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Erectile Dysfunction Treatments in Rockville Maryland

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What is ED?

Erectile dysfunction (ED) is the inability to get and keep an erection firm enough for sexual intercourse, also known as impotence. ED is not considered normal at any age and may be associated with other problems that interfere with sexual intercourse, such as lack of desire and problems with orgasm and ejaculation (Cleveland Clinic).
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What is an erection?

This is the hardening of the penis allowing a man to perform sexual intercourse. A penis has two chambers inside called the corpora cavernosa. These chambers extend from the head of your penis deep into the pelvis. The insides of these chambers are made of spongy tissue and can gain blood volume and grow in size. Once a male becomes aroused, their brain sends signals to trigger a hormonal response that allows those same arteries to open and allow blood in. The veins get compressed, trapping blood in a man’s penis.

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What are the signs a person might have an issue with ED?

Several factors play a key role in contributing and/or causing ED. Ongoing ED can be caused by, risk factors (that the male participates in), age, diagnosis of certain ailments, and psychological reasons (Mayo Clinic).

Risk factors

Specifically, medical conditions, particularly diabetes or heart conditions. Consistent tobacco use, obesity, specific medical treatments (prostate surgery or radiation), medications, drug, and alcohol use. Medical professionals will recommend patients who are participating in one or more of these risk factors, start exercising more, eating healthy, give up drugs, stop heavy drinking and smoking.

Disease

High cholesterol
A high level of low-density lipoprotein (LDL, or “bad”) cholesterol can lead to atherosclerosis.
Diabetes
Men who have diabetes are at high risk of erectile dysfunction and heart disease.
High blood pressure
Over time, high blood pressure damages the lining of your arteries and accelerates the process of vascular disease. Certain high blood pressure medications, such as thiazide diuretics, can also affect sexual function.
Low testosterone
Men with low testosterone have higher rates of erectile dysfunction and cardiovascular disease than do men with normal testosterone levels. It is helpful to note, natural testosterone production begins to decrease around age 40, about 10% of men ages 40 to 60 have low testosterone, and about 20% have it after age 60, common causes include fatigue and depression, low or diminished sex drive is a frequent indicator of low testosterone (Urology Austin)
Vitamin D Deficiency
Vitamin D and L-arginine deficiency might be associated with male ED separately or equally, especially in individuals with underlying endothelial dysfunction. Moreover, the blood concentrations of vitamin D and L-arginine should be analyzed in men with symptoms of ED. (Middle East Fertility Society Journal)

Age

About 40% of men are affected by erectile dysfunction at age 40, and nearly 70% of men are affected by ED by the time they turn 70 (eMedicine Health)

Medications

Some medications aimed to help patients with certain diseases can be dangerous for people getting other treatments for ED.  Patients that are taking medications for low/high blood pressure, take nitrate drugs, and/or are on dialysis, should talk to a medical professional to keep them safe.

Psychological factors

Mental issues can affect men and contribute to ED, some of those issues are depression, anxiety or other mental health conditions, ongoing stress, relationship problems due to stress, poor communication, and/or other concerns.

Deformities of the penis

The most common is Peyronie’s disease which is the development of scar tissue inside the penis.

Common Tests for ED

To better understand what might be causing ED, medical professionals will try to rule out certain conditions related to penial deformities and common issues. The standard tests are:

Combined Intracavernous Injection and Stimulation (CIS) Test

This is the simplest, and most commonly used test for evaluating and diagnosing ED. It uses penile injections, visual or manual sexual stimulation, and a subsequent erection.

Color Doppler Ultrasound

This test uses harmless, non-invasive sound waves to produce a picture of the penile arteries, which enables experts to evaluate the arteries’ functions.

Pharmacologic Cavernosometry and Cavernosography

These tests evaluate penile veins and help identify any venous leakages (UCSF Health).

