Part 4 of an exclusive 6-part AccessRX series
No doubt about it, research on Erectile Dysfunction, or ED, therapy has come a long way since a quirky British researcher and physiologist named Giles Brindley dropped his drawers to display his erection during his speech at a 1983 urological convention in Las Vegas. He told the rather stunned audience that he’d achieved the erection by injecting his penis with a non-specific vasodilator, which prompted corporal smooth muscle relaxation, resulting in a boner.
While accounts of the details of Dr. Brindley’s show-and-tell vary among witnesses, all agree that it was quite a surprise. There was a collective gasp from the audience of normally jaded physicians and their presumably not-so-jaded spouses. To prove that the erection was not a prosthesis, Dr. Brindley descended from the stage (some say he “waddled” awkwardly, with his pants still around his ankles), and invited a close-up erection inspection from audience…um…members. But Brindley was no crackpot exhibitionist; his research on vasodilators and the erectile process led the way not only to a legitimate treatment for ED – penile injection – but also to eventual development of oral drug therapies that are specific and safe.
Those oral ED drugs have been truly life-changing for many men (and their partners), but in some instances the medications are either not effective, or there are medical reasons a man cannot take them. But that doesn’t mean any guy with ED should give up – not at all. There are several tried-and-true therapy treatments for ED. We’re going to look at three of them: vacuum therapy, injection therapy, and hormone therapy.
Oh, the pressure! Vacuum devices (penis pumps)
There are several different kinds of penis pumps. Some are mere sex toys (masturbation aids, to be more exact), and some are marketed as permanent penis lengtheners (don’t believe the marketing). But the type of penis pump we’ll talk about here – the kind that is a medically accepted and FDA-approved therapy for Erectile Dysfunction – is technically called a “vacuum constriction device,” or VCD. It is also referred to as a “vacuum erection device,” or VED.
As its name implies, a VED is a vacuum apparatus that works by drawing blood into your penis, causing an erection. You then place an elastic constriction ring at the base of your penis to keep it rigid. (In fact, the ring’s the thing that distinguishes a VED from many garden-variety sex toys or the so-called “male enhancement” pumps.) The VED is a mechanical method based on simple principles of hydraulics, which makes sense when you think about it, as an erection itself is a product of hydraulics. VEDs are quite reliable and have been used to help build a better boner for more than a century, but it’s only over the past couple of decades that the VED in its current form has gained popularity.
The typical VED is a clear plastic cylinder with an opening at one end, which is placed over the shaft of the penis. There’s a pump mechanism at the other end of the cylinder, used to generate negative pressure within the cylinder. Some pumps are manually operated, and some run on batteries. The manually operated pumps usually require two hands to operate – one to control the pump handle and the other to steady the cylinder on the penis – which can be a little awkward. But the battery-operated pump can be used with one hand, and is preferred by many men.
Once you’ve achieved an erection, you place a constriction ring on the base of your penis to act as an artificial valve, which keeps the blood from leaving your penis. These rings come in several shapes, sizes, and tightness levels; you may need to experiment with several to determine which ring size feels most comfortable and does the best job of maintaining an optimal erection. Once you have the ring in place, you can remove the plastic cylinder and replace it with something much more pleasant, which is a polite way of saying you can get down and get dirty. However, most VED manufacturers suggest that the constriction ring remain in place for no longer than 30 minutes.
All FDA-approved vacuum devices have pop-off valves on the cylinders, which limit the amount of pressure held within the chamber (the general range is 200-250 mmHg). This is extremely important. If you use a product without this safeguard you run the very real risk of pressure-induced penile injury. We can’t emphasize it enough: Whether you have ED or not, it’s really best to stay away from non-approved, unregulated penis pumps, which are potentially dangerous. Numerous medical equipment companies offer FDA-approved VEDs that are specially designed and constructed for maximum safety.
Even the approved devices, used exactly as instructed, have some inherent disadvantages, can cause unwanted side effects, and should not be used at all by some guys. Some men and their partners have cosmetic issues with the device (it can cause some unsightly vein swelling, particularly in white guys), and/or they have trouble integrating the whole VED process into lovemaking. Not only is the VED blatantly mechanical, which some people find not-so-sexy, but it can take as long as 10-20 minutes to obtain an erection, and it can be kind of difficult to concentrate on turning your partner on when you’re preoccupied with your personal hydraulics. Some fellows just find it altogether too cumbersome, particularly if they’re not in a committed, loving relationship with an understanding partner. On the other hand, some couples make it work by thinking of the VED as an enhanced sex toy; they make a game of it. She has her vibrators; he has his VED.
As for side effects, they can include bruising, skin breakdown, and penile pain caused by the ring. If the ring is too tight, it can interfere with ejaculation, although generally not with orgasm. Temporary penile numbness can be a problem too. Usually, however, these side effects are easily reversible.
