Category: Erectile Dysfunction

Watch board-certified urologist Dr. William Brant discuss Erectile Dysfunction: Causes and Treatment. Gain valuable insights into the world of men’s health as Dr. Brant unravels the mysteries behind this condition and explores effective treatment options. Don’t miss out on this informative video that can empower you to take charge of your sexual well-being and improve your quality of life. Tune in now and unlock a wealth of knowledge on Erectile Dysfunction!

Male sexual arousal involves a complex and coordinated effort among the brain, nerves, muscles, hormones, and ultimately, the blood vessels of the penis. If any physical part of the system doesn’t work properly, it can lead to erectile dysfunction (ED), the inability to achieve and maintain an erection for intercourse. In addition, psychological stressors and mental health issues can cause or worsen ED.

As an example, a physical problem that interferes with your arousal or impairs the ability to achieve an erection may cause you anxiety about your sexual abilities. The anxiety then causes a feedback loop, making you hesitant, slowing your response further, and ultimately worsening your ED.

Urologist and men’s sexual health physician Dr. William Brant understands that talking about erectile dysfunction may make you feel uncomfortable, but he and his staff want to assure you that you aren’t alone — the 1994 Massachusetts Male Aging Study found that about 52% of men experience some form of ED — and it’s nothing to be ashamed about. We offer a number of treatments that can help you regain your sexual function, including cutting-edge shockwave therapy. Here’s what you need to know.

How does an erection occur?

An erection results from increased blood flow into your penis, which can be stimulated either by sexual thoughts or direct contact with the tissue.

When aroused, a man’s penis muscles relax, allowing for increased blood flow through the penile arteries. The blood fills two chambers, one on each side of the penis, stiffening the tissue into an erection. The erection ends when the muscles contract, squeezing the blood out through the penile veins.

What are some standard treatments for ED?

There are a number of options that are commonly used to treat ED.

Medications

Medications are typically the first line of treatment for erectile dysfunction. These include Viagra® (sildenafil), Levitra® (vardenafil), and Cialis® (tadalafil). All three are phosphodiesterase (PDE5) inhibitors, which means they block the action of phosphodiesterase, a chemical that prevents you from achieving an erection. The medications increase blood flow to your penis, helping you achieve and maintain an erection suitable for sexual activity.

Psychotherapy

If psychological or mental health issues are contributing to your ED, talk therapy may prove helpful. During your sessions, you and the therapist can discuss:

• Your stress and anxiety factors
• How you feel about sex
• How you feel about your sexual performance
• Subconscious issues that affect your sexual wellbeing
• ED can take a toll on you and your partner’s relationship, so you might also want to speak with a couples’ counselor to help you reconnect emotionally. With greater openness and trust, you may feel more confident about your performance.

Penis injections

Some medications are injected directly into the penis. These drugs, including alprostadil (edex® and CAVERJECT®), as well as papaverine and phentolamine (TriMix or Bi-Mix), all widen and relax blood vessels, boosting blood flow to the penis.

So, how can shockwave therapy help my erectile dysfunction?

Low-intensity shockwave therapy (LiSWT) is already established as a treatment for healing wounds, bone fractures, and damaged or inflamed connective tissues. But now many doctors, such as Dr. Brant, are incorporating it as a non-invasive treatment for ED.

The treatment goes by several names — LiSWT, Gainswave, Acoustic wave, and True Pulse Protocol — and it can reduce your dependence on oral or injected medications. Dr. Brant and his team use the Li-ESWT (Low-intensity extracorporeal shockwave therapy) system for men who have mild-to-moderate blood flow-related ED and who’ve had success with PDE5 inhibitors.

Dr. Brant uses a wand-like device to deliver low-intensity sound waves into the deep tissues of your penis. The waves clear away any plaque buildup in the blood vessels that prevents flow into the two chambers, without affecting the skin around the treatment area. The waves also stimulate growth factors so that your body can build new, healthy blood vessels, improving the quality of your erections. The treatment requires no anesthesia or medication, is non-invasive, has no side effects, and takes only about 15 minutes per session. The number of sessions you need is customized to your body and your goals, but it’s fair to say that many men need one to two sessions per week for about six weeks for optimal results.

