Impotence: Treatment Options for Erectile Dysfunction and Penis Implantation Explained

Treatment options for impotence and erectile dysfunction.

90% of cases of impotence are treatable and usually do not require surgery. We asked him to list some recent findings in this area.

Q: What new discoveries have been made regarding the treatment of impotence?

A: A major discovery in the last decade is that we have found that emotional or psychological problems do not cause impotence. Studies indicating blood flow in and out of the penis have found that approximately 75% of impotence originates from the organ itself.

Q: How do you determine whether impotence is a psychological or physiological problem?

A: When we see patients, we refer them to an eight-page questionnaire. For example, if a man experiences erections during masturbation or while sleeping, or cannot achieve an erection with one sexual partner but can with another woman, it's usually not a physiological problem. After questioning the patient, we perform physical examinations, including checking the genitals for signs of excessive female hormones. We also check the pulse in the lower limbs and perform a localized neurological test. Then, if the problem is psychological, we usually refer the patient to a sex therapist or psychiatrist.

Q: What are the physiological causes of most cases of impotence?

A: The most common cause is arteriosclerosis, which thickens the walls of the penile arteries-possibly due to high cholesterol in the blood. This narrows the blood vessel walls, hindering blood flow to the penis, making it impossible to achieve or maintain an erection, no matter how aroused you are. Sometimes it's due to problems with other blood vessels, nerve malfunctions, hormonal imbalances, etc., but this is less common.

Q: What are the treatment options?

A: If it is physiological impotence, the treatment options include penile implantation, intracavernosal injection, vacuum aspiration device, hormone therapy, and occasionally other surgeries.

Q: Let's discuss all these treatment methods at once. How is penile implantation performed?

A: Generally, there are two types: non-inflatable and inflatable. To understand how they work, you need to draw a cross-section of the penis. On the back of the penis are two corpora cavernosa, one on the left and one on the right. When there isn't enough blood to fill the cavities within the corpora cavernosa, or too much blood flows out, they won't swell and harden. Therefore, implanting a penile prosthesis, one on each side, replaces the original principle of blood expansion, allowing the penis to achieve an erection. The non-inflatable type uses a semi-rigid or flexible rod-like structure in each tube to allow for an erection. This rod can be bent by hand; you can bend it close to your body when wearing pants to make it less noticeable; during intercourse, you bend it to an angle that allows for an erection. The disadvantage is that you will always feel a hard object inside the penis, and it won't swell to the size of the inflatable type. The principle of an inflatable artificial penis is to insert two sand-like, water-filled, cylindrical bags into the two corpora cavernosa, which can be pressurized to allow fluid to enter, creating an "erection." There are two types of inflatable artificial penises. The first type is called the "self-contained" artificial penis, in which the entire device is on one piece. The water reservoir is located at the base of the penis (near the pubic bone), and the switch is near the glans. When an erection is needed, simply squeeze the area near the glans a few times, and water will fill the cylindrical sac to create an "erection". After use, simply fold the penis in any direction for a few seconds, and the water in the cylindrical sac will flow back into the water reservoir, causing the penis to soften.

The second type of inflatable artificial penis is a three-piece design, with the reservoir placed below the abdominal muscles and the switch located inside the scrotum. Currently, there is also a two-piece design, where the reservoir and switch are combined into one piece and placed inside the scrotum. When you are ready to have sex, simply locate the switch inside the scrotum and squeeze it several times to achieve an erection of the desired firmness, which can then be maintained for the desired duration. Sexual intercourse can continue even after ejaculation.

Q: How satisfied are patients with penile implantation?

A: Both of the methods mentioned above have over 90% patient and partner satisfaction. Both methods have a high success rate. Another piece of evidence of success is that when the implanted device stops working, most people want it reinserted rather than removed, which is pleasing to me and shows they like this approach.

Q: In the last two methods you mentioned, do they look very natural during erection? Will women notice anything unusual?

A: It looks very natural, and your sexual partner won't notice anything different; it's like a nice layer of makeup. There will only be a small scar that can be covered by pubic hair, or a small scar at the front of the scrotum, depending entirely on the type and the incision chosen by the surgeon.

Q: Will these devices cause discomfort for men?

A: After two or three weeks of implantation, most people don't feel any discomfort. It feels like a part of their body, and they almost forget it exists. Men who have had penile implants can also experience orgasms and ejaculation, and can even have children.

Q: Intracavernosal injection of medication is a recent development in research on impotence. How is it performed?

A: There are three commonly used medications: papaverine, fentrolamine, and prostaglandin E1. These medications dilate blood vessels, allowing blood to flow more easily into the corpora cavernosa of the penis. Patients can ask their doctor to determine whether an erection lasts for half an hour, an hour, or an hour and a half, but no matter which medication is injected, the erection should not last longer than four hours. After injection, sexual intercourse should not exceed eight to ten times per month.

Q: Does penile injection sound like it won't arouse sexual interest?

A: Usually, the medication is injected into the shaft of the penis through a needle inserted vertically from the back. It's a very small needle, and the patient will only feel a slight sting. However, the erection after the injection can last for five to fifteen minutes.

Q: What is a vacuum suction device?

A: Place a tube on your penis to create a vacuum, drawing blood into the corpora cavernosa. Then, slide a contraction ring from the bottom of the ring into the base of the penis, securing it to prevent venous blood backflow and keep the blood within the corpora cavernosa. Remove the contraction ring after intercourse, and the penis will soften.

Q: What are the disadvantages of vacuum suction devices?

A: For some people, the effect isn't very good; it only allows the penis to reach about two-thirds of its normal hardness, usually enough for penetration. It's not a very good erection and may be a little uncomfortable, with the skin feeling a bit tight, but most patients get used to it. The success rate is about 70% to 80%, but some people simply don't want to use a vacuum aspirator because it looks unnatural and is inconvenient during intercourse. Therefore, in my experience, very few patients choose to use it.

Q: What is hormone therapy?

A: Less than 5% of cases involve hormonal problems. Most issues stem from the testes' inability to produce male sex hormones, sometimes a problem with another hormone (prolactin, a sex hormone from the anterior pituitary gland). I usually refer these patients to an endocrinologist. Men with male hormone deficiency require monthly hormone injections, which usually work very well. Patients with prolactin-related issues are typically treated with a medication called bromocriptine.

Q: It sounds like there's a good solution, but research indicates that over 60% of men with erectile dysfunction delay seeing a doctor for at least a year, and some even wait five to ten years. What would you say to people with sexual problems?

A: There is absolutely no reason to believe that impotence is a greater secret than diabetes. Professional doctors must help patients talk about their issues. Currently, medical schools are only beginning to teach about impotence and its treatments, especially urologists. They must help patients feel more comfortable in order to treat it effectively. Gradually, this taboo and shame should be overcome.