Intracavernous Pharmacotherapy (ICP)
Considered a very effective but often under-utilized treatment for Erectile Dysfunction, ICP involves an injection of a combination of FDA-approved vasodilators into the spongy tissue of the penis, using an auto-applicator. This combination causes an expansion of the penile arteries and penile tissues, resulting in increased blood flow to the penis. An erection typically develops within minutes. The erection feels perfectly natural and normal; however, it will not subside after ejaculation until the effect of the medicine wears off. In rare cases side-effects of ICP include penile bruising, pain or tenderness, scarring, and a prolonged erection (known as a priapism).
Boston Medical Group physicians have developed a unique approach to this method that has been effective for thousands of patients. Because it is applied locally and is non-systemic, it is often recommended for men with diabetes, heart conditions, high blood pressure or other illnesses. In the last 10 years ICP has re-emerged as a treatment option for men who do not respond to well-known oral medications for ED. Many men prefer to use ICP over other methods given its record of safety, quality, and highly predicable results.
Oral Medications (ED Pills)
Oral medications for ED have become very well known, and their convenience often makes them the first-line of treatment. While effective for many men, those who take nitrates for chest pain should not use oral medications given the potential for an unsafe drop in blood pressure. Other potential side effects include, but are not limited to, blurred vision, loss of hearing, and headaches.
Intra-Urethral Suppository (MUSE)
MUSE contains a vasodilator known as Alprostadil (or Prostaglandine E1) prepared in the form of a pellet that is inserted into the urethra, via an applicator. The medicine is absorbed through the urethral wall into the erectile chambers known as the corpus cavernosa.
Given the availability of less invasive, more effective treatments, penile prosthesis is often a treatment of last resort. The best penile prosthesis is comprised of two inflatable tubes, a pump, and a reservoir. The tubes are surgically inserted into the corpus cavernosa, the pump in the scrotum and the reservoir behind the pubic bones. When the pump is activated, fluid flows from the reservoir into the tubes, which harden and become erect. Pressing a valve on the pump mechanism deactivates it, and the fluid returns to the reservoir, resulting in a flaccid penis. Complications can include infection, bleeding, pain and discomfort, mechanical failure, or extrusion of part of the prosthesis through a weakened wall of the erectile chambers.
Penile implant surgery is a major surgery that is usually invasive and expensive. Nonetheless, it can benefit men who do not respond to any other form of treatment.
These surgical procedures are not performed by Boston Medical Group physicians.
Vacuum Suction Devices (VSDs)
A VSD is a battery or manually-operated cylindrical pump which fully encloses the penis. When activated, it creates a vacuum by sucking air out of the sealed chamber, which draws blood to the penis. A firm rubber ring is placed around the base of the penis to trap the blood in the erectile chamber, which keeps the penis firm. Disadvantages can include incomplete erections, discomfort, and the time required for operation, but VSDs are often valuable when used along with other treatments, like ICP.
Arterial and Venous Surgeries
Approximately 2% to 5% of patients are candidates for vascular reconstructive surgery, which includes arterial bypass and venous ligation. Risks include those related to other major surgical procedures. Boston Medical Group physicians do not perform these surgeries.
Hormonal Replacement Therapy
Some men experience a condition called andropause, similar to menopause in women, which can be caused by low testosterone. Symptoms can include, but are not limited to, feelings of sluggishness, fatigue, poor sleeping habits, weight gain, low sex drive, or erectile dysfunction. For the appropriate candidate, hormonal replacement therapy can be valuable in reversing these symptoms and even improve libido (sexual drive).
Blood tests are required for the purpose of diagnosis, monitoring the treatment effectiveness, as well as any other adverse side-effects.
Sex therapy is often the treatment of choice for patients with psychological Erectile Dysfunction. It demands the cooperation of the sexual partner, multiple sessions, and an experienced sex therapist for the best results.
Intranasal medications offer a non-traditional method of administering different combinations of vasodilators with the goal or improving blood flow. Their effectiveness is questionable is not endorsed by mainstream medical communities.
While many different treatment options exist for Premature Ejaculation, Boston Medical Group physicians can determine which treatments are most appropriate for you based on your personal condition. A list of generally available treatment options is detailed below.
Intracavernous Pharmacotherapy (ICP)
ICP involves an injection of a combination of FDA-approved vasodilators into the spongy tissue of the penis, using an auto-applicator. The erection feels perfectly natural and normal; however, it will not subside after ejaculation until the effect of the medication wears off. Side-effects of ICP can often be avoided and are rare, but can include penile bruising, pain or tenderness, scarring, and a prolonged erection (known as a priapism).
Boston Medical Group physicians have developed and a unique approach to this method that is often effective for PE patients. The treatment allows a patient to maintain an erection for up to 60 minutes, regardless of the occurrence of ejaculation. With a greater ability to endure longer sexual experiences, men are often better able to engage in intercourse without fear of losing their erection.
Start and Stop Technique, Squeeze technique, and Kegel Exercises
The Start and Stop technique involves trying to delay ejaculation by withdrawing the penis or stopping the thrusts right before climax. The Squeeze technique involves having the partner firmly squeeze the head of the penis just before ejaculation. These techniques require a great deal of dedication and cooperation on the part of the partner; however, these techniques can be effective with proper guidance from a qualified sex therapist.
Pelvic floor exercises, known as Kegels, involve repetitive contractions of the pelvic muscles that control the flow of urination. Strengthening these muscles can help improve ejaculatory control, but this method is often best used in conjunction with other treatments, such as ICP.
Local Anesthetic Gels, Sprays, and Creams
The goal of local anesthetic products, such as lidocaine and prilocaine, is to numb the head of the penis to reduce sensation, and thus, reduce the likelihood of uncontrolled ejaculation. The effects of these creams is most often temporary, as numbing the penis does not allow a man to acclimate to the sensation of lovemaking, and hence, his ability to control the urge to ejaculate. If a condom is not used, the female partner often complains of reduced sensation in the vagina, resulting in reduced pleasure.
Central Nervous System (CNS) Suppressants
The most commonly used CNS suppressants are anti-anxiety or anti-depression medications such as Tricyclic Antidepressants or Selective Serotonin Reuptake Inhibitors (SSRIs). Examples include sertraline, paroxetine, and fluoxetine. The main purpose of these drugs is to restore a neurotransmitter imbalance in the brain, but because they can have a feeble inhibitory effect on ejaculation, they are sometimes employed as an off-label treatment for PE. Ongoing therapy is required and usefulness is often limited by a number of side-effects such as nausea, vomiting, dry mouth, drowsiness, reduced libido, and even Erectile Dysfunction. Rarer cases of serious complications such as mania, withdrawal symptoms, and harmful drug interactions have also been associated with certain SSRIs.
Dietary or herbal supplements are often touted as having remarkable effects on sexual vigor and stamina. Some men may experience limited results from these supplements, but most of these treatments are not monitored by the FDA and should be taken with great care, if at all. As is true before beginning any treatments, a physician should be consulted to determine what is the best and safest option for you.