There are a variety of causes erectile failure. We will perform a though yet cost effective evaluation that should allow a good understanding of the cause for your erection difficulties. We can then advise options to improve your sexual life. We understand that openly discussing erectile problems is difficult for you, but rest assured we are trained specialist in this field and can provide you with the professional evaluation and advice you and your partner expect.

Evaluation includes:

History as taken by a questionnaire and urologist.

Genital and prostate physical examination.

Lab testing to include a prolactin, free and total testosterone and PSA in most men over 50.

Rigiscan testing when indicated.

Duplex doppler penile flow testing when indicated.

* Rigiscan testing is a sensitive monitoring device that records the quality and quality of nocturnal erections ( those erections occurring at night during your deepest sleep) during a two session. The information then will be downloaded to a computer that will record a graph of the events. Normally a man will develop 3-5 erections during deep sleep that last from 10-30 minutes. This test will allow us to better understand the etiology of your erectile dysfunction.

* Duplex doppler testing allows us to check the blood flow in and out of the penis. We know that a lare percentation of males with erectile difficulties tend to have vascular insufficiency (low penile artery blood flow) or low venous leak pressures.

The options currently available for treatment of erectile dysfunction depend on the cause.

VIAGRA (silenadil) a pill taken orally before intercourse to promote and enhance the erection.

MUSE an intraurethral suppository of the erection inducing medication prostaglandin.

(VED) Vacuum Inflation Device or

(PIT) Penile Injection Therapy with prostaglandin.

PROSTHESIS Surgical Implant of a penile prosthesis

VIAGRA is discussed in a separate handout. It is usually our first line treatment unless contraindicated.

MUSE is the brand name of a small intraurethral suppository the size of a pencil lead. The medication is inserted with a small applicator into the urethra. After insertion within 10 minutes it will enhance the erection adequately to allow intercourse in 65-75 % of men.

* Side Effects include hypotension in 1% of patients, and burning or aching in the urethra in 25% of men. The medication can be first tried at home after though instruction on its’ use in the office.
Trial will be necessary to determine the correct dose for you. The cost is approximately $130. for six.

VED is a popular and safe treatment in which a pump is used to develop the erection and a band is placed at the base of the penis to maintain it. This therapy can be used in conjunction with other therapies when necessary. It is 65-70% effective in producing an adequate erection.

* Side Effects include bruising, Mild pain from the compression band. The cost of this device is approximately $500.00.

PIT is the direct administration of prostaglandin via a small needle into the penile shaft. It is 80-85% effective in producing an adequate erection for intercourse. Separate information is included.

A Prosthesis may be advised in those patients refractory to the other conservative options. Both rigid and inflatable prosthetic devices are available. The devices are placed in the penis in the operating room and you will have a short sta in the hospital.

Dr. David B. Paul M.D. & Dr. Bradley J. Qualey M.D.