Male sexual health depends on both psychological and physical factors.
Erectile dysfunction is common as men age. Risk factors include smoking, diabetes, obesity, high blood pressure, heart disease, and vascular disease. Minimizing these risk factors may encourage good erections into old age. Additional treatments may include oral pills, vacuum devices, penile injection therapy, low-intensity shockwave therapy, and surgical insertion of a penile pump.
Decreased libido may be a sign of low testosterone and can, in turn, affect erections. Testosterone replacement can sometimes improve libido and erectile function.
We offer all non-surgical treatments for erectile dysfunction. We provide counselling, teaching and supplies for men who have persistent erectile dysfunction after trying oral therapies such as Viagra, Cialis, or Levitra.
Vacuum pumps create negative pressure in the penis to draw in blood and facilitate an erection. There is some mixed evidence that regular use of a vacuum pump may improve natural erections. See additional info in the right hand column of this page. Our nurse specialist can teach you how to properly use a vacuum device free of charge. You can purchase a vacuum device from a sex shop, online, or from us. You may choose to rent a pump from us to see if you like it before purchasing one, as they are expensive.
Intracavernosal injections are self-administered injections of medication into the penis with a small needle; this method results in reliable erections in the vast majority of men. The proper method and dosing can be taught during a free private consultation with the nurse specialist at the Urology Resource Centre.
Low-Intensity Shockwave Therapy is an option for men with mild to moderate vasculogenic (as opposed to neurogenic) erectile dysfunction. This treatment involves directing pulses of sound waves to the erectile bodies of the penis to stimulate the growth of blood vessels. Treatments are painless and are typically administered weekly for 6 consecutive weeks. We use the Storz Duolith shockwave device, a state of the art focused shockwave generator. This treatment is not covered by OHIP.
Surgery for erectile dysfunction is considered a "last resort" but is a good option in many men who have failed other treatments. We do not pereform this surgery but will be happy to refer you to a specialist who offers this surgery if appropriate. Unfortunately, wait times can be very long for this surgery in Canada.
Peyronie's Disease (PD) is a poorly understood disorder in which scar tissue develops in the penile shaft leading to curved erections. Many men with PD also develop erectile dysfunction. If curvature is bothersome, we recommend using a special penis traction device. The best device is called "Restorex" and can be purchased online from the US. It is not cheap. There are Restorex instructional videos on YouTube. There is conflicting evidence regarding whether shockwave therapy may be helpful with some studies suggesting a benefit, particularly if administered early in the course of the disease. In the past, we offered Xiaflex (medicine injected into the penis scar tissue, or plaque); unfortunately this is no longer available in Canada. Surgery is a last resort, as there are considerable risks, and is usually reserved for severe curvatures. If PD is associated with erectile dysfunction, we can offer additional treatment directed at strengthening erections, as discussed above.
We recommend all men with sexual health concerns consider reaching out to a sexual health counsellor or psychologist. This can help patients and their partners cope with the emotional distress that often accompanies ED. Furthermore, some patients have a major "psychogenic" component to their ED (ie: "performance anxiety"); counselling is the best treatment for this form of ED.