. It involves using a wandlike device (transducer) held over the blood vessels that supply the penis. It creates a video image to let your doctor see if you have blood flow problems.This test is sometimes done in combination with an injection of medications into the penis to stimulate blood flow and produce an erection.
  • Psychological exam. Your doctor might ask questions to screen for depression and other possible psychological causes of erectile dysfunction.

Treatment

The first thing your doctor will do is to make sure you’re getting the right treatment for any health conditions that could be causing or worsening your erectile dysfunction.

Depending on the cause and severity of your erectile dysfunction and any underlying health conditions, you might have various treatment options. Your doctor can explain the risks and benefits of each treatment and will consider your preferences. Your partner’s preferences also might play a role in your treatment choices.

Oral medications

Oral medications are a successful erectile dysfunction treatment for many men. They include:

  • Sildenafil (Viagra)
  • Tadalafil (Adcirca, Cialis)
  • Vardenafil (Levitra, Staxyn)
  • Avanafil (Stendra)

All four medications enhance the effects of nitric oxide — a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow and allows you to get an erection in response to sexual stimulation.

Taking one of these tablets will not automatically produce an erection. Sexual stimulation is needed first to cause the release of nitric oxide from your penile nerves. These medications amplify that signal, allowing normal penile function in some people. Oral erectile dysfunction medications are not aphrodisiacs, will not cause excitement and are not needed in people who get normal erections.

The medications vary in dosage, how long they work and side effects. Possible side effects include flushing, nasal congestion, headache, visual changes, backache and stomach upset.

Your doctor will consider your particular situation to determine which medication might work best. These medications might not treat your erectile dysfunction immediately. You might need to work with your doctor to find the right medication and dosage for you.

Before taking any medication for erectile dysfunction, including over-the-counter supplements and herbal remedies, get your doctor’s OK. Medications for erectile dysfunction do not work in everyone and might be less effective in certain conditions, such as after prostate surgery or if you have diabetes. Some medications might also be dangerous if you:

  • Take nitrate drugs — commonly prescribed for chest pain (angina) — such as nitroglycerin (Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Monoket) and isosorbide dinitrate (Dilatrate-SR, Isordil, Bidil)
  • Have heart disease or heart failure
  • Have very low blood pressure (hypotension)

Other medications

Other medications for erectile dysfunction include:

  • Alprostadil self-injection. With this method, you use a fine needle to inject alprostadil (Caverject, Edex) into the base or side of your penis. In some cases, medications generally used for other conditions are used for penile injections on their own or in combination. Examples include alprostadil and phentolamine. Often these combination medications are known as bimix (if two medications are included) or trimix (if three are included).Each injection is dosed to create an erection lasting no longer than an hour. Because the needle used is very fine, pain from the injection site is usually minor.Side effects can include mild bleeding from the injection, prolonged erection (priapism) and, rarely, formation of fibrous tissue at the injection site.
  • Alprostadil urethral suppository. Alprostadil (Muse) intraurethral therapy involves placing a tiny alprostadil suppository inside your penis in the penile urethra. You use a special applicator to insert the suppository into your penile urethra.The erection usually starts within 10 minutes and, when effective, lasts between 30 and 60 minutes. Side effects can include a burning feeling in the penis, minor bleeding in the urethra and formation of fibrous tissue inside your penis.
  • Testosterone replacement. Some people have erectile dysfunction that might be complicated by low levels of the hormone testosterone. In this case, testosterone replacement therapy might be recommended as the first step or given in combination with other therapies.
A battery-powered penis pump
Penis pumps, surgery and implants

Penis pumps, surgery and implants

If medications aren’t effective or appropriate in your case, your doctor might recommend a different treatment. Other treatments include:

