Hey guys, dr. Alex Tat here and for those of you who don’t know me, I’m a fellowship-trained neurologist specializing in male sexual and reproductive medicine. Today, we’ve got a really exciting video for you. We’re gonna be talking about how we can both treat and cure. Erectile dysfunction. Welcome back to the man cave season, 1 episode, 3, so erectile dysfunction. How can we both treat and cure it? We know that a wrecked-tile dysfunction is one of the most devastating problems that a man can experience. It significantly affects self-confidence. It changes how men see themselves and can even cause depression. Too often, erectile dysfunction becomes a silent burden that men carry it gradually eats away at them, while creating distance between them and the ones that they love. My goal and the goal of other specialists, like myself, is to remove the stigma of IDI so that men feel comfortable seeking care and restoring both intimacy and confidence in their personal lives. Now, if you haven’t seen it already, I strongly recommend that you watch our previous video discussing what causes erectile dysfunction. There will be a link at the top of the screen and then in the description down below I, truly believe that understanding what causes IDI is critically important because it lays the foundation for understanding how we can both treat and cure it, and that’s what we’re going to talk about today, treatment and cure. Now we’re gonna be focusing on what are known as the five pillars of erectile dysfunction treatment. These are the five tried and true fda-approved treatment methods. There is a newer emerging therapy known as shock wave therapy. That’s really exciting as an option for men with mild erectile dysfunction, but since it’s not FDA, approved or covered by insurance, we’re gonna save that for a later video. Now, let’s go to the drawing board. So this image should be familiar to you. If you saw our last video, a man’s penis is essentially three tubes, there’s a urethra at the six o’clock position which carries urine, and there are two erectile cylinders that travel down the length of the penis known as the corpora cavernosa. These are the tubes that are responsible for erections. They accomplish this by filling with blood and becoming rigid that blood flow is provided by the penile artery, which travels down the center of each erectile tube when a man is stimulated. This artery dilates and fills the spongy erectile tissue, the corpora, the erectile tubes, expand in both length and girth in order to provide a firm, satisfying erection, it’s what’s known as a hydraulic mechanism fluid in this case, blood flow moves into a confined space to increase both pressure and rigidity. Now, what’s interesting is that all of our treatments for edie are based on either maximizing or reinforcing this mechanism. Our first-line therapy for edie is a class of oral medicines that most everyone has heard of known as phosphodiesterase inhibitors. These are medicines like viagra, also known as sildenafil in cialis, also known as Ted ala film. Although these medications were really expensive when they first came out 20 years ago, they’re now available as generics that are quite affordable, men can even get them in the mail without ever seeing a doctor in person with services like hims enrollment. These medications are great for men with mild, erectile dysfunction and work by amplifying a signal that tells the piano artery to dilate. This go out men with mild easy to achieve firmer, more reliable erections. Generally speaking, they should be taken beforehand in anticipation of sex and on an empty stomach. This allows the medication enough time to be absorbed and then to travel to where it’s needed. Patients often ask me if one brand of pill is stronger than the other. The main difference between each of these medications is how long the effect lasts and how far in advance each medication must be taken. Although men may have different preferences, none of the medications are necessarily stronger than the other. So why would somebody choose one of these medications as treatment for their erectile dysfunction? The benefit of oral medication is that it’s an easy first step if you’ve never tried anything for your edie. One of these medicines can be a great first option, just take it on an empty stomach and you’re good to go right. The challenge is that these medications really only work for men with mild erectile dysfunction, and they can fail in anywhere from 15 to 50 percent of men. That may mean that they never worked to begin with, or maybe they worked at first but then stopped working later as time goes on now. Something that’s worth noting is that these medications require that men have in tact nervous system. This means these medications tend to work very poorly and men who have spinal cord injuries or who have significant damage to the nerves and the pelvis. Following prostate removal, they can also have significant side effects, headaches, flushing, sinus, congestion, muscle aches changes in vision. These are all potential side effects, and some men can’t take these medications. For that very reason, they can also interact with certain types of heart medication and cause an unsafe drop in blood pressure, which can be another obstacle for some men. Lastly, they can have a real problem with spontaneity now taking a medication an hour ahead of time on an empty stomach may not seem like that big, a challenge, but imagine your average date night, a man and his partner are getting ready to go out. Should he take his medication before dinner? What, if he’s not sure if he’s gonna, have sex or not, but if he does take his medication, but the side effects keep him from enjoying the rest of his night if he waits to take his medication until after dinner, there’s a good chance of the food he’s already eaten may prevent the medicine from working as well as it should, and if he’s taking it too late in the evening, it may not have enough time to start working when he needs it to these scenarios, aren’t just hypothetical they’re based on stories that I’ve heard from my own patients