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See Treatment and Medication for more detail.

ED is a sensitive topic, and the clinician must be aware of the patient’s comfort level. Taking the history provides an opportunity for the physician to initiate patient and partner education about ED and its treatments and to facilitate communication. It also allows the physician to establish a rapport with the couple, which assists in treatment. Formal questionnaires may be valuable in this setting.

Imaging studies are rarely performed, except in situations involving pelvic trauma or surgery.

ED is an adverse effect of many commonly prescribed medications. For example, some psychotropic drugs and antihypertensive agents are associated with ED. Persistent posttreatment ED is a listed adverse effect of the 5-alpha reductase inhibitors finasteride and dutasteride and of alpha blockers.

Selected patients with ED are candidates for surgical treatment.

The penis appears relaxed and normal in the flaccid state, and it is not obvious by looking at a man that he has an implant.

Hyperprolactinemia from antipsychotic medication, especially risperidone, has been associated with sexual dysfunction. Treatment has included dose reduction, drug holidays, adjunctive medication, and switching to another drug (eg, olanzapine); however, data to support any of those strategies are limited.[73] A small open-label study by Fujioi et al of adjunctive aripiprazole for patients with antipsychotic-induced hyperprolactinemia and sexual dysfunction reported a significant decrease in erectile dysfunction at week 24.[74]

Balloon angioplasty has been studied as treatment for erectile dysfunction in men with focal atherosclerotic narrowing of the penile artery. In a prospective study in 22 men with 34 isolated penile artery stenoses, Wang et al reported achieving procedural success with balloon angioplasty in 31 cases. At 8 months, however, CT angiography showed binary restenosis in 14 of 34 lesions in 13 patients, and at 1 year, clinical success had been sustained in only 11 of the 22 patients.[79]

Erectile Dysfunction and Penile Prosthesis - WebMD

Following the routine outpatient procedure, a four to eight week recovery period is necessary before the implant is used.

Angiography is useful if the patient is a potential candidate for some type of vascular surgery. Young men with traumatic vascular injuries resulting in ED are candidates for this angiography because they may qualify for a vascular reconstruction.

After all the information regarding the patient’s status has been gathered, the various options for management of erectile dysfunction (ED) can be discussed. It is best to include the patient’s partner in this discussion.[1] The task of the physician is to identify which treatment would be most appropriate and most likely to have long-term success. To do that, the physician must take the time to understand the patient’s problem and be knowledgeable about the available options.

Table 2. Advantages and Disadvantages of Different Types of Penile Implants for Erectile Dysfunction
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Penile Implants: Understanding Your Treatment Options

Increased sensitivity for erections may last 36 hours with intermittent dosing. Low-dose daily dosing may be recommended for more frequent sexual activity (eg, twice weekly); men can attempt sexual activity at any time between daily doses. In 2011, tadalafil was also FDA approved for daily use for the treatment of men with BPH, as well as ED.

Penile Implants offer real hope to men with ..

Sexual counseling is the most important part of treatment for patients with sexual problems. Many professional sexual counselors are skilled in working with patients, but the primary care physician, the urologist, and the gynecologist also serve in this capacity to some degree. These are usually the first professionals to learn about the problem, and they often have to extract the information about the sexual problem from the patient.

While ED increases, use of penile implants declines - CNN

Rajpurkar and Dhabuwala reported significantly better erectile function and satisfaction with a penile implant than with sildenafil or intracavernosal alprostadil (PGE1).[109] This was a nonrandomized study in which all 138 subjects were initially offered sildenafil. The mean follow-up was 19.54 months, and questionnaires were used to obtain the data.

Erectile Dysfunction | ED Treatment | Plano, Frisco, …

With the semirigid prosthesis, 2 matching cylinders are implanted into the corpora cavernosa (see the image below). These devices provide enough rigidity for penetration and rarely break. The major drawbacks are the cosmetic appearance of the penis (which remains semierect at all times), the need for surgery, and the destruction of the natural erectile mechanism when the prosthesis is implanted.

Erectile Dysfunction Treatment - WebMD

Daily use of a vacuum erection device for a month before implantation of a penile prosthesis may prove beneficial. A randomized controlled trial by Canguven et al found that this strategy was associated with a significantly greater mean stretched penile length on the day of surgery; in addition, surgeons reported easier corporal dilatation intraoperatively.[108]

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