Erectile Dysfunction

Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for sexual intercourse. Unfortunately, as men age ED is almost inevitable, and typically will worsen with time.

Recent studies now show almost 40% of men over the age of 40 will experience ED, and 1 in 5 Americans may experience early onset ED even in their 20s and 30s. ED can affect self-esteem, increase stress, and negatively affect sexual relationships.

Many men do not seek treatment due to embarrassment, but it is our aim to provide expert care in a confidential and supportive environment. Please call our office to schedule a consultation if ED is of specific concern to you.

Causes of ED

  • Diabetes
  • High Blood Pressure
  • High Cholesterol
  • Low Testosterone
  • Heart disease
  • Obesity
  • Peyronie’s Disease – Penile plaque with curvature
  • Neurological Disease – Parkinson’s Disease, Multiple Sclerosis
  • Substance Abuse – Alcohol, smoking
  • Medications – Beta-blockers, narcotics, anxiolytics, anti-depressants, anti-psychotics
  • Prior Pelvic Surgery
  • Sleep Disorders

Treatment Options


PDE-5 inhibitors, like Viagra or Cialis, are typically first-line treatment for men with ED. Although effective for many, others do not respond to oral medications, or some men cannot tolerate their respective side effects.

Side effects typically include headache, flushing, runny nose, back pain, and rarely prolonged painful erection or vision changes.

Typically, medication is taken 1-2 hours prior to planned intercourse. Certain meds may need to be taken on an empty stomach. Effects usually last anywhere between 8 to 36 hours. Before starting any medication, ask your physician if you heart is healthy enough for sex.

Testosterone Replacement Therapy (TRT)

A wellness panel is typically checked on initial consultation for erectile dysfunction. This panel usually will check your hormonal axis including your free and total testosterone levels.

Low testosterone, in the appropriate patient, can be replaced to help improve erectile quality, sexual performance, and sexual desire or libido. TRT can also carry other benefits, including improved energy level, and increased muscle mass and stamina.

TRT can be achieved using creams, weekly intramuscular injections, or subcutaneous long-lasting pellets. As always, talk with your urologist as there are also known risks to TRT that merit further discussion.

Wave Therapy for ED

Wave Therapy for erectile dysfunction is a new, cutting-edge treatment modality allowing for strong, spontaneous, long-lasting erections without the need for pills, injections, or invasive surgery. This is a relatively painless procedure that can be done in the office in under 10-minutes. Typically, 6 total treatments are needed to achieve the desired outcome. Results can last for months to years, maximizing a man’s (and partner’s) overall sexual satisfaction. It is also cost-effective long term as alternative treatments require continuous use of somewhat costly medication.

Wave Therapy has many other names. It can be called Low-intensity Shockwave Therapy (LIST), Low-intensity Extracorporeal Shockwave Therapy (Li-ESWT), Shockwave Therapy (SWT), or Extracorporeal Pulse Activation Therapy (EPAT). All names deliver the same effective ED treatment – don’t let the jargon confuse you.

Vacuum Erection Device (VED)

VED is a non-invasive, medical-grade device that uses suction pressure to induce blood flow to the penis. Next, a small band is placed at the base of the penis to maintain an erection for up to 30 minutes.

It is quite effective but does require training for proper use. Insurance companies will rarely cover the cost of the device, but long-term it is more cost-effective than oral medications as it is only a one-time expense. VED is a proven therapy that is of higher quality than “penile pumps” found at novelty shops.

Inflatable Penile Prosthesis (IPP)

Typically, patients opt for surgery with an inflatable penile prosthesis after failing several of the above-mentioned options. This involves major surgery with a 6-week recovery time.

It is important to note that once a patient opts for placement of an IPP, natural erections are no longer a possibility. Please discuss with our urologists if this option seems right for you, as many men note vastly improved sexual satisfaction after failing multiple other treatment options.