For many years impotence was a problem that was not talked about because of its personal nature. Men suffering from this condition often do not know about the various treatment options available to them and do not seek help. One mission of the Center for Male Reproductive Medicine is to educate men about erectile dysfunction and provide them with effective, cost-efficient and rapid solutions which they can use to restore an active and gratifying sex life. We believe in the "goal-oriented" approach to impotence and, as such, rarely recommend costly vascular and sleep studies which can be useful in diagnosis, but offer no practical solutions. Usually within 1-2 visits, and at a cost of under $400, a successful treatment program can be established for most men.

Penile Anatomy & Physiology

A basic knowledge of how a normal erection occurs is necessary to better understand the causes and treatments of erectile dysfunction . The penis is a highly vascular organ that fills with blood in the excited state to produce an erection. The penile artery brings blood to the penis and the dorsal penile veins allow blood return to the body. The penis is composed of three chambers, the paired corpra cavernosa and the corpus spongiosum. The corpus spongiosum contains the urethra or "urine" channel on the underside of the penis. The corpus cavernosum is the erectile body responsible for providing rigidity to the penis. It contains "spongy" vascular tissue surrounded by a tough elastic covering (tunica albuginea).

When a man is aroused a signal from the brain travels down the spinal cord and along the pelvic nerves to the penis. These nerves which travel alongside the rectum and prostate terminate at the penile artery and "spongy " tissue. Chemical signals from the nerves cause the arteries to enlarge and allow increased blood flow into the penis. The spaces in the spongy tissue fill with blood and the penis begins to elongate (figure below).

When the elastic covering of the corpra is stretched to its limit, the intra-penile blood pressure increases and the penis becomes rigid. The penile veins become compressed against the tunical albuginea, effectively "trapping" the blood and enabling the erection to be maintained. For all of these coordinated events to occur, a sufficient amount of the male hormone testosterone must be present.

From this highly abbreviated description of erectile physiology one can see that any problem effecting the brain, spinal cord, erectile nerves, penile artery, "spongy" tissue, penile veins or testosterone production can influence a man's ability to have a normal erection.

Treatment

Treatment options for erectile dysfunction can be divided into four broad categories, pharmacological, mechanical, surgical, and psychological.
Pharmacological treatment involves delivering medication which can help restore erections. There are several different types of medication and ways of administering them. In general, medical therapy is the most appealing form of treatment and can be highly successful.

Mechanical treatment involves the use of a vacuum erection device or "pump" along with a constriction ring. The penis is placed in a vacuum tube and the air is pumped out. This creates negative pressure and allows blood to flow into the penis. Once the penis becomes erect, a rubber ring is placed around the base of the penis to prevent the blood from leaving. The vacuum tube is then removed. This non-invasive mode of therapy is effective in treating erectile problems form most causes although the device can be cumbersome to use.

Surgical therapy is the most invasive form of treatment for erectile dysfunction. The penile implant is a very good option for those men who have failed medical therapy or have a severe arterial or venous causes of impotence. Penile microsurgical revascularization procedures are reserved for those men who have a discrete identifiable penile arterial blockage. This surgery is technically challenging and must be performed by an experienced microvascular surgeon. The overall results are good in carefully selected patients. Penile vein ligation surgery has met with some controversy over its effectiveness but may yield fair results in patients with a venous leak.

Mechanical treatment involves the use of a vacuum erection device or "pump" along with a constriction ring. The penis is placed in a vacuum tube and the air is pumped out. This creates negative pressure and allows blood to flow into the penis. Once the penis becomes erect, a rubber ring is placed around the base of the penis to prevent the blood from leaving. The vacuum tube is then removed. This non-invasive mode of therapy is effective in treating erectile problems form most causes although the device can be cumbersome to use.

Surgical therapy is the most invasive form of treatment for erectile dysfunction. The penile implant is a very good option for those men who have failed medical therapy or have a severe arterial or venous causes of impotence. Penile microsurgical revascularization procedures are reserved for those men who have a discrete identifiable penile arterial blockage. This surgery is technically challenging and must be performed by an experienced microvascular surgeon. The overall results are good in carefully selected patients. Penile vein ligation surgery has met with some controversy over its effectiveness but may yield fair results in patients with a venous leak.

Psychological therapy is very useful in those cases of erectile dysfunction which are a direct result of psychological causes. These patients may also benefit from pharmacologic or combination therapy. The treatment of erectile dysfunction is rapidly changing as our understanding of erectile physiology expands. Men are becoming increasingly aware of the many different solutions available for this problem and are actively seeking help. Wives and partners are becoming more involved in the treatment process. If you or a loved one suffers from erectile dysfunction, help is just a phone call away.