PHOENIX ERECTILE DYSFUNCTION

Sexual problems are more common than most people think. Over half of all couples will experience some form of sexual dysfunction during their lifetime. Such problems may lead to a decrease in self-confidence, anxiety, and generally less pleasure in life. A satisfactory relationship with one’s partner may also be threatened.

Through the treatment and care we provide, Dr. Fishman has helped his patients regain their confidence and feeling better than ever. Many of his patients experience intimate re-connections with their partners, improvements in their sex life, and overall improvements in their lifestyle.

Central Arizona Urologists can help patients who experience such difficulties as the inability to achieve or maintain an erection (impotence), orgasm problems, premature ejaculation, and loss of interest in sex. We offer a confidential assessment that will determine the cause for the problem and offer a treatment to correct it. For men, research now shows that the majority of all sexual problems are physically related, with pure psychological sexual dysfunction being rare. Thus, before treatment can begin, a careful assessment is needed.

For men with erectile dysfunction, Central Arizona Urologists will evaluate the patient in one to two sessions. On a first appointment a comprehensive history and physical examination occurs along with possible blood tests. Depending upon the conclusions of that visit, diagnostic studies may be indicated or a trial of medical therapy may be instituted. Diagnostic studies generally are directed at assessing the vascular integrity to the erectile mechanism. In our office, we can use small doses of muscle relaxant medications (vasodilators) injected into the penis to assess penile arousability and blood flow.

Erectile Dysfunction Phoenix Overview

An erectile dysfunction (ED) is the inability to get and keep an erection firm enough for sexual intercourse. Studies have indicated that about 52% of men suffer from erectile dysfunction at some point in their lives. Having erection trouble from time to time isn’t necessarily a cause for concern. But, if erectile dysfunction is an ongoing problem, it may cause stress,relationship problems, or affect your self-confidence.

Problems getting or keeping an erection can be a sign of an underlying health condition that needs treatment. Heart disease or poorly controlled diabetes are two common examples of comorbidities. Once an underlying medical problem has been treated, this may be enough to reverse your erectile dysfunction. An evaluation at an erectile dysfunction clinic in Phoenix is the first step in treating an erectile dysfunction.
If treating an underlying condition doesn’t help your erectile dysfunction, then medications or other urologic focused treatments may work.

Causes of Erectile Dysfunction

Erectile dysfunction isn't just a part of the aging process nor is it normal for a man to lose his erectile function as a result of getting older. In most cases, ED is caused by an underlying medical condition that should be addressed by a physician.

Erectile Dysfunction Diseases and Conditions

Diabetes: Diabetes can cause damage to the nerves and blood vessels that control the flow of blood to the penis. This nerve and artery damage can make it difficult to achieve an erection.
Vascular Diseases: Vascular diseases such as atherosclerosis (hardening of the arteries), hypertension (high blood pressure) and high cholesterol, can affect the blood vessels by restricting blood flow to the heart, brain, and to the penis, in the case of ED.
Neurological Diseases and Spinal Cord Injuries: Many neurological diseases such as stroke, multiple sclerosis (MS), Alzheimer’s disease, Parkinson’s disease as well as spinal cord injuries can all cause ED in men because of the interruption of nerve impulses from reaching the penis.
Surgery or Trauma: Surgeries for the treatment of diseases in the prostate, bladder, colon or rectal areas can damage nerves and result in ED. Many men who undergo radical prostatectomy, for example, often experience some degree of ED after surgery.
Low Testosterone: Imbalances of hormones such as low testosterone can also be a factor in ED. A deficiency in testosterone can cause low libido and low energy which can result in erectile dysfunction. While improving low testosterone doesn’t cure ED, it does positively affect a man’s sex drive, which results in improved erections. Low testosterone is also associated with diabetes and obesity, health conditions that can cause ED.
Medications: Some medications, including those used to treat high blood pressure, can interfere with the blood flow to the penis.

Symptoms of Erectile Dysfunction

Trouble getting an erection
Trouble keeping an erection
Reduced sexual desire

Available Treatments for Erectile Dysfunction in Phoenix:

Oral Medications
There are multiple treatments for ED, however, it is very common to offer oral pills in the class of PDE-5 inhibitors { Viagra® (sildenafil citrate), Cialis® (tadalafil), Levitra (vardenafil), and Stendra (avanafil) } as a first line of therapy. Oral pills will benefit up to 60-70% of patients.

Penile Injection Therapy
The 3 most commonly used medications for injection therapy are Trimix, Bimix, and Papaverine. Most men begin injection therapy with Trimix, which is a mixture of 3 ingredients: alprostadil, phentolamine, and papaverine. These ingredients work by relaxing the smooth muscle and opening the blood vessels in your penis, causing an erection. Dr Fishman will determine based on a patient's response to the trimix injection whether to advance this formula or change to a different medication that would work best for you.

Surgical Therapy — Penile Prosthesis Implantation
Penile implants are a permanent, effective treatment for erectile dysfunction. A penile implant is also called a penile prosthesis. The implant is a penis pump-like device — it has two cylinders that are implanted in the penis and a pump in the scrotum that creates an erection when the patient squeezes it. The implant includes a saline reservoir in the abdomen, which provides fluid to create the erection.

Advantages of Surgical Therapy

Completely concealed inside the body
Simple to use
Devices are inflated to provide rigidity and deflated for concealment
Like a natural erection
When deflated, the cylinders are soft and flaccid (three-piece implant)
Completely discreet—no one will know you have it unless you tell them

Disadvantages and Side Effects:

Requires some manual dexterity
Cylinders remain partially filled with fluid when deflated (two-piece device)
Infection may require removal
Mechanical failure

Vacuum Erection Devices
A vacuum constriction device (VCD) is an external pump that a man with erectile dysfunction (ED) can use to get and maintain an erection. The pump helps the penis to become erect and a band attached to the pump helps to maintain the erection.

