In this video today. we are going to talk about treatment options for erectile dysfunction in addition to medications which I’ve previously covered if you’re new here I’m Dr. Rena Malik, urologist and pelvic surgeon, and I’m so happy to have you here, I cannot believe we are nearly at one million subscribers so please if you like what you see here share this channel with your friends make sure they subscribe and help everyone get a little bit more knowledgeable about their urologic and sexual health I want to give a special shout out to bluechew for sponsoring this video. erectile dysfunction is defined as the inability to have penetrative intercourse and affects about half of men over the age of 52 but the questions that most of my patients ask is why do people even get erectile dysfunction well the number one cause is due to vascular problems and that includes issues like high blood pressure high cholesterol lack of exercise and smoking another 30 comes from diabetes over half of men with diabetes will develop erectile dysfunction in fact having the disorder itself increases your risk by three and a half times and the longer you have diabetes the more likely you are to develop erectile dysfunction that’s because diabetes affects the blood flow and the nerves to the penis both of which are extremely important for erections medications contribute to another 15 and that includes most commonly medications for blood pressure specifically those that are called thiazides or beta blockers like metoprolol which is very commonly prescribed also medications for depression specifically ssris or serotonin selective reuptake inhibitors commonly cause issues with erections other smaller causes of erectile dysfunction include neurologic causes specifically things that affect the nerve function to the penis that can include spinal cord injury multiple sclerosis or other neurologic conditions another five percent comes from pelvic surgeries like prostatectomy or other surgeries that happen in the lower part of the abdomen where the nerves course that go to the penis and lastly a very small percent about three percent are due to hormonal causes like low testosterone low thyroid or issues with your pituitary gland so when you develop issues of erectile dysfunction you should go see your primary care doctor and urologist particularly you should be screened by your primary care doctor for cardiac disease risk factors because erectile dysfunction can be the first sign of heart disease and so if you want to learn more about that check out my video that i made before about how erections can be the first sign of heart disease when you see your doctor to talk about your issues with erections they’ll get a history from you they’ll ask a lot of questions about your experience with erections in the past if this has been gradual or sudden if you’ve had any trauma recently as well as a physical examination to really any other physical causes that might be contributing and often with that we’ll also get an early morning testosterone blood draw to make sure that you don’t have any hormonal causes like low testosterone based on the history and physical examination we can rule out things like psychogenic causes or factors that may be associated with your thoughts around performance anxiety that might be contributing to erectile dysfunction that are best treated by a sexual therapist or psychologist another test that some people might offer is a penile doppler test and this test looks at the blood flow to the penis however very often it doesn’t change management what it does do is it allows us to provide reassurance for patients who might have psychological causes of erectile dysfunction and most commonly it’s used for young men who’ve had some sort of trauma and had a sudden onset of erectile dysfunction to identify areas that may have developed an abnormality called an arteriovenous fistula and the reason there’s not a whole lot of other diagnostic testing is because the treatment essentially is almost always the same unless you’ve had a trauma and you might benefit from a very selective surgery which is extremely rare then the treatment as i mentioned is always the same so we start with lifestyle changes so what can you do sitting at home to help improve your erections so if you think about things that can help your erections well anything that’s good for your heart is also going to be good for your erections the most study type of dietary changes are the mediterranean diet which is diet high in fresh produce fish and polyunsaturated oils like olive oil you want to avoid processed foods anything that comes in a box really saturated fats dairy and red meat and in studies they’ve shown that having a mediterranean diet has improved erectile dysfunction or slowed the rate of decline in strength of erections exercise is also a great way to help improve erections multiple studies have proven this and you want to ideally aim for 60 minutes three times a week now you can break that up as much as you want you can do 10 minutes in the morning 10 minutes in the afternoon 10 minutes later and you can do it over the course of the seven days so it doesn’t have to be a big ordeal it doesn’t have to be all at once lastly if you are on some of the medications that might cause erectile dysfunction we’ll put up a list right here you can talk to your doctor about trying to switch to either another hypertensive medication for high blood pressure or another medication for depression that might have less side effects for erections and lastly very simply quit smoking if you are because that’s not going to help your erections and if you’re having alcohol on a chronic basis meaning daily with large amounts try to limit that or decrease that significantly because that will also help with your erections a lot of you ask if there’s any supplements or herbal medications that can help well there’s some major issues here is one we don’t know exactly what is in the supplements they’re unregulated and the ingredients and dosages listed on the bottle may not be what’s actually in the supplement and sometimes they’re even contaminated with other medications medications that we already use for erectile dysfunction like tidal fill or sildenafil or heavy metals interestingly the placebo effect which is when you take a pill that you think is going to improve your erections