Some men shouldn’t use a VED at all, including those who have reduced sensation in their penis due to spinal cord injury or some other cause. These men are at risk for trauma with repeated use of the constriction band. Also, men with extreme penile curvature may be more likely to injure themselves because the straight cylinder can exert undue stress on their penis. There are several other medical conditions that preclude use of a vacuum device. But many men can and do use a VED successfully. In any case, it probably goes without saying that although some acceptable and approved devices can be obtained without a prescription, you should only use one with the blessings of your doctor. And make sure you are well instructed in how to use it.
The good news is that a VED isn’t extravagantly expensive (most cost from $300 to $500), and its cost is often covered by insurance. It’s one type of therapy that is easily stopped with no untoward side effects, and with proper use, it generally doesn’t cause any negative long-term effects. Despite the potential disadvantages of VEDs, many guys find them easy to use – maybe not as easy as an oral ED med, but easy enough – and “the pump” has allowed many couples to successfully resume their sex lives.
Injection therapy: one little prick can produce a big one
We’ll be the first to admit that the very thought of sticking a needle in your knob is a little cringe-inducing. But it’s really not as bad as it sounds. The needles used for injection therapy for Erectile Dysfunction are short and very fine, and designed to be as painless as possible.
You can thank the aforementioned Giles Brindley for this method of ED treatment, but due credit must also be given to numerous other early researchers, including the surgeon who, in 1977, accidentally injected the drug papaverine in a patient’s groin while performing a bypass procedure on the guy. As it happened, this patient had been suffering from ED, but the shot produced a prolonged and fully rigid erection that lasted two hours. Subsequently other researchers, including our pal Doc Brindley, studied and carefully documented the impressive erectile effects of papaverine and similar drugs.
Over the years, researchers and clinicians have experimented with more than forty different drugs for injection therapy for ED, but the ones most commonly used today are papaverine, phentolamine, and the hormone prostaglandin E1 (alprostadil). Basically these all work as vasodilators; they relax the muscle cells of the arteries in the penis, causing the arteries to dilate and resulting in increased blood flow. All three can be used in combination; said combo is often referred to as “triple P” or “trimix.”
Your doctor will work with you to determine the best drug or combination of drugs, as well as the most effective dosage. Since the idea is for you to ultimately do it on your own, your doc should carefully coach you in the process of self-injection. If you don’t have the manual dexterity for this, or you’re just too squeamish to do it, your doctor may be able to teach your partner how to give you your shots. However, most men who stick with (so to speak) injection therapy find that with a little practice and familiarity, they gain sufficient confidence and are able to easily give themselves shots at home. And many even find that they get used to the needle sensation over time.
Side effects of ED injection therapy can include aching in the penis, depending upon the type of drug used, and pain or irritation at the site of the injection. In some cases a prolonged erection (priapism) can result, but that usually just happens during the initial dosing, when the clinician is still trying to adjust the dosage. Other effects such as flu-like symptoms, dizziness, and pain have been reported by some men. And there are some guys who for various reasons aren’t candidates for injection therapy for ED. Your doctor will help you determine if you’re one of them.
If you absolutely abhor needles, perhaps you’ll be interested to know that the prostaglandin alprostadil is also available as a suppository, placed into the opening at the tip of the penis. If you ask us, that sounds nearly as uncomfortable as a shot. Besides, the suppository doesn’t seem to be quite as effective as alprostadil injections. But the good news is that research has pointed to alprostadil as an effective topical agent, applied as a gel or cream directly to the glans of the penis. In fact alprostadil, in combination with the permeation enhancer (absorption aid) DDAIP, has been approved in Canada under the brand name Vitaros as a first-line treatment for ED. We’ll let you know when it’s available in the US.
For now, an injection of triple P or alprostadil may not be the shot heard ’round the world, but it could be the shot that saves your sex life. If you can’t take an Erectile Dysfunction pill, and the pump doesn’t work for you, this could be the ED therapy for you.
Restoring balance: hormone therapy for ED
Sometimes erectile dysfunction is a result of low hormone levels, particularly low testosterone – a condition now commonly known as Low-T. (This is not to be confused with the traditional British “low tea,” which has to do with lace doilies, buttered scones, and stuffy manners.)
Low-T is most often associated with aging. Perhaps you’ve heard the word andropause. We’ve known about menopause for millennia, but it’s only relatively recently that “andropause” has entered the popular lexicon. Formerly called “male menopause,” and currently dubbed “manopause” by people who, if you ask us, take altogether too many liberties with the English language, andropause refers to that time in a man’s life when the male sex hormones, aka androgens (of which testosterone is one), tend to decline. Sometimes, but not always, ED is one of the symptoms, often accompanied by low sex drive, irritability, and a general lack of energy – the middle-aged blahs, in other words.
Though some decline in testosterone is normal as a man gets into his 40s, 50s, and beyond, other factors besides ordinary aging can cause Low-T. In some cases these “other factors” can cause Low-T – and ED – in younger men too. For instance, high levels of the stress hormone cortisol can wreak havoc on testosterone. So can elevated levels of prolactin, a chemical secreted from the pituitary gland – and high prolactin can be caused by an overactive thyroid. A benign (non-cancerous) tumor on the pituitary gland can also cause the gland to produce too much prolactin. Toxicity, environmental factors, and lifestyle issues such as smoking or lack of exercise can also have an indirect but negative effect on hormone levels. Low-T can even be caused or aggravated by some diseases, such as liver disease, which can create elevated levels of estrogen in the male body, effectively lowering the testosterone levels and contributing to ED. And some types of surgery or other medical treatments can decimate a man’s hormone levels.
