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Curing erectile dysfunction: From therapy to surgery
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Curing erectile dysfunction: From therapy to surgery

Dr Karthikeyan V S recounts two cases of erectile dysfunction in which medical therapy and penile implant surgery helped couples to consummate

Erectile dysfunction (ED) is a condition in which the person is unable to get or maintain an erection. Dr VS Karthikeyan discusses two instances of erectile dysfunction where counselling, medical treatment and penile implant surgery helped couples to consummate.

ED is a common medical problem, according to a 2002 article published by the Boston University School of Medicine (Sexual Medicine). It is seen mostly in men above 40 with mild to severe complications, the article says. Also, about 5% to 10% younger men (below the age of 40) have issues of ED.

Reducing stress, weight and counselling helped this man overcome his ED

A couple (35-years-old husband and 22-years-old wife) has been married for three years but have been living together for only one and a half years as the wife used to work in another city. She quit her job to spend more time with her family. The issue with this couple was that the husband was not able to have good erections during sexual intercourse.

When I asked the wife about this, she said that her husband did not want to have an intimate relationship with her even when she wanted to. The husband told me during his consultation that he had good erections and that there was no problem in getting an erection earlier. However, when recalling his condition, he said that he had not been able to have an erection for the past one and a half years (a condition he described as Erectile Dysfunction). He also mentioned that he was stressed due to the financial burden and even when he was able to get an erection while he was masturbating, he did not feel like having sex with his wife.

We had to understand the root cause of this case; hence we started counselling the couple. Along with this, a test was performed, a diagnostic intrapenile injection test to understand the level of blood flow in the penis. In this test, we found out that blood flow to the penis was significantly reduced, so I advised the husband to make lifestyle changes and especially to reduce stress on priority. He was also obese, so I had also advised him to reduce weight. Obesity can cause diabetes, cholesterol, and heart disease, which leads to erectile dysfunction.

After these counselling sessions, medical interventions and continuous follow-ups, the husband’s confidence improved. He started having a good relationship with his wife, and his erections improved. After six months of medical therapy, the wife conceived spontaneously. This case proves that a thorough analysis of the history and identification of the root cause of the problem by appropriate testing, medical therapy, lifestyle change and counselling, can help the couple conceive naturally when the male partner has erectile dysfunction.

Penile implant surgery

A husband and wife, 32 years old and 23 years old, had been married for four years. Although they had a good relationship, the husband was having difficulty getting erections during sexual intercourse (Erectile Dysfunction). He did not have any health issues and was not addicted to alcohol or smoking. The couple had consulted several doctors and tried various treatments for erectile dysfunction, including shockwave therapy (which involves using a wand-like device to stimulate the penile tissue and increase blood flow which helps with erections) and P-shot therapy (injecting tissues or cells into the penis to treat erectile dysfunction).

The couple came to see me four months ago and after a long discussion, we did the following test: Intracavernous injection test (to determine the blood flow to the penis) and Penile Doppler Ultrasound (procedure that shows blood flow into and out of the penis), both of which showed that the blood flow to the penis was poor.

Since the couple was young and wanted to improve their intimate life, we started by talking to them about self-intravenous injections and trimix (a mixture of three drugs) which relaxes muscles and opens blood vessels in penis leading to erection. We further tested trimix where blood flow was bad. We also used a vacuum erection device, but no improvement was seen. Based on his findings, I counselled him for the penile implant operation.

Penile implant surgery involves placement of silicone implants and the penis becomes hard, resulting in a rigid erection. This is done in case of failure of medical therapy and when none of the other options work. Penile implants are the best and most effective means of improving erections. The two major types of implants are malleable and inflatable implants.

This patient decided to undergo an inflatable penile implant where we place two cylinders into both sides of penis, and we place a pump in the scrotum. The pump is connected to the reservoir kept in the abdomen. This implant gets inflated when water from the reservoir enters into the cylinders when the pump is pressed. This produces a rigid erection.

This implant consists of three pieces and is inflatable. The second type is called malleable implant which does not deflate because there is no water in this system.

A penile implant may be an option for you, especially if you are a young couple who may be able to conceive naturally. In this couple, a semen analysis and a detailed evaluation on the wife was done before the penile implant surgery and it was normal. After six months of the operation, the wife got pregnant naturally. This proves that surgery for ED can provide good results and that assisted reproduction techniques such as in-vitro fertilization (IVF) can be avoided.

As told to Steni Simon  


Dr Karthikeyan V S is microsurgical andrologist and urologist at Apollo Hospitals, Chennai. 

 

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