Sexual arousal is a complex process involving a coordinated effort on the part of the brain, hormones, nerves, muscles, and blood vessels. If any part of the system doesn’t function properly, the end result can be erectile dysfunction (ED).

ED is a sensitive subject for most men. But this problem, which causes a persistent inability to achieve and maintain an erection, is more common than you probably think — and it’s treatable. About 5% of men at age 40 have complete erectile dysfunction, increasing to about 15% at age 70. And mild-to-moderate ED affects around 10% of men per decade of life, so that by 50 years, close to 50% of men suffer some degree of dysfunction.

Board-certified urologist and men’s sexual health physician Dr. William Brant understands the impact any degree of erectile dysfunction can have on your quality of life, and he provides a number of evidence-based treatments to help you reclaim your health and your sexual confidence. And because ED can be an indication of an underlying disorder, he stresses the importance of seeking prompt medical attention if you experience any symptoms. Here’s what he wants you to know about the condition and its solutions.

Erectile dysfunction basics

In many ways, ED is a blood flow issue. In order for an erection to occur, blood must flow uninterrupted into corpora cavernosa (masses of erectile tissue) and stay there until sex is complete. Anything that interrupts that flow, whether physical or psychological, can lead to some degree of erectile dysfunction.

Physical causes, which includes underlying medical conditions, are responsible for about 90% of ED cases. Atherosclerosis is one of the most common causes, because it narrows or clogs the arteries in the penis, preventing the necessary blood flow.

Other physical causes include:

• Diabetes
• High blood pressure or cholesterol
• Obesity
• Hormonal disorders, including thyroid conditions and testosterone deficiency (low T)
• Structural or anatomical disorders of the penis, such as Peyronie’s disease
• Parkinson’s disease
• Multiple sclerosis
• Injuries in the pelvic area

Numerous prescription medications can also cause ED by impacting blood flow, including high blood pressure and heart medications, antidepressants, sleeping pills, chemotherapy or prostate drugs, and illicit drugs and alcohol.

ED solutions

We offer a number of different treatments that help with ED. These include:

Medications

Oral medications including Viagra® and Cialis®, which are PDE-5 (phosphodiesterase-5) inhibitors, block a chemical that prevents sufficient blood flow, so you can achieve an erection. Essentially, these medications act to amplify the erections you already have.  However, these medications may be ineffective at helping conditions such as low T, Peyronie’s disease, or injury and should not be the only treatment method tried.

Vacuum erection device (VED)

This external device fits over your penis, and as you pump it up, it pulls blood into the penile tissue. A plastic ring placed at the base of your penis maintains the erection for up to 30 minutes.

Penile injections

Some medications that widen and relax blood vessels can be injected directly into the penis, increasing flow.

Penile implants

Penile implants are the most definitive solution, analogous to having a knee replacement for a knee that has failed conservative treatments.  If conservative ED treatments yield no joy, a penile implant procedure may be an option. Dr. Brant implants new hydraulic cylinders directly in the penis. This long-lasting solution provides firmer erections in a more natural manner.

Shockwave therapy

Low-intensity shockwave therapy (LiSWT) is already in use to heal wounds, bone fractures, and damaged connective tissues, but doctors are now viewing it as a potential treatment for ED, one that can reduce your dependence on medications.

Dr. Brant and his team use the Li-ESWT system for men who have mild-to-moderate vasculogenic (blood flow-related) ED and who’ve had success with the PDE-5 inhibitors.

Dr. Brant uses a wand-like device to deliver low-intensity sound waves into the tissues of the penis, clearing away plaque that may be blocking the blood vessels and preventing blood flow into the corpora cavernosa. In addition, the waves stimulate growth factors that allow your body to develop new, healthy blood vessels. The treatment is noninvasive and takes only about 15 minutes in-office to complete.

