Transurethral therapy
This is an effective needle-free form of treatment. A small pellet of drug is introduced into the urethra (the tube through which urine is passed) using a special disposable applicator. The drug is then absorbed through the wall of the urethra and passes into the erectile tissue, giving an erection within 5 to 10 minutes.
Hormone treatment
Only a small proportion of cases of erectile dysfunction are caused by hormone abnormalities. The most frequent hormone abnormality is a reduced level of testosterone (male sex hormone) which can be restored by appropriate testosterone replacement. It is unwise to take testosterone preparations unless laboratory investigations confirm deficiency.
Penile prosthesis
Essentially these are splints which are inserted surgically into the penis. There are two main types: semi-rigid rods which maintain the penis in a state of rigidity all the time but which allow the penis to be bent downwards out of the way when not required. The second type is more sophisticated and involves insertion of a hydraulic device which causes stiffening of the penis when a pump (implanted in the scrotum) is activated. As implantation of penile prosthesis causes destruction of erectile tissue, they should never be considered until other forms of treatment have been tried.
Surgery
A few cases of erectile dysfunction that are caused by abnormalities in blood-flow into and out of the penis can be treated by surgery. However, surgery to the arteries and veins is rarely effective, other than in men who have sustained penile or pelvic injuries, and the decision at this stage will generally be whether to use a penile prosthesis.
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