It’s also important to know that an imbalance in other hormones besides testosterone could be causing some of your symptoms. Among these are thyroid, adrenal hormones, and DHEA. The point is that the body’s hormones all work in concert, and when any one of them is “out of tune,” it can upset several others, resulting in a host of problems – including ED.
We should stress that ED is not always caused by Low-T or any other hormonal imbalance, and only your doctor or other qualified medical practitioner can determine if your problem is indeed hormonal. For some men with ED, however, hormone therapy may be just what the doctor ordered – literally.
Testosterone is available in several branded and generic forms, and in “synthetic” or “bioidentical” varieties. (There’s some controversy about the advantages of bio-ID versus synthetic, but it is beyond the scope of this article to explore this issue. Check with your doctor and/or do some critical research on your own for more information.) Currently testosterone is administered in several ways. It can be given as an intramuscular injection, usually every two to three weeks. Note that these are not the same kinds of shots as those penile injections we discussed above. Testosterone injections are generally given in the thighs, buttocks, or upper arm. Testosterone can also be delivered via a patch that’s placed on the skin and changed daily. Or it can be topical – a gel or cream that you apply daily to your skin.
Drug companies can’t patent actual hormones, but they can and do synthesize hormones and patent these synthetic products. They can also patent delivery systems, and it seems they’re always coming up with something new and interesting. Lately you may have seen commercials for a novel form of testosterone called Axiron (Lilly), which is prescribed for men with Low-T and applied as an underarm gel. That’s certainly a convenient way to administer testosterone, but we recommend keeping it in some place other than your medicine cabinet if your woman habitually uses your deodorant. Keep it away from your kids or grandkids too. You don’t want your three-year-old granddaughter growing a beard or getting backne.
This brings us to the potential side effects of testosterone, which may include an elevated red blood cell count (this can increase the risk of stroke or heart attack), high blood pressure, painful or enlarged breasts, water retention, and PMS. Okay, we’re just kidding about the PMS, but some of those symptoms do sound familiar… Also, if you’re wearing a patch, you could experience a rash or other skin reaction from the patch. Testosterone might also cause or aggravate prostate problems, such as increased PSA (prostate-specific antigen) levels, or increased growth of a pre-existing prostate cancer. Needless to say, you should be under the care of your doc while you’re elevating your T-levels.
By the way, there are also two other substances – bromocriptine (sold under the brand name Parlodel) and cabergoline – that may possibly help restore sexual interest and erectile function when ED is caused by high prolactin levels. These aren’t hormones, but are dopamine agonists that work on the brain. They are oral medications with their own sets of potential side effects, so again, you must be under the care of a doctor to take them.
Prescription testosterone replacement therapies are a controlled substance (CIII) because testosterone can be abused (anabolic steroids, anyone?). And testosterone is generally only prescribed for men who actually do have low testosterone levels, which can be determined with blood tests (they’re generally far more accurate than saliva tests). Testosterone supplementation is not recommended for guys whose T-levels are in the low part of the normal range.
Moreover, sometimes testosterone replacement restores libido and energy and even mood, but not the ability to get an erection. If your ED is not caused by a hormonal imbalance, you may very well be a candidate for one of the several good ED medications already on the market.
When it’s all – or partly – in your head (the big head, that is)
One final point: As noted in the first article in this series, Erectile Dysfunction often has physiological causes. In fact, some doctors say that a man’s erectile capabilities, or lack thereof, is a mirror of his overall physical health (or lack thereof). However, sometimes the causes of ED are chiefly psychological, particularly if it occurs in a younger man. Even if the ED is caused by physical issues, it can still have very profound psychological effects on both a man and his partner.
That’s why many guys with Erectile Dysfunction may find psychological counseling to be helpful. Think of it as a type of adjunct ED therapy. Whether it’s one-on-one – just you and your therapist – or couples counseling, talking it out can really make a difference. It doesn’t have to be a years-long commitment, either; sometimes just a few sessions can give you remarkable insights and help you get to the root of your problem. Don’t be afraid or embarrassed to explore this option. Ask your doctor, clergy person, or some other trusted professional to recommend a qualified and properly certified counselor.
The main point to remember is that you don’t ever have to suffer in silence or go it alone. If you have ED, do whatever you need to do to take back your power.
Previously in this series:
- Erectile Dysfunction overview: causes and options for treatment
- FDA Approved Medications for Erectile Dysfunction currently on the marketplace: Viagra, Cialis, Cialis for daily use, Levitra, Staxyn
- Erectile Dysfunction medications currently in research phases
In future articles we will explore:
- Surgeries for Erectile Dysfunction
- Foods and natural remedies for Erectile Dysfunction: Yohimbe, watermelon, chocolate, etc.
Note: When ordering prescription drugs online, always make sure you are ordering from a reliable source, such as AccessRX.com.