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The effects of prostate cancer and its treatment are also discussed, as are Peyronie’s disease, priapism and ejaculatory disorders. New chapters in this edition discuss the profound effects of lifestyle change on sexual function, alternative and internet drugs that affect sexual function, endovascular approaches to ED, penile length considerations, the effect of radiation on erectile function, and optimizing ED research.

Presenting a better understanding of what causes erectile dysfunction and the effective medications and non-medication treatments used to treat the condition, this invaluable title offers all physicians, residents, and fellows – and even medical students and other health professionals such as nurse practitioners and physician assistants – an essential reference for enhancing diagnosis and treatment of this common and debilitating disorder.

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Rosen, Raymond C., PhD (et al.) Erectile Dysfunction: Etiology and Risk Factors.

Pastuszak, Alexander W., MD, PhD (et al.) Making the Diagnosis of Erectile Dysfunction.

Becher, Edgardo F., MD, PhD (et al.) Hormonal Evaluation and Therapy of Erectile Dysfunction.

Hockenberry, Mark S., MD (et al.) Effects of Lifestyle Changes and Testosterone Therapy on Erectile Function. Traish, Abdulmaged M., PhD, MBA (et al.) Cardiovascular Issues in the Treatment of Erectile Dysfunction.

Jackson, Graham, FRCP, FESC, FACC (et al.) Alternative and Internet Drugs that Affect Sexual Function. Israel, Jonathan, MD (et al.) Prescription Medications that Affect Sexual Function.

Herberts, Michelle, BS (et al.) Oral Prescription Therapy for Erectile Dysfunction.

Hecht, Sarah L., MD (et al.) Self-Injection, Transurethral, and Topical Therapy in Erectile Dysfunction. Bednarchik, Cynthia L., MS, APN, FNP-BC (et al.) DeLay, Kenneth J., Jr., MD (et al.) Endovascular Approaches to Penile Arterial Revascularization for Vasculogenic Erectile Dysfunction. Ring, Joshua D., MD (et al.) The Effect of Radical Prostatectomy on Sexual Function. Jenkins, Lawrence C., MD, MBA (et al.) The Effect of Radiation on Erectile Function. Chiles, Kelly A., MD, MSc (et al.) Penile Length: Natural History, Preservation, and Recovery.

Davoudzadeh, Natan P., MD (et al.) Penile Rehabilitation After Prostate Cancer Treatments. Cotta, Brittney H., MD (et al.) Peyronie’s Disease: Natural History, Diagnosis, and Medical Therapy. Craig, James R., MD (et al.) Injection Therapy for Peyronie’s Disease. Shaw, Eric, MD (et al.) Peyronie’s Disease: Surgical Therapy.

DiGiorgio, Lorenzo, MD (et al.) Management of Priapism.

Le, Brian V., MD, MA (et al.) Butcher, Michael J., DO (et al.) Optimizing Research in Erectile Dysfunction.

Quickly search our world-class physicians and faculty by keyword, location and insurance provider. The management algorithm at the Sexual Medicine Program at Weill Cornell Medicine - New York Presbyterian Hospital proceeds in a stepwise manner in order to ensure comprehensive, state-of-the-art treatment in the management of erectile dysfunction (ED). This begins with first line therapy including management of associated medical conditions and psychological support combined with oral medical therapy. Second line therapy includes vacuum erection device therapy, penile injection therapy, and transurethral prostaglandin suppository administration. Third line therapy usually involves surgery with implantation of a penile prosthesis.

Oral Agents (Pills) Avanafil (Stendra), Sildenafil (Viagra), Tadalafil (Cialis) and Vardenafil (Levitra, Staxyn) are called inhibitors of phosphodiesterase type 5 (PDE5-I) and they all work by the same mechanism.

Viagra® was the first oral agent with proven benefit in the treatment of erectile dysfunction. Nowadays, there are several oral products which differ in time needed to achieve erection, effects of food intake on activity, and daily or on-demand use.

This gives physicians and patients more flexibility in choosing the best type of medication to suit individual needs.

The advantage of medications in this group is their simplicity of use. Medications in this group help promote the development and maintenance of an erection. Stimulation is required for these medications to work.

It is important to note that these medications do not affect sex drive or libido. Treatment with any of these PDE5 inhibitors allows approximately 65% of men to resume sexual intercourse.

Headache, flushing, transient visual disturbances, back pain, and dyspepsia are the most common side effects. Vacuum erection devices, also known as vacuum constriction devices, have been utilized for improving erectile rigidity for over a century. Bruising, skin breakdown, and penile pain associated with the application of the constriction band are among possible side effects.

Intraurethral Agents (Suppositories) Intra-urethral administration of alprostadil suppository (MUSE™) induces an erection sufficient for sexual intercourse in 30-40% of men. A pellet, the size of a grain of rice, is placed 1 inch into the urine channel following urination while the patient is standing. The reported side effects include pain and dizziness. Injection therapy represents a cornerstone of ED therapy and remains the gold standard for medical therapy.

