Erectile Dysfunction (ED) is defined as the inability to achieve or maintain a sufficient erection for satisfactory sexual performance. It has been reported that ED affects men, regardless of age, at one point in their lives.
The first line of treatment for ED would be oral phosphodiesterase type 5 inhibitors (PDE5i). Locally available PDE5i include sildenafil, vardenafil and tadalafil. As PDE5i work only on the vasculature of the penis, they have no effect on libido, and should not be considered an aphrodisiac. PDE5i are safe and well-tolerated by men. However, men on nitrates are not suitable to use PDE5i.
As such, we can consider second-line treatment or other adjunctive treatment modalities that can be discussed further in the andrology clinic.
One viable option would be selfadministered intra-cavernosal injections (ICI). The commonly used local preparation is alprostadil 20mcg (a prostaglandin E1 analogue). Unlike PDE5i, after ICI, erections usually occur within minutes, independent of sexual stimulation. The main side effect of ICI would be priapism (persistent erections without sexual stimulation), and we would advise men on ICI to make a trip to the Emergency Room if the erections fail to wear off after 2 hours.
Vacuum Erection Devices (VED) work by drawing both venous and arterial blood into the penis, to cause The current cure for ED is the placement of a Penile Prosthesis, which is a day surgical procedure where a permanent implant is placed into the patient’s body via a small peno-scrotal incision (where the base of the penis meets the scrotum), and the patient will be able to use the prosthesis 6 weeks later. Options include the inflatable penile prosthesis (with a physiological flaccid state on deflation) and the malleable semi-rigid penile prosthesis.