I’ve had so many guys tell me that they’ve gone out, pretending to not be hungry, missed out on dinner at their favorite restaurant and did all this just hoping that their medication pulls through at the end of the night. Now these medications can work for some guys, but it’s important to keep both their strengths and their shortcomings in mind when considering a solution for erectile dysfunction. Now what if the pills, don’t work as a specialist, the majority of the men that I meet fall into this category, typically their primary care doctor or another urologist, has already tried them on an oral medication and it’s failed or stopped working over time. Those patients are looking for a better option. Well, one option is to take medication similar to the oral medicines that we discussed earlier and dissolve it into a solution that can then be injected directly into their rectal bodies of the penis. This is what’s known as an intricate or notional injection. This allows for a higher dose of a medication to be delivered right where the body needs it, and it typically achieves results within three to five minutes. Unlike the oral medications injections work in men that have injuries to the nerves that supply erections, they also avoid the side effects that are common oral medication like headaches or stuffy nose. These injections go by a few different names: edex and calves. Eject are two brand names of injectable all prosthetic. Although most patients tend to go with generic options from compounding pharmacies, as they tend to be more potent and much less expensive. These compounded names include, buy, mix, try, mix and quad mix. Now the drawback of intra confrontational injections is that they require men to stick a needle in their penis every time they want an erection that can be pretty painful for a lot of guys and a real mental roadblock I have a lot of diabetic. Patients use needles all the time for their insulin, but they are not excited about the idea of putting a needle in their penis and I can’t really blame them. Also, although injections don’t have the side effects of headache, stuffy nose or flushing, a lot of the injections can burn. They can also cause scar tissue from repeated needle sticks that can curb or bend the penis known as payro knees disease. They also carry the real risk of working too well. This is what’s known as a priapism or an erection lasting longer than four hours that just won’t go down. A priapism is extremely painful. It can require some pretty uncomfortable maneuvers to get down in some cases, although rare it can require surgery, a result in penile damage with scarring and a permanent loss of penile length and girth. But the real challenge with a day-to-day use of injections is their lack of spontaneity. These medications that could be kept in the refrigerator and the injection needs to be performed immediately before sex. This frequently takes men out of the moment, as they run downstairs, get their medication out of the fridge retrieve their syringe and needles draw up. Their medication, give themselves a shot and then run back to join their partner. This pulls a lot of men out of the moment and it can be such a hassle that many men feel like they miss out on some chances to be intimate. Maybe it’s the middle of the night and they want to have sex, but they don’t want to get out of bed and go through the whole ordeal or performing an injection. It’s also a logistical issue: when going on vacation or traveling, with a medication for men that don’t have a steady partner, it can be a non-starter injections are far from private and what? If a new partner wants to go to their own house, where a man doesn’t have his medication again, injections can work. I know some men that have put mini fridges in their bedroom and even have their partners administer their injection as part of foreplay, like with the oral medication. It’s important to keep all these strengths and shortcomings in mind, but what are some of our other options? Another option is a device known as a vacu erection device or a ve D. This is a hollow tube that goes around. The penis creates a seal with the skin and then pulls blood into the penis. Has it evacuates air out from around it? This can give a man an erection without the use of any medication. The problem is that it can be uncomfortable. It can’t be used by men who are on blood thinners because of the risk of serious bruising and the erection goes away. The moment you break the seal, this means that, in order to maintain the erection, you actually have to slide a rubber band onto the base of the penis. This holds the erection in place, but it also prevents the penis from getting any blood flow. This means the rubber band can only be used for 30 minutes out of time without risking long-term damage, the erection tends to be cold and the band blocks ejaculation during climax. It also creates a hinge and allows the erection to become floppy at the base of the penis, which can be a real problem during sex. As a result, I typically don’t recommend the ve D as a long-term solution for erectile dysfunction. I think it’s fantastic for other conditions like penile rehabilitation after prostatectomy, but most men find it too cumbersome to be a long-term IDI treatment option. Another option is something known as an ALP Rossville urethral suppository, also known by its brand name muse. This is a pill. That’s inserted into the tip of the penis. It then dissolves inside the urethra and is absorbed into the corpora or the erectile cylinders of the penis. The urethral suppository tends to be a little stronger than oral medications, but not as strong as injections, but I mentioned this option, mostly for the sake of being thorough. The urethral suppository tends to burn and cause significant penile pain with erections and, as a result, it’s rarely used anymore. So what do we do for men who want a better option? Maybe the oral medications don’t work. The injections, sound painful and none of the other options really offer the sort of spontaneity that most men desire. After all, most men want to be independent and they