Erectile dysfunction (ED) is a condition characterized by repeated difficulty achieving or maintaining an erection. It can profoundly affect relationships and many aspects of life, leading to embarrassment, anxiety, avoidance of intimacy, depression, and isolation.
At Montefiore Einstein’s Department of Urology, we want you to know that you are not alone. ED can affect men of all ages and ethnicities. It is estimated that half of men older than the age of 40 experience some degree of ED. We understand that talking about these matters can be difficult, but our compassionate team of experts is here to help you regain confidence, restore intimacy, and embrace a fulfilling and satisfying life.
When diagnosing and treating ED, our empathetic specialists look for underlying conditions that may contribute to your condition, working closely with primary care physicians, cardiologists, and endocrinologists. We believe in family-centered care, and encourage patients to involve their partners in the process. They can provide a unique perspective and be a source of support throughout your journey.
We take your unique circumstances and concerns into account, recommending treatments that have helped many individuals recover from this widespread condition. In fact, Montefiore Einstein has one of the busiest penile implant centers in the region, enhanced by our collaborative approach to men’s health.
Erectile dysfunction affects approximately 30 million men in the United States each year, with 75 percent to 90 percent of patients experiencing this condition due to anatomical or physiological factors. While many men assume that it is a normal part of aging, it can actually indicate a more serious underlying condition.
The penis is a vascular organ, so conditions impacting your heart, arteries, lower extremity blood vessels, and veins can have a direct impact on your ability to achieve and maintain an erection–which is why maintaining a healthy lifestyle can significantly help in preventing this condition. Because of this, early diagnosis is crucial, especially for men in their 40s, 50s, or 60s.
Speak to your doctor if you are experiencing:
Some underlying causes of ED can be very serious, and even life-threatening. However, with early diagnosis, they usually respond well to treatment. Some conditions that can cause ED include:
* There is a complex relationship between testosterone and metabolic health, which is currently being studied. Your doctor is the best source of information on whether or how it may affect you.
Your doctor will conduct a thorough initial evaluation, taking your and your family’s medical history, and performing a physical exam. He or she may then order one or more of the following tests:
We provide a complete range of treatment options, many of which include medications, devices, or surgery. It’s important to be open and honest with your doctor about what feels right for you, in order to determine the best course of treatment.
Medications for ED, such as Viagra® (Sildenafil), Cialis® (Tadalafil), and Levitra® (Vardenafil), work directly on the blood vessels to improve blood flow to the penis. By expanding the arteries, these medications can facilitate an erection, but sexual stimulation is still necessary. Studies have shown that these drug treatments are successful for 70 percent to 80 percent of men. However, since ED medications may cause a drop in blood pressure, men who take nitrate medications for heart disease symptoms should not use them.
Approximately 35 percent of men may not respond well to oral medications, and a smaller percentage may experience uncomfortable side effects such as flushing, sudden warmth, changes in vision, upset stomach, or heartburn.
There are two types of injections, which are often used when men don’t respond well to oral medications.
This method involves using a narrow, prefilled plastic applicator to insert a suppository directly into the urethra, about 5 to 10 minutes before sexual intercourse. The medication works by relaxing the muscles of the penis and widening the arteries, allowing for adequate blood flow to achieve an erection.
Side effects such as dizziness, a burning sensation in the urethra, or aching in the penis, legs, or pelvis may occur. However, these side effects typically subside when the medication leaves the body. To ensure safety, your doctor may advise refraining from driving or operating heavy machinery within an hour of using this medication
This is the first medication approved by the United States Food and Drug Administration (FDA) for the treatment of ED. This method involves injecting medication directly into the shaft of the penis using a very fine needle, similar to those used for insulin. Typically, patients try it in the doctor’s office and then receive training to administer the injections at home.
This medication is injected about 20 minutes before sexual activity. Since it requires refrigeration, this medication is most suitable for men who work at home or have minimal travel commitments. Side effects may include a temporary aching sensation in the penis.
This is one of the earliest and most effective treatments for ED. It involves placing a cylinder around the penis to create a vacuum and assist in pumping blood, resulting in an erection. To maintain the erection, a constrictive band is placed around the base of the penis for about 30 minutes. After intercourse, the band is removed, and the erection subsides. Side effects may include light bruising on the penis, which is generally temporary. This device offers a non-invasive option for managing ED and can be an effective solution for many individuals..
This is the next course of action when men don’t respond well to injections, and is suitable when the underlying cause of ED is diabetes, vascular disease, and spinal cord injury. The penile implant is an outpatient surgery which typically lasts around an hour. The implant itself can last for a duration of 10 to 15 years. After surgery, a recovery period of 4 to 6 weeks without sexual activity may be advised. Following the recovery period, men continue to experience the same sensation and sexual responses as before. There are no visible signs as the entire implant is internal. Penile implants do not alter the sensation in the skin of the penis, nor do they have any negative impact on a man’s ability to achieve orgasm.
There are two types of penile implants:
Malleable implants - provide permanent firmness with two semi-rigid rods. The procedure is performed with anesthesia in the hospital and takes 30 to 60 minutes. Due to the constant firmness of the implants, they may be more detectable in clothing. Manually bending the rods downward can help conceal them.
Inflatable implants can be inflated and deflated as needed. The implant includes two inflatable cylinders, a reservoir, and a pump unit, which are surgically implanted into the penis and scrotum. Pressing the embedded pump portion of the device allows fluid to flow from the reservoir to the implants to create an erection-like state.
This specialized procedure is primarily performed on men under 40 who have suffered a traumatic injury to the pelvis, resulting in compromised blood vessel function. It involves bypassing blocked penile arteries by connecting an artery in the lower abdomen to one at the top of the penis, ensuring sufficient blood flow. Following surgery, individuals require a recovery period of four to six weeks and are advised to abstain from sexual activity for a minimum of six weeks. This procedure is not recommended for men with atherosclerosis.
We provide comprehensive solutions in the event that your doctor identifies a hormone imbalance or a psychological issue as the root cause of your ED. Our services encompass hormone replacement therapy and counseling, both of which can be effective treatments in addressing ED and restoring sexual function.
To inquire about an erectile dysfunction consultation, call: