How to Manage Erectile Dysfunction

By Timothy Byler, MD

Physician Timothy Byler specializes in urology. He is affiliated with Upstate Urology in Syracuse.
Physician Timothy Byler specializes in urology. He is affiliated with Upstate Urology in Syracuse.

In the United States, many men are commonly affected by erectile dysfunction (ED). These concerns are often suppressed as men are embarrassed to talk about it or feel like it is just part of aging.

In fact, a large study showed that roughly 40 percent of 40-year-old men experienced problems with erections and this number soared up to almost 70 percent at age 70.

In each decade after 40, the rate of ED rose 5 to 15 percent consistently. Therefore, if you have a concern, you are certainly not alone.

In most cases, there isn’t much extra testing or lab work that needs to be done if you bring up an erection concern. Your doctor will do a thorough history of your medical problems and physical examination to make sure nothing else is contributing. Patients with diabetes, spinal or back problems, high blood pressure, heart attacks, multiple sclerosis, anxiety, depression or who take certain medications often have problems with erections.

Sometimes speaking up about your problem may lead to uncovering one of these more concerning issues early.

Once your doctor has made sure there is nothing more concerning, most men are treated with oral pills. Most of us have heard about these or know other men who have or routinely use them. These medications cannot be taken if you take nitrates (certain medications) for blood pressure or chest pain as they can react with each other. For best results, these medications should be taken on an empty stomach, one hour before foreplay and alcohol should be limited.

Common side effects include headache, vision changes, flushing or muscle cramps. This class of medication has revolutionized the field and given many men the confidence they lost previously.

There are several different oral pills with different dosing and your doctor will help you figure out which one is best for you.

For a group of men, medications won’t work or side effects will be problematic. The advanced options for erection loss include penile pumps or injection therapy. Each of these has its pros and cons that your doctor will discuss with you. Often, these options are reserved for urologists who are experts. Don’t get discouraged, many options work better for one man than another.

If all others fail or a man wishes for a more permanent solution, there are surgeries to help erection loss. Penile implants come in two main types: one that is rigid all the time and one that has a pump that controls if it is soft or hard.

The choice between these is very patient specific and your doctor will discuss both to help you chose which is right for you. Most studies show that over 90 percent of men who have a penile implant are happy with their choice. Not all men are candidates for surgery or implants and these options require careful consideration.

Physician Timothy Byler is an assistant professor of urology and member of Upstate Urology at Upstate University Hospital. He received his medical degree from Rutgers University – New Jersey Medical School and completed his residency at SUNY Upstate Medical University. Contact him at 315-464-1500.

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