June 16 issue - Before 1998, it was called impotence—and it caused so much shame and embarrassment that it was rarely discussed in polite circles. Viagra (sildenafil) changed all that. The little blue pill increases blood flow to the penis, helping men attain good erections when they are erotically stimulated. But the drug has not vanquished erectile dysfunction.
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In fact, a third of the nation’s 20 million to 30 million sufferers still need help. Some men don’t respond to Viagra, while others suffer side effects such as headache, upset stomach and visual disturbances. Still others can’t try it because they have unstable heart disease or take nitroglycerin or other nitrate medications, which make Viagra dangerous.
Fortunately, there are alternatives. Erectile dysfunction is a medical condition with many possible causes, so discuss the problem fully with your doctor. And don’t waste your money on dietary supplements promising miraculous results. The ineffective remedies include yohimbine, ginseng, DHEA, Andro and a bewildering array of vitamins and herbs. Here are some alternatives that actually work.
Alprostadil: Like Viagra, alprostadil increases blood flow to the penis by dilating vessels. But the drug must be administered directly into the penis. Men can learn to do this themselves, using injections (Caverject, Edex) or soft urethral pellets (MUSE). Many men find the idea unpleasant, even frightening. But most men who learn the techniques get good results. About 80 percent respond to an injection, while about 50 percent get an erection from the soft pellet. And even better days may lie ahead, if attempts to develop an alprostadil cream are successful.
Vacuum pump: When the time is right, you place the obstinate organ in an airtight plastic cylinder and use a hand-operated pump to remove the air. As the air pressure drops, blood is pulled into the arteries of the penis, which becomes erect. A special band is then applied to the base of the penis to keep it erect after the pump is removed. The technique may be cumbersome, but none is more effective.
Penile implants: Silicone rods or inflatable devices are surgically implanted into the penis. The rods produce a permanent erection but are flexible enough to conceal under clothing. The inflatable models can be pumped up with fluid on demand but are more prone to complications. More than 200,000 American men have had penile implants. Most are satisfied with the results, but fewer are choosing surgery now that less invasive treatments are available.
Counseling: Roughly 15 percent of erectile problems stem from psychological issues. If a man continues to have nighttime erections, or experiences difficulties only with a particular partner, the problems may be emotional at root. Counseling and sex therapy can often help resolve them.
For more information on sexual function, see “The Harvard Medical School Guide to Men’s Health” (Free Press. 2002) (health.harvard.edu/menshealth).
