Many men achieve stronger erection by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine and alprostadil, widen blood vessels. These drugs may create unwanted side effects, however, including persistent erection (known as priapism) and scarring. Nitroglycerin, a muscle relaxant, can sometimes enhance erection when robbed on the penis.
A system for inserting a pellet of alprostadil into the urethra is marketed as muse. The system uses a prefilled applicator to deliver the pellet about an inch deep into the urethra. An erection will begin within 8-10 minutes and may last 30-60 minutes. The most common side effects are aching in the penis, testicles, and area between the penis and rectum, warmth or burning sensation in the urethra redness from increased blood flow to the penis, and minor urethral bleeding or spotting. Research on drugs for treating ED is expanding rapidly. Patients should ask their doctor about the latest advances.
Surgery usually has one of three goals:
- To implant a device that can cause the penis to become erect
- To reconstruct arteries to increase flow of blood to the penis
- To block off veins that allow blood to leak from the penile tissues
Implanted devices, known as prostheses, can restore erection in many men with ED. Possible problems with implants include mechanical breakdown and infection, although mechanical problems have diminished in recent years because of technological advances. Malleable implants, usually consist of paired rods, which are inserted surgically into the corpora cavernosa. The user manually adjusts the position of the penis and therefore, the rods.
Adjustment does not affect the width or length of the penis. Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid. Tubes connect the cylinders to a fluid reservoir and a pump, which are also surgically implanted. The patient inflates the cylinders bt pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis somewhat.
They also leave the penis in a more natural state when not inflated. With an inflatable implant, erection is produced by squeezing a small pump implanted in the scrotum. The pump causes fluid that flow from a reservoir residing in the lower pelvis to two cylinders residing in the penis. The cylinders expand to create the erection.
Urgery to repair arteries can reduce ED caused by obstructions that block the flow of blood. The best candidates that surgery are young men with discrete blockage of an artery because of an injury to the crotch or fracture of the pelvis. The procedure is less successful in other men with widespread blockage.
Urgery to veins that allow blood to leave the penis usually involves an opposite procedure – intentional blockage. Blocking off veins (ligation) can reduce the leakage of blood that diminishes the rigidity of the penis during erection. However, experts have raised questions about the long-term effectiveness of this procedure and it is rarely done.