The drug a couple chooses may depend on age, he said. Studies of couples and their sexual behaviors have revealed that “most couples, as they get older, actually have more regimented sexual behaviors. They usually have sex once, maybe twice during a full weekend.”
For them, spontaneity may not be as important. For younger couples, who have sex more often, “Cialis may be the best option for them.”
Side affects of all the drugs include headaches, flushing and a drop in blood pressure. Cialis may also cause back pain.
Men with heart problems and some other health conditions cannot take the pills, Kava said. The drugs can be fatal for men taking nitroglycerine or any nitrates, he said.
And for some men the pills don’t work, Hakim said.
“They are not magic pills,” he said. “Depending on the severity of the erection problems those pills will be less successful as it becomes more severe.”
The next level of treatment includes injections and vacuum pumps, both of which can be effective. While the thought of injections is less than appealing to most men, the results are excellent, Kava said. Patients are taught to perform the injections.
“I will tell you from thousands of patients, once they get the hang of it, the erection is of such high quality that many people continue to use the injectables. It’s a very natural feeling erection. It doesn’t hurt, and very rarely do we have anybody have any side effects.”
Though rare, one risk of injections and some drugs is prolonged erection or priapism, an erection lasting more than four hours, he said. “It can cause severe and irreversible damage to the inside of the penis,’’ Kava said.
If pill and external treatments are not effective, doctors say an internal prosthetic device is an option.
“It gives them the spontaneity and quality of erection that they can’t get with many of the other treatments,” Hakim said, including pills, injections or vacuum pump. “Internal devices or a penile prosthesis are effective continuously on demand, which means a man and his partner can achieve a full erection on demand and within seconds that contains itself as long as they want to have sex.”
While these surgeries have been performed since the 1950s, he said, improvements in surgical technique and devices are dramatic.
The 30-minute procedure is minimally invasive, and requires only a 24-hour hospital stay. Men may experience some discomfort for days or a couple of weeks, doctors say.
“Once they get beyond that period of time, and they start working with the device, they forget about the pain,” Kava said. “It’s a really satisfactory device as far as patients and their partners go.”
“They have by far the best satisfaction rate for any treatment for erection problems, up into the 99 percent range,” Hakim said. “We see men every day with problems with prostate surgery or have had other significant medical problems who just can’t function … and you’re basically fixing that, giving them their life back.”