- What exactly is male impotence?
- How common is impotence?
- Is impotence usually psychological, or "all in your head"?
- How can you determine what my specific problem is?
- Is any testing required?
- If my problem is psychological, what kind of treatment is available?
- What about male hormone "testosterone" shots or patches?
- What are some other treatments?
- I want sex to be natural and as spontaneous as possible. Are any other treatment options available?
- What is injection therapy?
- You mentioned penile implants, tell me more?
- How safe are penile implants?
- Will my insurance help pay for an implant if I decide I want one?
- Have you implanted many men?
1). Q. What exactly is male impotence?
A. Impotence means that a man is unable to have a penile erection of satisfactory firmness or duration for normal sexual activity.
Q. How common is impotence?
A. Approximately 30 million men in the US are impotent. Many men are embarrassed to seek treatment, and some are not aware that impotence can be successfully treated in almost all cases.
Q. Is impotence usually psychological, or "all in your head"?
A. Impotence is most often due to physical (organic) causes. Few men have purely psychological impotence.
Q.How can you determine what my specific problem is?
A. At the first visit, we will obtain your medical and sexual history and perform a urological examination. Additional studies may also be recommended.
Q. Is any testing required?
A. Blood and urine tests are often needed to measure your hormone levels and to check for diabetes and prostate cancer. Measurement of your sleep erections, penile blood flow and nerves related to sexual activity may also be ordered.
Q. If my problem is psychological, what kind of treatment is available?
A. Counseling is often prescribed. Sex therapy or psychotherapy may be appropriate. If this doesn't work, or the patient does not wish sex therapy or psychotherapy, other treatments are available with a high success rate.
Q. What about male hormone "testosterone" shots or patches?
A. Male hormone supplements only help if your hormone level is low. Most men have normal male hormone levels.
Q. What are some other treatments?
A. In 1997, the FDA approved the use of intraurethral inserts of Prostaglandin E-1 (Muse) which gets absorbed through the urethra directly into the erectile chambers resulting in an erection. Many men will find it a satisfactory treatment. In 1998, the FDA approved the use of Sildenafil (Viagra) as the first oral treatment for impotence. This very popular treatment choice has an approximate 60% success rate for organic impotence and about a 90% success rate for psychogenic impotence.
Vacuum tumescence/constriction devices are available, but they do not produce a rigid erection in many men. They may also interfere with ejaculation, and are cumbersome to use.
Q. I want sex to be natural and as spontaneous as possible. Are any other treatment options available?
A. Penile implants give the most rigid and reliable erection and can be used as often as you like. Other possible options include penile vascular surgery and penile injection therapy. Penile vascular surgery is rarely indicated.
Q. What is injection therapy?
A. There are certain medications such as Prostaglandin E-1 (Caverject and Edex) which can induce an erection when injected into the penis. You must inject everytime you want an erection. Many men find this very satisfactory.
Q. You mentioned penile implants, tell me more?
A. Penile implants have been available for more than 20 years. There are several non-inflatable and inflatable types. All implants are completely internal. After you have healed, the genitalia look normal and most men and their partners are not aware of the implant. The implant gives an excellent, reliable erection and the inflatable models give a natural-appearing penis when inflated and deflated. The success rate of penile implantation is over 90%.
Q. How safe are penile implants?
A. The complication rate is low. Many men with diabetes and heart disease (frequently present in men with impotence) can tolerate this procedure if they are properly evaluated and treated beforehand. For most men, this is an ambulatory procedure not requiring an overnight hospital stay.
Q. Will my insurance help pay for an implant if I decide I want one?
A. Most insurance carriers and Medicare cover a penile implant for men with physical impotence. Our office staff can check with your insurance carrier for you.
Q. Have you implanted many men?
A. Over the last 30 years, I have implanted more than 1,000 men and have taught urologists how to perform the surgery and have demonstrated this surgery abroad. I have also lectured and written textbook chapters on the subject.
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