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Age and ED

Age plays a huge factor in ED.  It is estimated that by the time a man is in his 40’s, he has about a 40% chance of having some form of ED, and this prevalence increases about 10% per decade thereafter. It turns out that the most common cause of ED, regardless of the patient’s age, is due to a problem (and aging) with the vascular system of the penis (NCBI).

ED vs Similar conditions:

Low Testosterone

Low Testosterone means the testicles are not producing enough of the male hormone testosterone (Urology Austin).  Though, there is a correlation between low testosterone and ED it’s not always a conclusive reason for specifically causing ED.

Peyronie's disease

This disease is a noncancerous condition resulting from fibrous scar tissue that develops on the penis and causes curved, painful erections (Mayo Clinic).

Specific treatments for ED

Once a patient has sought out medical attention for ED, it is a good idea to pick a treatment that works best with their body and lifestyle choices. The options are varied but not all treatments are created equal. Common treatments doctors might recommend are: oral medications, Shockwave Therapy, seeing a psychologist, and/or pumps/surgery/implants.
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Oral medications for Erectile Dysfunction

Some of the common oral treatments are Sildenafil (Viagra), Tadalafil (Adcirca, Cialis), Vardenafil (Levitra, Staxyn), Avanafil (Stendra). These effects enhance the effects of nitrate — a natural chemical your body produces that relaxes muscles in the penis (Mayo Clinic). Here is more information on contemporary drug delivery options used in the treatment of ED and highlights for the future in promising pharmacological developments (Taylor and Francis Group, 2020).

Seeing a psychologist: Mental Health Solutions for ED

Some common causes of ED can be anxiety, depression, or low self-esteem. To alleviate these issues, medical professionals might suggest seeing a therapist, counselor, and/or psychologist. Psychological treatment [ED] is most likely to be helpful for men who:
  • Have an erect penis when they wake up in the morning.
  • Can get a firm erection when masturbating.
  • Have gone through a stressful major life event, such as divorce, separation, death of a loved one, change in job, or moving.
  • Grew up in an environment where sex and sexuality were considered negative, wrong, or "bad," or who were sexually or physically abused as a child.
  • Lost their mother or father during early childhood.
  • Have a history of serious relationship problems.
  • Have a history of anxiety disorders or physical problems that have a psychological component (such as irritable bowel syndrome, migraines, asthma, or nervous bladder) (University of Michigan Medicine).

Invasive Treatments for ED: Pumps/surgery/implants

Patients that aren’t candidates for other treatments (above) might ask a medical professional about penis pumps, surgery or implants. These treatments are usually recommended for people with penial deformities or scar tissue.

Shockwave Therapy for ED

Low-intensity extracorporeal shock wave therapy (LI-ESWT) is a novel modality that has recently been developed for treating erectile dysfunction (ED) (NCBI). Published meta-analyses have shown significant improvement in International Index of Erectile Function—erectile function domain scores in men undergoing Li-ESWT, especially when compared to men receiving sham treatment (Science Direct, 2018)

Shockwave Therapy

One of the treatments Dr. Jennifer Miller highly recommends for a lot of her ED patients is Shockwave Therapy. As mentioned above, this therapy uses noninvasive low-intensity Extracorporeal Shockwave Therapy. This therapy will boost blood flow and eventually create stem cells to the penis. There are many Shockwave Therapy models on the market that claim to “cure” ED. Dr. Jennifer Miller recommends the use of Shockwave therapy with the specific characteristics:

“Energy”

Shockwave Therapy devices that work address the root causes and treatment of ED have an “energy” greater than .22 mj/mm2

FDA Approved

Patients should look for FDA and clinical trial approvals for all therapies. For higher quality, more consistent, treatment-producing devices.

