Treatment depends on the cause. Testosterone supplements may be used for cases due to hormonal deficiency. However, the cause is more usually lack of adequate penile blood supply as a result of damage to inner walls of blood vessels. This damage is more frequent in older men, and often associated with disease, in particular diabetes.
Treatments (with the exception of testosterone supplementation, where effective) work on a temporary basis: they enable an erection to be attained and maintained long enough for intercourse, but do not permanently improve the underlying condition.
ED can in many cases be treated by drugs taken orally, injected, or as penile suppositories. These drugs increase the efficacy of nitric oxide, which dilates the blood vessels of corpora cavernosa. When oral drugs or suppositories fail, injections into the erectile tissue of the penile shaft are extremely effective but occasionally cause priapism.[citation needed]
Exercise, particularly aerobic exercise is an effective cheap treatment for erectile dysfunction.[23][non-primary source needed]
When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the penis to maintain it. These pumps should be distinguished from other penis pumps (supplied without compression rings) which, rather than being used for temporary treatment of impotence, are claimed to increase penis length if used frequently, or vibrate as an aid to masturbation. More drastically, inflatable or rigid penile implants may be fitted surgically. Implants are irreversible and costly.[citation needed]
All these mechanical methods are based on simple principles of hydraulics and mechanics and are quite reliable, but have their disadvantages. In a few cases there is a vascular problem which can be treated surgically.[citation needed]
Counselling is often a consideration, both where a psychological cause is suspected or must be ruled out, or to assist in management of any distress.[citation needed]
[edit]Medications
The cyclic nucleotide phosphodiesterases constitute a group of enzymes that catalyse the hydrolysis of the cyclic nucleotides cyclic AMP and cyclic GMP. They exist in different molecular forms and are unevenly distributed throughout the body.
One of the forms of phosphodiesterase is termed PDE5. The prescription PDE5 inhibitors sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are prescription drugs which are taken orally. They work by blocking the action of PDE5, which causes cGMP to degrade. CGMP specific phosphodiesterase type 5 causes the smooth muscle of the arteries in the penis to relax, allowing the corpus cavernosum to fill with blood.[citation needed]
These medications work when there is sexual stimulation. Depending on the treatment, it will need to be taken 20 minutes to 1 hour before sex and the period of time over which it works can vary between 3 hours and up to 36 hours.[citation needed]
Alprostadil
Alprostadil can be injected into the penis or inserted using a special applicator - usually just before sexual intercourse.[citation needed]
Alprostadil has also become available in some countries as a topical cream (under the brand name Befar),[24] and preliminary studies have shown a clinical efficacy of up to 83%.[25][non-primary source needed]
Androskat
Androskat is a mixture of papaverine and phentolamine injected into the penis before sexual intercourse. It does not require refrigeration.[citation needed]
[edit]Surgery
Main article: Penile prosthesis
Often, as a last resort if other treatments have failed, the most common procedure is prosthetic implants which involves the insertion of artificial rods into the penis.[26][unreliable source?]
[edit]Devices
Vacuum Therapy
Main article: penis pump
These work by placing the penis in a vacuum cylinder device.[27][not in citation given] The device helps draw blood into the penis by applying negative pressure. A tension ring is applied at the base of the penis to help maintain the erection.[27][not in citation given] This type of device is sometimes referred to as penis pump and may be used just prior to sexual intercourse. Several types of FDA approved vacuum therapy devices are available with a doctor's prescription.
[edit]Alternative medicine
Numerous alternative therapies are used to improve sexual function. Some include: niacin, zinc, ginseng root, ginkgo. None of these however have been recognized as effective by the FDA.[28][clarification needed] While zinc deficiency may be a cause of lower testosterone levels in hemodialysis patients, which may benefit from zinc supplementation,[29][dead link][non-primary source needed] such supplements have no effect on the testosterone levels of healthy males who consume a zinc-sufficient diet
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