The ED Challenge-Beyond the Pill

Erectile Dysfunction (ED) is one of the more common sexual issues for men. While ED tends to appear in men who are older, it is also common for men who have undergone certain bladder cancer treatments. While there are many treatments for ED available, I also believe in removing as many complications as possible before one looks at the medical and surgical treatments. There are things you can do before you even talk to your doctor so, let’s begin there.

Treatment

As I said earlier, ED is more likely to happen when you get older. So, there are things you can do to make your ED treatment work better. Think about it this way, if you don't make these changes, you’re actually making the treatment for ED work harder than it has to, making it less likely to be successful…and I’m not even including the ED caused by the treatment for bladder cancer yet. So, according to many research-based guidelines, you should:

• Exercise – you’ll see an improvement in blood pressure, blood flow and improved health in general. You may also want to try kegels.
• Make dietary changes – Eating healthy food reduces the risk of heart disease, clogged arteries and diabetes – all of which are related to related to ED.
• Quit smoking/ drinking – Yes, both smoking and drinking are bad for you and both are directly related to the development of ED.
• Reduce stress – Stress can appear from many places, including work, money, and your relationships. Finding healthy ways to decrease stress, such as exercise, may decrease the chance of ED showing up.

These are a few healthy changes you can make to decrease the chances of ED appearing, which will allow you to have a healthy sexual life into your later years. Now, lets talk about the medications and options you can choose from if ED does appear. While there is no guarantee these treatments will work, it’s still important for you to discuss these with your doctor prior to, during, and after your treatment for bladder cancer.

Oral meds

For many men, oral medications for ED can work very well. Some of the more popular medications include:

• Sildenafil (Viagra)
• Tadalafil (Cialis)
• Vardenafil (Levitra)
• Avanafil (Stendra)

So, how do these meds work? Basically, they all boost the effect of Nitric Oxide – a natural chemical your body makes which relaxes the muscle within the penis. This aids in an increased flow of blood to the penis, which will help you to get an erection due to stimulation. Some side effects include nasal congestion, headache, vision changes and an upset stomach. If you are taking nitrate medication, these ED medications may interact and cause a dangerous drop in blood pressure. Talk to your doctor about this drug interaction.

Other meds and suppository treatment

Three of the less well-known medical treatments include:

Alprostadil (self-injection)

Using this form of treatment, you would use a fine needle to inject the medication directly into the base/ side of your penis. This treatment is known to cause erections that last more than an hour. Side effects include pain at injection site, an erection that lasts ‘too long,’ and mild bleeding at injection site.

Alprostadil (urethral suppository)

You use a special applicator to place the small Alprostadil suppository inside the urethra of the penis. The erections are known to last between 30 to 60 minutes. Side effects include pain, minor bleeding and the creation of fibrous tissue inside your penis.

Testosterone replacement therapy

Some men may be already dealing with low testosterone, which could complicate treatments for ED. You doctor should test your hormone levels, where your doctor could then prescribe the appropriate forms of treatment.

Pumps and surgery

These options may not be your top choice, but many men have used these methods successfully:

Penis pump

Basically, a penis pump is a tube that is placed over your penis, where a pump is used to remove all the air within the tube. Therefore, the vacuum created pulls blood into your penis so, you have an erection. Then, you place a tension/ “cock” ring around the base of your penis to hold in the blood.

Penile implants

One of the more invasive ED treatments includes surgery to implant devices into the sides of the penis. These devices are either inflatable or bendable rods. Implants are typically the last treatment offered because they are the most invasive, with the additional complication of post-surgical infection.

So, what we have here is just a quick snapshot of the treatments for ED, which are available today. Not all treatments work for everybody so, it's important to keep your doctor informed on what you’re experiencing and your concerns about bladder cancer and ED. If you have any more questions, please feel free to ask and I’ll get more information for you.

Thanks for reading, Dr. Nick.