Clinical Use

At-home devices are typically self-guided, therefore the user isn’t granted the benefits of working with a trained experienced medical professional. Since there is a lack of medical supervision, these devices tend to have specific limitations, making it difficult for the user to have consistent, effective results compared to clinic-based therapies.
The Phoenix
This an “FDA, Patented” at-home “Acoustic Wave Therapy” device used to treat ED. We do know that at-home devices like the Phoenix are typically self-guided, therefore the user isn’t given the benefits of working with a trained experienced medical professional, that can administer the device properly. Since there is a lack of medical supervision, these devices tend to have specific limitations, making it difficult for the user to have consistent, effective results compared to clinic-based therapies.
“Wave” technologies
Some devices claim different wave technologies like Acoustic Wave to Sound Wave and Swiss Wave. Patients should be cognizant that many of these devices and technologies, lack medical evidence, research and are not capable of offering quantifiable, demonstrable results.
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Common Myths and Misconceptions

Myth: ED is a single problem

Fact: ED is complicated. Most of the time ED is one of many problems a patient might have and they all will need to be addressed to treat ED effectively.

Myth: Erectile dysfunction is an older man’s problem

Fact: 15% of the male population under the age of 40 say they experience ED on at least an occasional basis. Although age factors into ED its not going to be the only factor a medical professional considers (Urosurgery Houston).

Myth: Erectile dysfunction is largely psychological

Fact: Medical professionals expect that anxiety and/or distress can occur when experiencing ED but its not normally the only cause. Typical it’s because the penis’ blood flow is constricted (caused by possible disease)

Myth: You need surgery to treat Erectile dysfunction

Fact: Under rare and severe circumstances, it might be required to conduct invasive surgery for a patient’s ED. Sexual health specialists like Dr Miller can diagnose and treat many ED cases without surgery.

What is the Cost for ED Treatment

The cost of the treatment will vary between each patient. Shockwave Therapy normally last 15 minutes long (per session), once a week for six weeks. Be aware, this treatment might be out of pocket as most insurance companies determine these treatments (sometimes) to be an elective procedure like LASIK eye surgery or cosmetic surgery and subsequently might not cover the cost. Dr. Jennifer Miller offers all patients a free consultation to determine the specific treatment for each patient.
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What are some research treatments/articles?

Effect of Physical Exercise Combined with Shockwave Therapy on Erectile Dysfunction in Diabetic Patients

Effect of Physical Exercise Combined with Shockwave Therapy on Erectile Dysfunction in Diabetic Patients (Archives of Medical Sciences)

The benefits of LI-ESWT therapy in organic erectile dysfunction with chronic renal failure: a case report (2020)

THE BENEFITS OF LI-ESWT THERAPY IN ORGANIC ERECTILE DYSFUNCTION WITH CHRONIC RENAL FAILURE: A CASE REPORT (Jumbai Medical Journal, 2020)

Penile low intensity shock wave treatment for PDE5I refractory erectile dysfunction: a randomized double‑blind sham‑controlled clinical trial

This study showed that penile electromagnetic shockwave therapy may improve erectile function, to a modest extent, on certain patients that do not respond to PDE5I; making it an alternative for vascular ED patients that reject more invasive (World Journal of Urology (2020)

Prevalence of Low Testosterone According to Health Behavior in Older Adults Men

high-frequency strength exercise and smoking cessation lower the prevalence of low testosterone, and obesity and low muscle mass increase the prevalence of low testosterone (MDPI, 2021)

Statistics

40% of men are affected by erectile dysfunction at age 40, and nearly 70% of men are affected by ED by the time they turn 70 (eMedicine Health)
15% of the male population under the age of 40 say they experience ED on at least an occasional basis.
1 in 10 Men: Estimates suggest that one of every 10 men will suffer from ED at some point during his lifetime (Cleveland Clinic).
The SARS-Cov-2 infection does not seem to positively influence the appearance of ED (International Journal of Advanced Studies in Sexology)

Summary

Patients with ED can go through many obstacles diagnosing and treating ED.  The treatments are diverse but they might not all produce successful results for each patient. Each patient should look for certain treatments with a doctor’s recommendation. 

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