Award-winning urologist - and pioneer in Men’s Health - Dr. Paul Turek blogs weekly about issues such as infertility, vasectomy and vasectomy reversal, sexual and hormonal dysfunction and more. Keep up with latest in this fascinating field of medicine.

What Comes After the Pill?

Making the world a better place with modern technology.

Making the world a better place with modern technology.

In this forum, I’ve already talked about how erections occur and also about pills used to treat erectile dysfunction in men. But what if they don’t help? What comes after the pill?

There are about 30 million men in the U.S. affected by erectile dysfunction. For 20% or more of men, common prescription therapies – Viagra, Levitra or Cialis – are not effective. For these men, we have many things “up our sleeves” to help. Before reviewing this cornucopia of cures, I really need to emphasize again the idea that erectile dysfunction may be a message that your body is not perfectly healthy. Think of it as a loud noise coming from under the hood of the car. It may run fine if you keep going, but you never know. Similarly, medical conditions such as high blood pressure, heart disease, high cholesterol, diabetes and low testosterone are important “loud sounds” that are associated with erectile dysfunction; they should be treated first and foremost. Often, by treating these illnesses, not only will erections improve, but you might live better and longer too.

Ok, so your cholesterol is fine. How then can erections be improved? Well the answer may be to “go local.” Local therapies attempt to improve erections by going to the source to treat the problem: the penis itself. Help the big guy out without involving the rest of the body. Penile salves, creams and urethral pills are available in many forms and are often compounded by pharmacies. One of these is a pill (MUSE) that is inserted just inside the urethra (the urine tube within the penis) and is absorbed by the penis to stimulate an erection. A little unconventional, but very effective in some men.

Although more difficult to imagine, local therapy can also involve injecting the side of the penis with highly active erectogenic agents such as papaverine, phentolamine and prostaglandins. Not the most palatable way to get an erection, but highly effective for the vast majority of men who fail to respond to pills. A more inviting alternative is based on recent developments in transdermal technology and involves delivering the same three medications in a clear gel into the urethra (TriMix Gel). Rub it in for a minute or two and you are up and running.

Available for 30 years now, penile vacuum pumps will also work in the majority of men. By creating 6 atmospheres of negative suction pressure around the penis, these mechanical devices draw blood directly into the penis. Once filled, a rubber ring is placed around the base of the penis to keep the blood in and away you go. But please don’t keep the ring on too long (more than 45 minutes) as bad things could happen…

In the most resistant cases, surgical implants may be needed to resurrect the erection.  Reliable and realistic, implants are the most invasive kind of local therapy and are effective in virtually all men. They can be rigid but bendable, inflatable, antibiotic coated and can have other neat widgets and gadgets. But they do require surgery, which distinguishes them from other treatments. They are also irreversible in the sense that they permanently alter penile anatomy, rendering ineffective most other treatments discussed here. So, let it be known that “vee have vays” of getting those erections back in case the pill doesn’t work.

Related posts:

  1. You Are The Pill That You Eat
  2. The Agents of Erection
  3. The Anatomy of an Erection
  4. Sexual Health Pop Quiz #2
  5. The Ailing Male Pill
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About Dr. Turek

A founder of the male fertility and male sexual healthcare movement, Dr. Paul Turek is also an internationally recognized master microsurgeon who specializes in vasectomy and vasectomy reversal, FNA testicular mapping, sperm retrieval and male erectile and sexual dysfunction.

He is a former Academy of Medical Educators Endowed Chair Professor of Urology, Obstetrics & Gynecology at UCSF and while there, directed a National Institutes of Health (NIH) grant for training new leaders in men's reproductive health. He has authored more than 175 publications on genetic, urological and epidemiological issues in men's reproductive health and regularly consults for the Centers for Disease Control and Prevention (CDC) and the NIH and other branches of the US government and industry on matters relating to men's reproductive health. He currently holds an NIH grant to create a human artificial testicle to make sperm.

He is Past-President of the American Society of Andrology, a Fellow of the American College of Surgeons, the Société Internationale d'Urologie and the Royal Society of Medicine (London). Dr Turek is also Editor of the Reproductive Volume of Netter's Images, 2nd Edition. His hobbies include vintage cars and long board surfing.

Twitter

  • May 16, 2012 22:59

    @doctorshep good to hear from you. I use the same scope. Pic of it on FB http://t.co/rq8Udnrp Remember, it’s the magician and not the hat!

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  • May 15, 2012 22:26

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  • May 14, 2012 15:30

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  • May 14, 2012 15:29

    New #DrTurek Post: Assisted Reproduction: A Two-Edged Sword - Almost 2 decades ago, just about the time when my fell... http://t.co/TqlUaBHr

  • May 13, 2012 21:48

    @FertilityPlanit is bringing community & solutions 2 fertility struggles & needs ur feedback. Time 4 short surv... http://t.co/k0RUYFuZ

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