  • Penis pumps. A penis pump (vacuum erection device) is a hollow tube with a hand-powered or battery-powered pump. The tube is placed over your penis, and then the pump is used to suck out the air inside the tube. This creates a vacuum that pulls blood into your penis.Once you get an erection, you slip a tension ring around the base of your penis to hold in the blood and keep it firm. You then remove the vacuum device.The erection typically lasts long enough for a couple to have sex. You remove the tension ring after intercourse. Bruising of the penis is a possible side effect, and ejaculation will be restricted by the band. Your penis might feel cold to the touch.If a penis pump is a good treatment choice for you, your doctor might recommend or prescribe a specific model. That way, you can be sure it suits your needs and that it’s made by a reputable manufacturer.
  • Penile implants. This treatment involves surgically placing devices into both sides of the penis. These implants consist of either inflatable or malleable (bendable) rods. Inflatable devices allow you to control when and how long you have an erection. The malleable rods keep your penis firm but bendable.Penile implants are usually not recommended until other methods have been tried first. Implants have a high degree of satisfaction among those who have tried and failed more-conservative therapies. As with any surgery, there’s a risk of complications, such as infection. Penile implant surgery is not recommended if you currently have a urinary tract infection.

Is Viagra Bad for Your Heart ?

Taken alone, Viagra won’t hurt your heart. But don’t take it if you’re already taking nitrates for heart health, Dr. Montague says.

Viagra was originally intended to treat angina (chest pain), which it does well — just no better than other medications. Stiffer erections were a side effect.

“Here’s a drug that not only treats angina and is good for the heart, but it works on the penis when other medications don’t,” he says.

Like nitrates, it helps dilate blood vessels constricted by coronary artery disease.

But it also similarly lowers blood pressure.

If you take the two medications together, your blood pressure could drop too low, putting you at risk for a heart attack.

Is it safe to take Viagra with my heart medications?

Sexual activity plays a crucial role in the psychological health and quality of life scores in patients with cardiovascular disease. Unfortunately, intimacy is frequently an issue in patient with cardiovascular disease.

The causes of sexual dysfunction following myocardial infarction are multiple and include anxiety, depression, medication effect and vascular insufficiency.

Regardless of the cause, the results can be devastating to relationships and the psyche.

There are three phosphodiesterase-5 inhibitors currently available in the United States: sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis). For simplicity and because of its name recognition, I will use the trade name Viagra to represent all phosphodiesterase-5 (PDE5) inhibitors even if the studies were completed using one of the other drugs.  I do not endorse Viagra above any of the others.

Viagra has been shown to be effective in the treatment of erectile dysfunction. Viagra works by increasing the amount of nitric oxide available which enhances erectile function.

So can I take Viagra with my heart medications?

Viagra has been shown to be safe in stable cardiovascular diseases including heart failure, hypertension, and coronary artery disease. Although many have looked, there has been no clear evidence that Viagra is associated with increased rate of heart attacks or cardiovascular events. When Viagra is combined with most blood pressure medicines, there is a small but real additive effect but no change in cardiovascular events.

However, when Viagra is combined with doxazosin and tamsulosin, two alpha-blocking medications often used to treat BPH (benign prostate hypertrophy) some patients develop low blood pressures. It is recommended that if these prostate medications are required, the smallest doses of each respective medication should be used.  Patients already receiving Viagra and other PDE5 inhibitors for pulmonary hypertension should not receive a second PDE5 for the treatment of erectile dysfunction.

On the whole, Viagra can be considered safe with almost all of your cardiac medications. Unfortunately, the combination of Viagra with nitrates should never be considered safe. Together they can cause life threatening hypotension, also known as low blood pressure.  Nitrates should not be taken within 24 hours of sildenafil or vardenafil and within 48 hours of tadalafil.

I have included a short list of commonly prescribed nitrates to help you avoid them.

    1. Nitroglycerin
    2. Sublingual nitroglycerin tablets (Nitrostat)
    3. Sublingual nitroglycerin spray
    4. Nitro patch
    5. Nitro paste
    6. Isosorbide mononitrate (Imdur, ISMO)
    7. Isosorbide dinitrate (Isordil)