don’t want to feel like they have to rely on something external. Well, we go back to the drawing board. If you look at our drawing, you can see that ultimately erections just come down to these YouTube’s, the corpora cavernosa filling with blood and becoming firm and rigid. Like I mentioned earlier, it’s a hydraulic system, so we say what if we could perform a quick 30-minute minimally invasive outpatient procedure, where we slide our own inflatable cylinders inside the body’s natural ones. We restore the support that these cylinders have been lacking and then, instead of having to rely on a pill or a shot, all a man has to do is squeeze a small pump. That’s hidden inside the bottom of his scrot Justices body used to fill these cylinders with blood flow. The pump fills these cylinders with saline, and this allows men to achieve a firm, rigid erection whenever he wants that lasts as long as he wants, and this procedure is what’s known as the penile implant out of all of the treatments that we have for erectile dysfunction. The penile implant is what’s known as the gold standard that everything else is compared against. It has a highest satisfaction rate: it’s natural, invisible, durable and it’s safe. All the things we care about is men, sensation, orgasm ejaculation. The implant doesn’t change any of those things. All this change is how a man achieves and maintains his erection. Now that may sound simple, but when it plays out in a man’s life, it really can be a life-changing and transformational procedure, like I’ve mentioned before I take care of a lot of men with erectile dysfunction and as a specialist I, typically don’t get the easy cases. I see men who have already failed oral medications and I have to say without a doubt that my implant patients are my happiest patients and that’s because for the first time in years they don’t have to worry about their erections. They know that, no matter what they’re going to be able to perform, so, let’s take a look at a model. I think you’ll be able to appreciate the modesty cover a nurse’s get really mad at me when I leave this out in clinic. So this is what a penile implant, also known as an IPP, looks like after it’s been placed, which is to say it doesn’t look like much of anything. Everything is internal and hidden. If you saw a guy in the locker room, you wouldn’t be able to tell that he’s had anything done, so the penis itself feels normal and natural. Now in the scrot, you can feel a testicle on either side in the normal position, because those aren’t changed with the surgery. But if you feel in the middle, you can feel the pump now this pump is what you squeeze to inflate the device. Let me demonstrate now that took me about a minute with each squeeze the pump moves, saline or saltwater from the reservoir, which is a little balloon that sits at a fat pad in front of the bladder to the cylinders themselves. They expand in length and girth and achieve a firm, rigid erection, and this will last as long as a man wants now when a man wants to let his erection down. All he needs to do is feel for the button that sits right on top of the pump itself apply a little bit of pressure to the button to activate it and then, with a little bit of pressure on the cylinders, the penis will return back to the flaccid state. All we do is apply a little bit of pressure and there we go back to normal now for most men. This is all done through a small three centimeter opening in the skin as part of a same-day procedure. Discomfort is minimal and in our practice we don’t even use narcotics. Men just don’t need them, and they do really well with anti-inflammatory medication and some special nerve blocks that we perform at the time of the procedure about half a mentor ready to start using their device. After only three weeks, the device itself has an estimated lifespan of 15 to 20 years, but we do know that over 50% of devices are still in and working at 20 years, that’s better than any other implantable device which includes pacemakers, artificial hips knees, you name it if the device malfunctions we just replace it, but fortunately that’s a rare occurrence. But what are the side effects of the penile implant? Well, my biggest concern is always the risk of infection. If you ever get a cut on your hand, your leg and it gets infected most of the time you can just take an antibiotic things get better, and it’s not that big of a deal if an implanted device gets infected, though antibiotics don’t always take care of things. Sometimes we have to remove the infected device wash the area out and then replace the device with a fresh woman. Fortunately, infections are also rare. The risk of an infection for a man without diabetes is about 1%, while the risk of a man with diabetes is closer to 3%. Now there is a lot to talk about penile implants, but if you’re considering penile implant placement as a cure for your erectile dysfunction, it’s important that you seek out a dedicated center of excellence. That does a lot. Do your research and ask your potential surgeon how many they do in a month or in a year, ask if you can speak with any of their patients that have had the surgery. If you do, this, you’ll be given yourself the best possible chance for a fantastic outcome. So those are the five key pillars for the treatment of erectile dysfunction. I hope this video was informative and offered some insight into what we do as sexual medicine experts to both treat and cure erectile dysfunction, so which of the five pillars of IDI treatment. Do you want to learn more about what questions do you have about them? Are you ready to finally seek treatment for yourself, or maybe someone you care about? Let me know by leaving a comment down below if you made it to the end of this video, and you learned something new click. The like button and subscribe for more content check out our last video to learn how erections are supposed to work and make sure to stay tuned for our next video look for us on Facebook, Instagram and Twitter links are all in the description down below until next time. This is dr. Alex Tat, signing off from the man cave.