Assortment of Options to Preserve Performance and Intimacy

Erectile dysfunction has certainly come into the open — as evidenced by the fact that airways carry as many commercials for drugs to treat it as for, say, allergy relief. According to one study, more than half of men between the ages of 40 and 70 have some degree of erectile dysfunction. Surprised? Don’t be. The male erection can be tenuous indeed, and any amount of worry, stress or anxiety can interfere with what should come naturally… but often doesn’t. Other causes: Medication side effects, circulatory problems and of course, surgery from prostate cancer.

Due in part to the ubiquitous television commercials for drugs like Viagra, Levitra and Cialis, erectile dysfunction has entered the public consciousness as a common “problem” with a relatively easy solution — but a bottle of pills is not necessarily the answer.

In fact, Christopher Saigal, MD, MPH, associate professor of urology at University of California, Los Angeles, told me that the two most successful and least invasive treatments for erectile dysfunction involve neither pills nor devices. “Weight loss and exercise are very important for people with ED,” he told me. “They’ve been shown to reduce erectile dysfunction to the point where sexual performance is nearly normal in obese men.” Because of changes in the health of the blood vessels to the penis, stopping smoking is also very beneficial.


Despite a plethora of ads that try to convince us otherwise, pharmaceutical solutions, like Viagra, aren’t a slam-dunk solution. Here’s why: Viagra — and other members of the class of medications called phosphodiesterase-5 (PDE-5) inhibitors (Levitra and Cialis) — can’t be taken by those with certain health problems, including men who take nitrates. They also shouldn’t be taken with certain antiviral, antibiotic or antifungal medications, among others, and must be used with great care if you’re on a class of drugs called alpha blockers, which are used to treat a number of conditions including high blood pressure. Side effects — including vision problems, headache, flushing and indigestion — are common. Plus, the PDE-5 inhibitors don’t work for everyone.

Fortunately for those who can’t or don’t want to rely on drugs, and who choose not to lose weight and exercise more, a number of alternatives exist. I have to admit, not a single one of them sounds ideal… but something is better than nothing when compared with the alternative of unsolvable sexual dysfunction.


Also known as a VCD (vacuum constriction device), the vacuum pump is a cylinder that fits over the penis. A pumping action sucks air from the cylinder to create a vacuum, drawing blood into the penis and creating an erection. Once the penis is erect, you slide a constriction ring or band down onto the base of the penis and remove the pump. The band is left on during intercourse to keep the penis filled with blood to maintain the erection. The band can be safely left in place for up to 30 minutes.

The vacuum pump doesn’t exactly promote spontaneity, but many men find the device helpful, says Dr. Saigal. However, it can cause the penis to become numb, cold and sometimes even turn purple. Plus there may be a decrease in ejaculatory force due to the constriction band, though this isn’t dangerous and doesn’t bother most men.

In fact, many men have good things to say about this device. When used as directed, it is perfectly safe and studies show that at least half of users are satisfied with their VCD. Typical cost is $300 to $500, but many insurance policies will cover at least part of the cost.

The pump is considered an appropriate alternative to Viagra and other pharmaceutical drugs when ED is caused by diabetes, poor blood flow to the penis or surgery for cancer. It should not, however, be used without physician approval by men with a history of bleeding disorders or who are on blood thinners. Those who have sickle cell disease, leukemia or thalassemia should not use the device.


It’s a cringe-worthy concept, but apparently intracorporeal injection — a shot of an erection-producing medication directly into the penis — actually works and may in fact be the best option for certain men. Patients learn how to inject themselves with prostaglandin E, using a very small needle directly into the side or base of the penis. This usually produces an erection within five to 20 minutes.

Though it is rarely a first-choice treatment, these injections are an option for patients who don’t respond to Viagra and other oral medications. A 2003 study in the International Journal of Impotence Research reported a 68% success rate in patients who had undergone a radical prostatectomy (removal of the prostate). Nearly half the patients involved continued to use the injections long term, which speaks to the success of this method. In the study conclusion, researchers called IC injections an effective “first option” in prostatectomy patients who underwent procedures in which the nerves were not spared, and an excellent “salvage option” for patients who had no success with oral therapy. However, it can’t be used frequently — only once every three or four days. In addition, patients should vary the injection site.


A penile prosthesis, where plastic cylinders are inserted surgically inside both sides of the penis, is another option. The cylinders are attached to a reservoir (fluid supply) implanted behind the abdominal wall muscles. Finally, there’s a pump device located in the scrotum. None of this is visible. When an erection is desired, the patient presses a button, which pumps fluid from the pouch to fill the cylinders in the penis, causing it to grow erect. After ejaculation, a releasing mechanism on the pump sends the fluid back to the pouch.

Breakdowns in the device are not common, but they can and do happen. Otherwise, Dr. Saigal said, “satisfaction level with the prosthesis is quite high,” including, he told me, with the orgasm men are still able to have.


What about vitamins and herbs? Daily Health News consulting medical editor Andrew L. Rubman, ND, says B vitamins and calcium plus magnesium are helpful, since these affect neurotransmitters in the brain that affect mood.

Dr. Rubman and Dr. Saigal both urged men to avoid products positioning themselves as “herbal Viagra.” “These often contain active pharmaceutical-strength compounds that can be dangerous,” said Dr. Saigal. Dr. Rubman told me that trained naturopaths can work individually with patients to find botanical medicines that may be effective, cautioning that men should “never take anything for a medical effect without advice and oversight.”

It’s worth noting that all of the options, including those little blue pills and others of the same ilk, address the mechanics of sexual function, such as circulation and blood flow to the penis. They don’t address an important component of arousal — feelings. For that, the old-fashioned way remains the best — finding a loving and exciting partner. As one very wise person once said, “the most erogenous zone in the human body is between the ears.”