Erectile dysfunction, defined as the inability to maintain an erection sufficient for sexual intercourse, is a sensitive topic, one which many men are reluctant to discuss, even with their doctor. However, ED is also a common problem. Mild-to-moderate ED affects approximately 10% of men for each decade of life (i.e., 60% of men in their 60s, 70% of men in their 70s), and treatments are available that can give you back your sex life.

Board-certified urologist and men’s health physician, Dr. William Brant provides research-driven treatments for erectile dysfunction to his patients in Salt Lake City, Utah. He understands that ED can often be a symptom of an underlying medical condition and that prompt medical intervention is important so that you can regain your full sexual health. One condition that’s particularly linked to erection problems is diabetes. Here’s what you need to know about the problem — and the solution.

The 411 on diabetes

Diabetes is a metabolic disease that causes high levels of sugar in the bloodstream. In a healthy individual, the hormone insulin moves sugar (glucose) from the blood into the body’s cells, either to be stored or to be used for energy. With diabetes, however, the body has a problem with insulin, so the sugar builds up in the blood.

There are two main types of diabetes. Type 1 is an autoimmune disease in which the immune system mistakenly attacks and destroys the beta cells in the pancreas, where insulin is produced. Without the cells, there’s no insulin available to regulate glucose. About 10% of diabetics have this type.

Type 2 occurs when your body becomes resistant to the insulin that’s produced, leading to a buildup of sugar in your blood. Being overweight or obese and not exercising are two primary causes of type 2 diabetes. Carrying extra weight, especially around your waist, makes your cells more resistant to insulin’s effect on your blood sugar.

The 411 on erectile dysfunction

Achieving an erection involves proper functioning of many different body systems, including the brain, nerves, hormones, muscles, and blood circulation. If there’s a problem with any of these systems, you may be unable to achieve or maintain an erection. Psychological factors such as stress and anxiety can cause or worsen the problem, as the brain plays a key role in sexual desire and controlling the body systems responsible for an erection.

What’s the diabetes-ED link?

It’s estimated that between 35-75% of men with diabetes will experience at least some degree of ED during their lifetime. In addition, diabetic men tend to develop ED 10-15 years earlier than men without diabetes, and the numbers only increase as the men age.

Medical research has identified several likely causes for ED in patients who have diabetes. These include:

Blood vessel damage

With high levels of glucose in the bloodstream, microvascular disease — damage to the small blood vessels — occurs. This is what leads to kidney damage, neuropathy, and loss of vision, among other things. To achieve an erection, blood must flow into the corpora cavernosa — healthy masses of erectile tissue in the penis — and stay trapped inside. In the presence of microvascular disease, though, blood flow is weak or impeded, leading to ED. Men with both diabetes and high blood pressure can also see an increased risk of ED because of further damage to the penile vessels.

Nerve damage

High levels of glucose may also cause nerve damage, especially in the nerves farthest away from the body.  Many diabetics have foot problems, but they often have problems with their hands and penis.  This can manifest as ED, loss of sensation, inability to climax, and other sexual issues. Having good glucose control may prevent this from worsening but typically once the damage is done, it does not spontaneously get better.

Low testosterone (T) levels

About 25% of men with diabetes have low T. Testosterone plays a role in sexual function in men, so low T can be responsible, in part, for ED.

Depression and anxiety

It can be anxiety-provoking or depressing to have to manage a difficult disease like diabetes, and depression is known to lead to various issues with having an erection. Depression can cause a lack of sleep, which itself results in a loss of morning erections, a natural occurrence in healthy men. And as we’ve seen, psychological factors can cause men to have difficulty achieving an erection or maintaining it during sex.

Medication side effects

Many men with diabetes depend on multiple medications to reduce complications from their disease and also their risk of heart problems. Some of these medications lower blood pressure or have physical and/or psychological side effects that make an erection difficult.

If you have diabetes and are also struggling with ED, there are treatments. They range from lifestyle choices like losing weight, exercising, lowering your blood pressure and cholesterol, and quitting smoking; to hormone replacement therapy, ED pills that increase blood flow to the penis, penis injections, and even penile implants.

