Erectile dysfunction (ED; impotence), or the inability to get and maintain an erection, is the most common sexual problem in men.

The incidence increases with age and affects up to one-third of men throughout their lives. It causes a substantial negative impact on intimate relationships, quality of life, and self-esteem.

ED Diagnosis

History and physical examination are sufficient to make a diagnosis of ED in most cases because there is no preferred, first-line diagnostic test. Initial diagnostic workup should usually be limited to a fasting serum glucose level and lipid panel, thyroid-stimulating hormone test, and morning total testosterone level.

First-line therapy for ED consists of lifestyle changes, modifying drug therapy that may cause ED, and pharmacotherapy with phosphodiesterase type 5 inhibitors. Obesity, a sedentary lifestyle, and smoking greatly increase the risk of ED.

Phosphodiesterase type 5 inhibitors are the most effective oral drugs for the treatment of ED, including ED associated with diabetes mellitus, spinal cord injury, and antidepressants. Intraurethral and intracavernosal alprostadil, vacuum pump devices, and surgically implanted penile prostheses are alternative therapeutic options when phosphodiesterase type 5 inhibitors fail.

Testosterone supplementation in men with hypogonadism improves ED and libido but requires interval monitoring of hemoglobin, serum transaminase, and prostate-specific antigen levels because of an increased risk of prostate adenocarcinoma.

Cognitive behavior therapy and therapy aimed at improving relationships may help to improve ED. Screening for cardiovascular risk factors should be considered in men with ED because symptoms of ED present on average three years earlier than symptoms of coronary artery disease. Men with ED are at increased risk of coronary, cerebrovascular, and peripheral vascular diseases.

ED Treatment

As you consider your treatment options make sure you and your doctor consider all of the options. It’s also important to consider the risks and benefits of each treatment.

Oral Medications

There are a number of prescription medications available that may improve blood flow to the penis. Commonly used medications are Viagra, Cialis, Levitra, and Stendra. Combined with sexual stimulation, this can produce an erection. These drugs are not for everyone. They can interfere with other medications you are taking and have some side effects in the case of incorrect dosage.


With injection therapy, like Trimix, a needle is used to inject medication directly into the base or side of the penis. The medication allows blood to flow into the penis, creating an erection.

Shockwave Therapy

Low-intensity extracorporeal shock wave treatment (LI-ESWT) works by applying low-intensity shock waves to the penis.

Physical Therapy

By working with a physical therapist, you can find out if kegel exercises may help relieve your erectile dysfunction. You can also try kegel exercises on your own.

Vacuum Erection Devices

A plastic cylinder is placed over the penis, and a pump (either manual or battery operated) creates a vacuum suction within the cylinder, drawing blood into the penis to create an erection. A stretchable tension band is placed at the base of the penis to help maintain the erection.

Intraurethral Suppositories

An applicator containing a small medicated pellet or suppository is inserted and released into the urethra through the opening at the tip of the penis. The pellet is about the size of a grain of rice and dissolves to increase blood flow to the penis, creating an erection.

Penile Implants

A medical device that is implanted into the penis. Entirely contained within the body, a pump fills two cylinders and creates an erection. Once activated you can maintain an erection as long as you desire.

We provide only non-invasive and minimally invasive procedures for erectile dysfunction treatment, to learn more about our therapies, contact us here and get a consultation for free.