Savvy senior - Jan. 21, 2010

Treatment Options for a Common Male Problem

Dear Savvy Senior

Are there any other types of treatments for erectile dysfunction beyond Viagra and the other drugs that are advertised on television? I don’t like taking pills if I can avoid it. What can you tell me?

Drooping Darryl

Dear Darryl,

When it comes to treating erectile dysfunction (ED), most men know of only three options: Viagra, Cialis or Levitra – the frequently advertised drugs on television. But there are a variety of other treatments that can help too. Here’s what you should know.

With an estimated 30 million U.S. men affected, ED is a relatively common problem especially in older men. In fact, nearly one-third of all men in their 50’s experience ED, and more than half of those in their 60’s have the problem.

The first step you need to take in finding a solution to your erectile problem, is to see a doctor who specializes in ED (usually a urologist) so he can find out what’s causing it. Depending on what he finds, here are the treatment options.

Lifestyle Fixes: For many men, ED is the sign of an underlying health condition like diabetes or hypertension. In fact, in younger men, erection problems are often the first symptom of cardiovascular disease. If this is your problem, adopting a healthier lifestyle such as losing weight, exercising regularly, improving your diet and not smoking may be all you need to fix the problem.

Pills: The convenience and effectiveness of Viagra, Cialis and Levitra make them popular treatment options for many men, but it’s important to know that these drugs don’t work for everyone and they can be rather costly. One Viagra pill, for example, costs about $15, and many insurers including Medicare don’t cover ED medications.

Shots or Suppositories: Another treatment to ask about is a shot of alprostadil, which is given directly into the penis with a tiny needle to create an erection. Your doctor can teach you how to do the injection yourself at home. The shots cost about $35 per injection and are covered by many insurers, but not by Medicare. Or, for a less expensive option ask your doctor about a generic combination of alprostadil, papaverine and phentolamine.

If injecting yourself with a needle gives makes you queasy, a suppository that’s inserted inside the urethra – containing alprostadil – is also available, though it is not considered as effective as the shots.

Vacuum Pumps: This is a drug-free treatment that’s very effective for many men. A penis vacuum pump works by pulling blood into your penis to make it erect. Then you put a snug ring around the base to maintain the erection, which lasts long enough to have sex. The cost for this device, which requires a prescription, can run from $300 to $600 but most insurers including Medicare will cover part of the cost. You can also buy a nonprescription pump online (Amazon.com carries some) for as little as $30.

Implants: If all the previous treatments fail, ask your doctor about a penile implant. The most common type is the inflatable implant where two cylinders are placed inside the penis that can be inflated anytime you want to create an erection. Most insurers including Medicare will cover this surgery.

Surgery: A last resort is vascular reconstructive surgery to improve the blood supply of the penis. It’s the equivalent to a coronary artery bypass, but it is rarely performed and there are only a handful of surgeons in the country who do it.

Therapy: If your ED is psychological and not physical, your doctor may prescribe sex therapy as your treatment. Psychological ED is often caused by stress, such as: work worries, financial worries, relationship conflicts and poor sexual communication.

Other Treatments: If testosterone deficiency is causing your ED, your doctor may prescribe testosterone patches, pills, gels or injections to give you a boost. Or, if you’re a believer in alternative treatments, nutritional supplements (arginine, bioflavonoids, zinc, Vitamin C and E, and flaxseed meal), herbal remedies (ginseng or ginkgo) and even acupuncture have been used to improve their ED, but be sure you talk to you doctor before you try anything.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.