Who should consider using a VCD?

Vacuum constriction devices are most commonly used to treat medical causes of ED. These causes include:

Poor blood flow into the penis.
Excess blood flow out of the penis during erection.
Damage to nerves that control the erection reflex.

Because VCDs are safe to use and have few long-term side effects, they are also sometimes recommended as a treatment for anxiety-based ED.

What are the side effects of VCDs?

The erection obtained by the VCD is not the same as an erection obtained naturally. The penis tends to be purplish in color and can be cold. To warm the penis so that it is not so cold, you can try putting a warm compress on it before having sex. Other side effects can include:

Numbness.
No ejaculation.
Bruising and swelling of the penis.
Difficulty achieving orgasm.

Our urologists offer a full range of treatment strategies after completion of patient evaluation. The form of treatment recommended, such as medication (Viagra), penile injections (Prostaglandin E1/Caverject), vacuum devices, or surgery depending on each patient’s individual needs.

Informative Erectile Dysfunction Links:
Urology Care Foundation- Erectile Dysfunction
Male Health Center
Viagra Web Site
Penile Implants (Coloplast)

Erectile Dysfunction FAQs

Can erectile dysfunction be cured?

Problems getting or keeping an erection can be a sign of an underlying health condition that needs treatment. Heart disease or poorly controlled diabetes are two common examples of co-morbidities. Once an underlying medical problem has been treated, this may be enough to reverse your erectile dysfunction

Why does erectile dysfunction happen?

Low Testosterone (T) is the cause of ED in a very small percentage of the cases. Therefore, testosterone replacement therapy does not cure ED in most cases. Low T is mainly related to libido or sexual drive and overall energy levels.

Can SLEEP APNEA cause erectile dysfunction?

A recent study from Mount Sinai Medical Center in New York City found that men with more severe erectile dysfunction have a higher risk for sleep apnea — a condition that’s characterized by deafening snoring and daytime sleepiness.
"These two conditions may be linked because abnormal periods of breathing during sleep apnea increase the risk of high blood pressure, heart disease, and chronic fatigue," says Ryan Berglund, MD, a urology specialist at the Cleveland Clinic . The good news? Treating sleep apnea with breathing support and medications may also improve erectile dysfunction.

Which erectile dysfunction drug is best?

There are multiple treatments for ED, however, it is very common to offer oral pills in the class of PDE-5 inhibitors { Viagra® (sildenafil citrate), Cialis® (tadalafil), Levitra (vardenafil), and Stendra (avanafil) } as a first line of therapy. Oral pills will benefit up to 60-70% of patients.

Guidelines from the American Urological Association (AUA) recommend offering PDE5 inhibitors as first-line therapy for ED unless the patient has contraindications to their use (eg, concurrent organic nitrate therapy). The AUA notes that insufficient evidence exists to support the superiority of any one of these agents over the others. [1] European guidelines suggest that the choice of drug (short- versus long-acting) depend on the frequency of intercourse (occasional use or regular therapy, 3-4 times weekly) and the patient’s personal experience.

Is erectile dysfunction normal?

ED is common and the risk of developing ED increases with age. Some studies cite that ED is the most common form of sexual dysfunction that affects men.

But estimates on just how common ED is vary widely. One 2018 review estimated that ED affects about a third of men. And a 2019 review found that the global prevalence of ED ranges between 3 percent and 76.5 percent.

The Massachusetts Male Aging Study, which was completed in 1994, is often cited by experts in discussions of prevalence, even though the research is older. This study found that around 52 percent of men experience some form of ED, and that total ED increases from about 5 to 15 percent between ages 40 and 70.

What causes erectile dysfunction?

Erectile dysfunction causes can be multifactorial. Organic versus psychogenic origins were traditionally a dividing line. The organic causes can vary from anatomic injury, to vascular origins, to neurogenic dysfunction.

How can I get tested for erectile dysfunction?

The amount of testing for erectile dysfunction has been streamlined over many years. Intake history and labs might allow a treatment plan to be devised. Further radiologic or functional testing would depend on the suspected origins of the condition.

Is erectile dysfunction permanent?

The underlying conditions contributing to the erectile dysfunction may remain permanent such as anatomic injury, hypertension or diabetes, but the treatment may overcome that permanence for successful outcome.

How is erectile dysfunction diagnosed?

Patient history will bring the majority of the facts to light regarding erectile dysfunction occurrence.

What are common treatments for erectile dysfunction?

Contemporary treatments for erectile dysfunction will steer patients towards efficacious options such as oral phosphodiesterase-5 inhibitor medications, vacuum erection devices and vasoactive penile injection therapy. Patients are warned to NOT pursue alternatives such as penile ultrasound therapy or shock wave therapy unless coordinated as part of an organized & funded University research study.

Will devices help with erectile dysfunction?

Vacuum erection devices are the cornerstone of options for management of erectile dysfunction.

How can exercises improve erectile dysfunction?

There are no direct muscular exercises to improve erectile dysfunction. The penile muscular tissue is under the control of the autonomic nervous system.

Can erectile dysfunction lead to infertility?

Patients who are unable to achieve erection will still be able to potential conceive as long as ejaculation of sperm can occur. The assisted reproductive techniques available to this patient and partner would be discussed with a fertility specialist.