ED Treatment Options

Penile Implants

A penile implant offers a long-term solution for ED.⁴ It is an erection assistance device that is placed inside the body during an outpatient implant procedure. It allows for spontaneity and puts the man back in control of his body. Penile implants were designed to mimic the look and performance of a natural erection.⁵

For more information about penile implants, visit the Penile Implants page.

Oral Medication

Pills like Viagra^™, Cialis^™, Levitra^™, or Stendra^™ may help achieve erections in response to stimulation. They generally should be taken at least half an hour to one hour before anticipated sexual activity. Potential side effects include headaches, facial blushing, upset stomach, back pain/muscle aches, and nasal congestion.¹⁰

TM* Third party brands are property of their respective owners.

Penile Injections

A penile injection is placed into the penis to inject medication to create an erection. This produces an erection within 5-20 minutes.⁶ Potential side effects include priapism (erection lasting 4 hours or more), penile pain, numbness or irritation, bruising at the injection site, and penile fibrosis (deformed penis shape).⁷

Vacuum Erection Devices

Vacuum erection devices are external pumps placed over the penis to help with ED. The device, consisting of a cylinder and pump, creates a vacuum that pulls blood into the penis creating an erection and a constriction ring that helps maintain the erection. Patients who use vacuum erection devices may experience penile discomfort, penile numbness, and an erection that is not warm to the touch, among other potential side effects.⁹

Insertable Medication

Insertable medications are another ED solution available but are not as commonly prescribed. A small pellet (suppository) is inserted into the urethra using an applicator and the pellet is released allowing for increased blood flow, creating an erection. Erections usually start within 10 minutes and last between 30-60 minutes. Side effects can include burning and aching in the penis and groin.⁸

Titan^® and Titan^® Touch Inflatable Penile Prosthesis – Important Safety Information

A penile implant, also called a penile prosthesis, is concealed entirely within the body to address erectile dysfunction (impotence). The implant requires some degree of manipulation before and after intercourse to make the penis erect or flaccid.

Indications
The Titan and Titan Touch Inflatable Penile Prosthesis is indicated for male patients suffering from erectile dysfunction (impotence) who are considered to be candidates for implantation of a penile prosthesis.

Contraindications
The Titan and Titan Touch Inflatable Penile Prosthesis is contraindicated in patients who have one or more of the following: (1) Patients with an active infection present anywhere in the body, especially urinary tract or genital infection. (2) Patients with a documented sensitivity to silicone. (3) Patients with unresolved problems affecting urination, such as an elevated residual urine volume secondary to bladder outlet obstruction or neurogenic bladder. (4) Patients unwilling to undergo any further surgery for device revision.

Warnings
Implantation of the device may make latent natural erections, as well as other interventional treatment options, impossible. Men with diabetes or spinal cord injuries, as well as immunocompromised patients, may have an increased risk of infection associated with a prosthesis. Implantation of a penile prosthesis may result in penile shortening, curvature or scarring.

Precautions
Removal of an implanted prosthesis without timely reimplantation of a new prosthesis may complicate subsequent reimplantation or may make it impossible. MRI quality may be compromised if the area of interest is in the exact same area or relatively close to the position of the Titan, and Titan Touch IPP. Be sure to consult with your physician. Patients should discuss all available treatment options and their risks and benefits with their physician. Health conditions which hamper sexual activity, such as severe chest pain (angina), may prevent successful use of this device. The prosthesis should not be implanted in patients who lack the manual dexterity or strength necessary to operate the device. Trauma to the pelvic or abdominal areas, such as impact injuries associated with sports (e.g., bicycle riding), can result in damage of the implanted device and/or surrounding tissues. This damage may result in the malfunction of the device and may necessitate surgical correction, including replacement of the device. The device may be used in the presence of Peyronie’s Disease.

Potential Complications
Penile implants are surgical solutions requiring a healing period that have risks associated with surgery such as scrotal swelling, auto-inflation, discomfort, angulation/curvature, swelling (edema), device malfunction, chronic pain, difficulty with ejaculation, transient urinary retention, fever, migration, patient dissatisfaction, infection at surgical site or wound, deflation, swelling of clotted blood or clear fluid (hematoma/seroma), wound leakage, bleeding, delayed wound healing, narrowing of the opening of the foreskin (phimosis), sensory loss, cylinder malfunction, formation of thick tissue (fibrous capsule formation), over/under inflation, erosion, scrotal reddening (erythema), genital change, and inguinal hernia.

This treatment is prescribed by your physician. Discuss the treatment options with your physician to understand the risks and benefits of the various options to determine if a penile implant is right for you.

Caution: Federal law (USA) restricts this device to sale by or on the order of a physician.

References

1. Definition & Facts for Erectile Dysfunction. NIH: National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/definition-facts. Accessed March 2023.
2. Burnett AL, Nehra A, Breau RH, Culkin DJ, Faraday MM, Hakim LS, Heidelbaugh J, Khera M, McVary KT, Miner MM, Nelson CJ, Sadeghi-Nejad H, Seftel AD, Shindel AW. Erectile Dysfunction: AUA Guideline. J Urol. 2018 Sep;200(3):633-641.
3. Treatment for Erectile Dysfunction. NIH: National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/treatment. Accessed March 2023.
4. Miller LE, Khera M, Bhattacharyya S, Patel M, Nitschelm K, Burnett AL. Long-Term Survival Rates of Inflatable Penile Prostheses: Systematic Review and Meta-Analysis. Urology. 2022 Aug;166:6-10.
5. Data on file at Coloplast
6. CAVERJECT^® IMPULSE Medication Guide. ©2022 Pfizer Inc.
7. CAVERJECT^® IMPULSE What are the causes of and treatments for ED? ©2022 Pfizer Inc.
8. MUSE^™ (alprostadil) urethral suppository IFU. Meda Pharmaceuticals, Inc. Revised April 2018.
9. Yuan J, et al. Vacuum therapy in erectile dysfunction – science and clinical evidence. International Journal of Impotence Research. 2010; 12: 211-219
10. Cialis.^™ Highlights of Prescribing information. Lily USA, LLC. Revised February 2018.

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