33 million American men suffer from erectile dysfunction or impotence. These slides discuss the evaluation and treatment options for this common medical condition

1. Erectile Dysfunction-
Impotence
Neil Baum
Touro Infirmary
New Orleans, LA

2. “Man survives earthquakes, experiences the
horrors of illness, and all of the tortures of
the soul. But the most tormenting tragedy
of all time is, and will be, the tragedy of the
bedroom.”
Tolstoy

3. Our Agenda This Evening
– What is E.D.
– How an erection occurs
– What causes E.D.
– E.D. as a health indicator
– Management and Treatment options for E.D.
– Hear from a treated patient
– Questions from the audience

4. Definition of Erectile
Dysfunction
The inability to attain or sustain an erection
adequate for sexual stimulation

5. Facts About ED
– Approximately 30 million American men suffer from
E.D.
– Men ages 40 - 70 have 52% likelihood of some
degree of erectile dysfunction
– E.D. is not normal, and is not an inevitable
consequence of aging
– Men occasionally are unable to get or keep an
erection-normal and does not indicate a problem.
– In most cases, E.D. can be treated
am

7. ED Risk Factors
• Age (Biggest Risk)
• Diabetes
• Hypertension
• Elevated Total or Low HDL Cholesterol
• Medicines (hypoglycemic agents, vasodilators,
antihypertensives, antidepressants)
• Smoking
• Depression
• Obesity

8. Causes of E.D.
• An injury (i.e. brain or spinal cord)
• A disease (i.e. diabetes or heart disease)
• An operation (i.e. prostate gland removal)
• Substance use (i.e. tobacco, drugs,
alcohol or medications)
• Peyroine’s disease

10. Peyroine’s Disease
FIBROUS PLAQUE
CORPUS CAVERNOSUM
CORPUS SPONGIOSUM
GLANS PENIS
x

11. E.D. and Prostate Cancer
– Radical prostatectomy
• During the process the nerves may be damaged
– Radiation therapy
• Over time, the radiation therapy may damage
blood vessels to the penis, preventing blood flow

12. Diabetic Control and Erectile
Dysfunction
• The better the diabetes control, the better
the erections
• Control weight
• Improve exercise level

14. What men want
• Easily allow them to achieve & maintain
an erection
• Reduce the need for planning
• Allow sex to feel normal again for
themselves and their partners
x

15. Treatment Options for ED
• First Line Oral medication (Viagra,
Levitra,Cialis)
• Second Line combination oral agents,
intra-urethral pellets, vacuum devices
• Third Line injections of Trimix solutions,
penile implants, vascular surgery,
Peyronie Disease treatment

16. Drug Therapy-Oral
– Drug therapy include
prescription medication
such as:
• Viagra®
(sildenafil
citrate)
• Cialis®
(tadalafil)
• Levitra®
(vardenafil
hydrochloride)
– Potential side effects:
• Headaches
• Facial blushing
• Upset stomach
• Mild and temporary
visual effects

17. Vacuum Devices

18. Vacuum Device

19. Vacuum Devices
• Advantages
Reusable
Generally effective
Few contraindications to use

20. Vacuum Devices-
Disadvantages
• Decrease in penile skin temperature
• Blood flow to penis decreased
• Hinge effect
• Ejaculation retarded
• Patients may feel uncomfortable with this
process of acquiring an erection
• Pain, bruising
• Dexterity issues
• High initial cost outlay

21. Drug Therapy-Injection
• Advantages:
– Lack of response or
contraindications to
oral drugs
– Reliable, instant,
predictable erection
– Patient preference

22. Pellets for the Penis

23. Drug Therapy:
Transurethral System
• Advantages:
– Lack of response to
oral therapy
– Contraindications to
specific oral drugs
– Adverse
reactions/intolerance
to oral drugs
– Rapid, predictable
erection

24. Penile Implants
• Ideal for men who have tried other
treatments without success

25. Penile Implants
• Two different types
of penile implant
– Malleable implant
– Inflatable Penile
Prosthesis

26. Inflatable Penile Prosthesis

27. Inflatable Penile Prosthesis
Advantages
– Easy to use
– Totally concealed in body
– Natural flaccidity compared to non-inflatable
implants
– Acts and feels more like a natural erection
– Expands girth of the penis
– Feels softer and more flaccid when deflated

28. Penile Implants Advantages
• 95% successful
• Long-term solution
• High patient and partner satisfaction
• Have an erection anytime for as long as
desired
• Feels natural to patient & partner
• No ongoing costs for pills

29. Inflatable Prosthesis Satisfaction
Rates
• Satisfaction rates
– over 98%
• Reliability rates
– mechanical reliability rates of over 97.5% at 5 years
• Concealable
– The entire penile implant is inside of the body and not
visibly noticeable
• Lifetime replacement policy
– Coloplast provides a lifetime replacement policy

30. Implant Risks
<3%
–Infection
–Chronic pain
–Device malfunction

31. Insurance Coverage
–Most insurance plans cover penile
implant procedures
–Medicare covers penile implant
procedures in most cases
–Reimbursement specialists in our
office can help confirm your
coverage

32. Penile Prosthesis

33. A word from one of my patients

34. Questions

35. Summary
• ED is highly prevalent
• ED incidence is age-related
• ED is associated with significant co-
morbidities -
• Nearly every man can be successfully
treated

36. No one need to suffer the tragedy
of the bedroom!