Erectile dysfunction is a common issue that affects nearly 30 million men in the United States.
Most cases of ED can be treated without surgery, making it a last-resort option advised by doctors.
But surgery is not for everyone.
Keep reading to learn more about surgical ED treatments.
What is Erectile Dysfunction?
When a man has erectile dysfunction (ED), he experiences difficulty in achieving or maintaining an erection firm enough for sexual intercourse. This condition can result from various physical, mental, and emotional factors.
Common triggers include:
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Diabetes
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High blood pressure
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High cholesterol
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Atherosclerosis
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Stress
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Anxiety
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Depression
Treating the root cause of erectile dysfunction can help minimize its frequency and severity. You can also treat the symptoms directly. In certain cases, surgery may be necessary for some men as a part of their treatment plan.
How Does Surgical Treatment Work?
There are two types of surgery used to treat erectile dysfunction: penile implants and vascular reconstruction.
Penile implants
In penile implant surgery, the surgeon implants a prosthetic device inside of the penis as a long-term solution for ED.
With this procedure, the patient is put under general anesthesia. Cuts are made above the penis (around the area where it joins the belly) or underneath it.
Penile implant surgery is typically outpatient, but can sometimes require overnight observation and monitoring.
It’s common for patients to experience pain, discomfort, bruising, or swelling for a few weeks after surgery. While recovery time varies between patients, men are usually instructed to wait at least eight weeks before they resume sexual activity.
There are two types of penile prosthesis surgery.
Bendable or semi-rigid implants
In this procedure, a surgeon will implant two malleable silicone rods inside the penis shaft.
These rods allow the patient to manually adjust the position of his penis: downwards for urination and upwards to achieve erection.
Although this surgery has a high success rate, it has several drawbacks.
The patient’s penis will look different, as it will stay erect at all times. This can be challenging to conceal.
Inflatable implants
In this procedure, the surgeon installs cylinders into the penis shaft, a pump into the scrotum, and a reservoir into the lower abdomen.
Unlike bendable implants, inflatable implants allow the penis to become flaccid.
To achieve an erection, the man simply squeezes the pump to move fluid from the reservoir to the cylinders. The cylinders then expand, creating an erection.
Inflatable implants wear out over time and require replacement surgery after about seven years.
While they are highly effective, they do have some downsides.
Aside from being expensive, penile implants may malfunction and cause painful erections.
Vascular reconstruction
Vascular reconstruction surgery can restore the patient’s ability to achieve natural erections without implants or cosmetic changes to the penis.
There are two types of vascular reconstruction.
In one, arteries are reconstructed to increase blood flowing into the penis.
In the other, certain veins are blocked to decrease the amount of blood exiting the penis.
Doctors rarely recommend this type of surgery as most men are not appropriate candidates. Also, very few medical centers host the procedure.
Additionally, its effects only last about two years.
Alternative Treatment Options
Physicians only recommend surgical implants and vascular reconstruction after other treatment options have failed. PDE5 inhibitors, vacuum pumps, and injection therapy are the first lines of treatment for ED.
PDE5 inhibitors
Arguably the most popular ED treatments are PDE5 (phosphodiesterase 5) inhibitors like sildenafil, tadalafil, and vardenafil. Many people know these medications by the brand names Viagra®, Cialis®, and Levitra.
PDE5 inhibitors block enzymes in your blood vessel walls. This process relaxes and dilates your blood vessels, increasing the flow of blood into your penis.
PDE5 inhibitors will only cause an erection during arousal. Their effects typically last four hours, but their duration depends on the user’s diet, dosage, and metabolism.
Once the drug has been broken down and excreted, its effects will be gone.
While PDE5 inhibitors are generally safe, potential side effects include flushing, headaches, congestion, indigestion, and stomach cramps.
Additionally, these drugs can have severe negative interactions with other medications. It is important to discuss any other medications you are currently taking – especially nitrates and blood pressure medications – with your doctor.
Vacuum pumps
If an individual cannot take PDE5 inhibitors, they may consider using a vacuum pump.
Vacuum pumps – which can be hand or battery-operated – come with a long cylinder attached to a pump. They are typically used with a constriction band, also known as a cock ring.
They work by drawing blood into the shaft of the penis to create an erection.
When used properly, they are safe, effective, and come with minimal side effects.
Injection therapy
If PDE5 inhibitors and vacuum pumps are ineffective, you may consider trying penis injections. Injection therapy is extremely effective and has few side effects.
With this method, the man or his partner injects a mixture of alprostadil, phentolamine, and papaverine into the penis.
Similar to PDE5 inhibitors, the mixture relaxes the blood vessels inside the penis. This allows the man to achieve an erection within several minutes.
Unlike PDE5 inhibitors, they do not require arousal or stimulation.
Erections typically subside within 30 minutes after orgasm. Seek medical attention if you have an erection that lasts longer than two hours after orgasm.
How Rex MD Can Help
If a man is not responding to traditional and alternative ED treatments, getting a penile implant or vascular reconstruction may help.
Most doctors recommend that patients try using prescription medication or alternative treatments before turning to surgery.