Penile implants may sound like an extreme solution for erectile dysfunction, but is it? Often, for men with ED, implants offer a safe option for regaining satisfaction in your sex life and have higher satisfaction rate than more conservative methods.

Based in Salt Lake City, Utah, urology specialist William Brant, MD, FACS, FECSM is an expert at identifying the causes of erectile dysfunction and designing a personalized treatment plan to help restore your ability to have an erection. Dr. Brant and our knowledgeable team are here to explain more about the pros and cons of penile implants, so you can decide if it’s right for you.

What are penile implants?

Penile implants is a general term that covers a wide array of implants designed to help you get and maintain an erection. If you’re worried that penile implants may be difficult to conceal under clothes, don’t fear — the most common implants only harden your penis when you’re ready to have an erection, otherwise, your penis will remain in a normal, flaccid state.

Some of the most popular types of penile implants include:

• One-piece implant – This device is made up of semi-rigid cylinders that are placed in the area of your penis responsible for erections. This is the least complicated kind of prosthesis and easiest to use; however, it offers the least natural-looking and natural-feeling erection as compared to the other implants.
• Two-piece implant – This implant adds a pump in your scrotum to fill the cylinders in your penis with fluid, creating an erection. You can drain the fluid out by bending your penis in a certain direction. Although it’s effective, this device is not the best at maintaining total flaccidity. It may not be a good option if you’re thin or have a larger penis.
• Three-piece implant – This device involves the same mechanism as the two-piece, but the pump can both inflate and deflate the penis. The pump pulls the fluid from a reservoir placed in the lower abdomen area in order to create the erection and sends it back to the reservoir ro return your penis to a completely flaccid state.  These are, by far, the most commonly used implants in the U.S.

Dr. Brant typically recommends the three-piece penile implant to his patients, unless there is a safety or medical concern that prevents you from getting it. The three-piece device offers great rigidity and flaccidity, and most importantly, gives you total control over your erection as well as allowing you to be totally discreet about having an implant.

What should I consider before getting a penile implant?

Penile implants offer amazing benefits, but there are a few drawbacks you should consider before getting one. Here is the breakdown of the pros and cons.

Pros

Some of the pros for getting a penile implant include:

• Allows you to control your erection
• Long-lasting, good for up to 20 years, although this depends on a combination of use and luck
• High patient satisfaction rate
• Returns your penis to a flaccid state when not in use (by deflating for the two or three-piece or bending the semirigid cylinders for the one-piece)
• Easy to use
• Best solution for ED that either doesn’t respond to medication or other treatment, or if those treatments are unsatisfactory.

Each device also comes with its own added benefits. As previously mentioned, the three-piece implant creates the most natural-looking erections, offering both excellent rigidity and total flaccidity. The one-piece device has a very low chance of malfunction (due to its simple construction) and is great for patients with limited dexterity.

Cons of penile implants

The biggest drawback to penile implants is its permanence. In most cases, once you receive a penile implant, you will no longer be able to achieve an erection by natural means. This also applies if you were to have the implant removed.

Other cons of penile implants include:

• Outpatient procedure, which involves recovery time at home
• Higher chance of malfunction with the two or three-piece device
• Less rigid erections (with the one-piece)
• Constant pressure on the penis (with the one-piece), which may cause injury in certain kinds of patients
• Slight risk of infection (very rare, as many modern implants come with an antibiotic coating to prevent this from happening).  Using modern techniques and protocols, Dr. Brant’s rate of infection is less than 1% (outside of unusual circumstances).

Dr. Brant takes the time to explore all nonsurgical treatment options for your ED, including medication and therapy, before suggesting penile implants. If you have concerns about penile implants, he answers all your questions and makes sure you understand both the pros and cons of penile implants before proceeding.

The procedure itself only takes about an hour, and you’ll be able to go home afterward. During the procedure, Dr. Brant makes a very small incision on the upper area of your scrotum to be able to insert the implant. The incision heals in about a week, and you’ll be recovered and able to resume having sex after two to six weeks (depending on the procedure and type of implant).