is quite high in studies for erectile dysfunction that’s why we do randomize controlled trials because when you take something and you think it’s going to improve your erections it actually does by up to 30 percent and so when you see people saying they’ve had these great results with certain supplements well a lot of it can be from that placebo effect let’s move on to medical treatment so i talked a lot about medical treatment in my last video comparing to dalophil and sildenafil so go check that one out i talk all about how our body makes erections and how exactly these medications work to help improve erections if you hate going to the doctor or you can’t swallow pills there’s a super convenient option available to you called bluetooth it’s an entire service it’s so so easy first step is you fill out a medical form online and within two days it’s reviewed by the blue chew team you’re connected to a licensed medical professional right on the platform no extra software is needed then if you meet criteria for treatment with medication you’ll receive a prescription of specially compounded sildenafil and todalophil in chewable form these are made by specialized licensed compounding pharmacies and delivered direct to your door in discrete packaging just like this it’s delivered right to your door for as little as twenty dollars a month blue chew is available in all of the united states except for north dakota and south carolina and to top it up they have great 24 7 customer service if you’re interested in trying blue chew make sure you check out the link in the description below as well as the coupon code for a free one month trial of 20 off your first prescription of blue chew okay outside of medications there are actually other options that can help treat erections and i’m going to talk about a few of them in this video the first one is called an intraurethral suppository this uses a medication called prostaglandin which after you insert it inside the urethra it diffuses across the urethra to get into the corporal tissue or the erectile tissue of the penis this increases the amount of cyclic adenosine monophosphate this is very similar to cgmp that i talked about in my last video about suldenophyll and tadallophil essentially it increases the smooth muscle relaxation within the penis to allow erections to last longer it comes in multiple doses from 125 micrograms up to a thousand micrograms it’s recommended to urinate before you administer it and once you put it in the urethra do it standing and then massage the penis to help absorb the agent into the tissues the side effects for this include 32 percent of people complain of penile pain 12 complain of some burning pain in the urethra and about five to six percent complain of minor bleeding or pain testicular pain or their female partners may have some vaginal discomfort and in a very small percentage about two percent will get dizziness because this medication can cause a drop in your blood pressure and lastly make sure that if your partner’s pregnant that you do not use this because the prostaglandin in the medication can transfer to your partner and induce premature labor another option is a vacuum erection device and i’m going to make a dedicated video about this later but let me know if you’ve used one before in the comments below and how well it worked for you and the last non-surgical option is an intracavernosal injection these are probably the most effective option for erectile dysfunction and this is usually a mix of one to three different pharmacologic agents that are injected directly into the penis and yes this sounds super scary but the needle is really tiny a lot of times when patients do the injection the first time they’ll actually look at me and say oh that’s it that’s all it was so really it’s not as bad as it sounds it’s a lot of fear and anxiety because of course it’s injecting something into your penis but it works very very well and how it works is it relaxes the smooth muscle of the penis and increases blood flow to the penis to help improve erections as i mentioned they come in one to three agents combined the ones that are a single agent are typically prostaglandin e1 these are exactly the same mechanism of action as the medication that’s in the intra-urethral suppository we just talked about another agent that’s used or medication that’s used in the injection is called papaverin and this works very similar to the medications sildenafil and tadalpha and other phosphodiesterase inhibitors because it has the exact same mechanism it’s a non-specific phosphodiesterase inhibitor phantolamine is the last agent and how that works is it relaxes blood vessels to allow increased blood flow the agents usually are called biomix when they have two agents or tri-mix when they have three agents we typically recommend the first dose is done in the office so that you learn how to do it and you can see if you have a response the efficacy of these is very very high as i mentioned up to 80 to 85 percent of people will see a response with this however there are some side effects 50 of men who use the single agent of prostaglandin e1 which is called cava reject or edex most commonly as a brand name will report some penile pain however that can be fixed by switching to a bi-mix or a tri-mix formulation three percent of people may notice some nodules on the penis where they’re doing the injection after using it for greater than 18 months two percent will see some bruising and eccomosis and three percent can have what’s called a hematoma or bleeding underneath the skin of the penis and one to two percent will have headaches or dizziness the most serious complication that we worry about is called a priapism or an erection that lasts longer than four hours i’ve talked about this previously so check out some of my other videos where i talk about priapism or what to do when you get an erection that won’t go away ultimately if you’ve tried all these options or some of these options and you’re still not having success there are other surgical options available namely penile prostheses and i’ve made a couple videos about these so check those out for now and if you want a more in-depth video about the different types of penile prostheses comment below and i’ll make one of those as well as always i’m going to take care of yourself because you are worth it