To date, a number of medications have been used for this purpose, most commonly papaverine, phentolamine, and alprostadil.

These medications have been administered in a variety of combinations with good effect. The success rate, defined by the production of an erection rigid enough for intercourse, has been in excess of 75%. Disadvantages include the more complex route of administration, potential for bleeding, bruising, penile fibrosis, and a higher incidence of priapism (albeit all uncommon side effects).

Penile Implant (prosthesis) Surgery represents a safe and effective means of treating men with ED.

Penile prosthesis has the highest satisfaction rates of all treatment options for erectile dysfunction. Patients who attempt, but dislike or fail to achieve, satisfactory results with pills, vacuum devices, suppositories or injections, are counseled about penile implant surgery.

Penile prostheses can be divided into two main categories: malleable (also known as non-hydraulic or semi-rigid) and inflatable (hydraulic). At our Sexual Medicine Program at Weill Cornell Medicine, 3-piece inflatable penile prostheses are the most commonly implanted.

Three-piece inflatable implants have paired cylinders, a small scrotal pump, and a large-volume fluid reservoir (which is placed behind the abdominal wall muscles).

Prior to surgery, it is important that all patients receive appropriate education concerning the operative procedure and its associated risks and benefits.

We also insist on all patients reading device literature and viewing a device video prior to committing to the procedure. Ensuring that the patient has realistic expectations prior to proceeding with implant surgery is essential to ensuring high postoperative satisfaction profiles.

Patients are advised that the prosthesis will allow them to achieve a rigid erection on demand and will have no effect on their libido and will not lengthen their penis. Patients are also informed of infection rates (1-3%) and rates of re-operation second to device malfunction (15% within 8 years). Penile implants offer the patient a very high level of satisfaction with spontaneity, consistency, and rigidity.

You can request an appointment to see a ED treatment provider in NYC via our online form at any time.

If you'd like to learn more about each of our providers that specialize in Erectile Dysfunction, please review the Physicians & Faculty profiles listed at the bottom of this page.

Our urologist faculty practice in New York City, and are experts in ED treatments including penile prosthesis surgery as well as non-surgical solutions.

The Most Recent Treatment Options for Erectile Dysfunction. Erectile dysfunction (ED) affects millions of American men. The effects of ED can be psychologically

devastating

In particular, the damage to the self-esteem of both partners can be extremely troubling and damaging to the relationship.

But the expert urologists at Georgia Urology are equipped to tack on the task to bring back confidence to all of our patients.

How Can Georgia Urology Help with Erectile Dysfunction? At Georgia Urology, the management and treatment of ED is a major component of our practice and our physicians are among the leaders in the care of these patients.

Many patients and their partners are often embarrassed to discuss such an intimate problem. Our providers strive to help our patients with these problems in a caring and supportive environment.

Goal-directed therapy is the mainstay of management.

We will provide the least involved therapy that gets the patient back to successful erectile function.

Let’s discuss the current options for therapy and briefly touch on a possible exciting new development in the treatment options for erectile dysfunction.

Unless you have lived on another planet for the past 15 years, you have heard of the oral medications available for ED.

Viagra, Cialis, Levitra, and Stendra are all members of the same family of medications called PDE inhibitors. These medications trigger the relaxation of arterial smooth muscle in the penis, leading to arterial dilation and venous constriction resulting in an erection. These medications are effective in about 70% of men in restoring successful erectile function. Side effects are usually mild and include flushing, headache, and/or mild gastritis. Rare side effects include hearing loss, vision loss, and a prolonged erection lasting more than a few hours.

In my 20 years of prescribing these medications, I have never seen these more serious side effects and I have prescribed these medications to thousands of patients.

These medications have traditionally been very expensive are rarely covered by insurance drug plans.

Recently, Sildenafil, which is the same as Viagra, went off-label in the 20 mg dose.

Georgia Urology has a direct pathway to the distribution of Sildenafil, and we are able to offer these pills to our patients for about a dollar a pill.

Vacuum erection devices (VED) have been commercially available for over 40 years.

They consist of a closed-end plastic cylinder and a vacuum pump that is either hand or battery-operated.

They are generally reliable, non-invasive, relatively easy to use, and inexpensive. The disadvantages are that they are not indiscreet being rather bulky, lead to a hinge-like erection (due to only getting the visible part of the penis erect), and can be painful in many patients. Intracavernosal injections have also been available for 30 years.

This treatment involves using a very small insulin-type needle to inject a vasoactive substance directly into the penile erectile tissues. This is a highly successful treatment (>70%) and is mainly used as the next option when patients fail oral medications.

The first injection is done by the provider where the patient or his partner is taught to do subsequent injections on their own. Complications include pain, fibrosis, and prolonged erections.

Side effects are uncommon and this is a very successful option once we get the patient past the fear of penile injection, which in reality are no more painful than an injection in any other part of the body.