In this video today. we are going to talk about  treatment options for erectile dysfunction  

in addition to medications which I've previously  covered if you're new here I'm Dr. Rena Malik,  

urologist and pelvic surgeon, and I'm so happy to  have you here, I cannot believe we are nearly at  

one million subscribers so please if you like what  you see here share this channel with your friends  

make sure they subscribe and help everyone get a  little bit more knowledgeable about their urologic  

and sexual health I want to give a special  shout out to bluechew for sponsoring this video.  

erectile dysfunction is defined as the inability  to have penetrative intercourse and affects about  

half of men over the age of 52 but the  questions that most of my patients ask  

is why do people even get erectile dysfunction  well the number one cause is due to vascular  

problems and that includes issues like high  blood pressure high cholesterol lack of exercise  

and smoking another 30 comes from diabetes over  half of men with diabetes will develop erectile  

dysfunction in fact having the disorder itself  increases your risk by three and a half times and  

the longer you have diabetes the more likely you  are to develop erectile dysfunction that's because  

diabetes affects the blood flow and the nerves to  the penis both of which are extremely important  

for erections medications contribute to another  15 and that includes most commonly medications  

for blood pressure specifically those that  are called thiazides or beta blockers like  

metoprolol which is very commonly prescribed  also medications for depression specifically  

ssris or serotonin selective reuptake inhibitors  commonly cause issues with erections other smaller  

causes of erectile dysfunction include neurologic  causes specifically things that affect the nerve  

function to the penis that can include spinal  cord injury multiple sclerosis or other neurologic  

conditions another five percent comes from pelvic  surgeries like prostatectomy or other surgeries  

that happen in the lower part of the abdomen where  the nerves course that go to the penis and lastly  

a very small percent about three percent are  due to hormonal causes like low testosterone  

low thyroid or issues with your pituitary gland  so when you develop issues of erectile dysfunction  

you should go see your primary care doctor and  urologist particularly you should be screened  

by your primary care doctor for cardiac disease  risk factors because erectile dysfunction can be  

the first sign of heart disease and so if you want  to learn more about that check out my video that i  

made before about how erections can be the first  sign of heart disease when you see your doctor to  

talk about your issues with erections they'll  get a history from you they'll ask a lot of  

questions about your experience with erections  in the past if this has been gradual or sudden  

if you've had any trauma recently as well as a  physical examination to really any other physical  

causes that might be contributing and often with  that we'll also get an early morning testosterone  

blood draw to make sure that you don't have any  hormonal causes like low testosterone based on  

the history and physical examination we can rule  out things like psychogenic causes or factors  

that may be associated with your thoughts around  performance anxiety that might be contributing  

to erectile dysfunction that are best treated by a  sexual therapist or psychologist another test that  

some people might offer is a penile doppler test  and this test looks at the blood flow to the penis  

however very often it doesn't change  management what it does do is it allows  

us to provide reassurance for patients who might  have psychological causes of erectile dysfunction  

and most commonly it's used for young men who've  had some sort of trauma and had a sudden onset of  

erectile dysfunction to identify areas that  may have developed an abnormality called an  

arteriovenous fistula and the reason there's  not a whole lot of other diagnostic testing  

is because the treatment essentially is almost  always the same unless you've had a trauma and  

you might benefit from a very selective surgery  which is extremely rare then the treatment as i  

mentioned is always the same so we start with  lifestyle changes so what can you do sitting  

at home to help improve your erections so if you  think about things that can help your erections  

well anything that's good for your heart  is also going to be good for your erections  

the most study type of dietary changes are the  mediterranean diet which is diet high in fresh  

produce fish and polyunsaturated oils like olive  oil you want to avoid processed foods anything  

that comes in a box really saturated fats dairy  and red meat and in studies they've shown that  

having a mediterranean diet has improved erectile  dysfunction or slowed the rate of decline in  

strength of erections exercise is also a great way  to help improve erections multiple studies have  

proven this and you want to ideally aim for 60  minutes three times a week now you can break that  

up as much as you want you can do 10 minutes in  the morning 10 minutes in the afternoon 10 minutes  

later and you can do it over the course of the  seven days so it doesn't have to be a big ordeal  

it doesn't have to be all at once lastly if you  are on some of the medications that might cause  

erectile dysfunction we'll put up a list right  here you can talk to your doctor about trying to  

switch to either another hypertensive medication  for high blood pressure or another medication for  

depression that might have less side effects for  erections and lastly very simply quit smoking if  

you are because that's not going to help your  erections and if you're having alcohol on a  

chronic basis meaning daily with large amounts  try to limit that or decrease that significantly  

because that will also help with your erections  a lot of you ask if there's any supplements or  

herbal medications that can help well there's some  major issues here is one we don't know exactly  

what is in the supplements they're unregulated and  the ingredients and dosages listed on the bottle  

may not be what's actually in the supplement and  sometimes they're even contaminated with other  

medications medications that we already use for  erectile dysfunction like tidal fill or sildenafil  

or heavy metals interestingly the placebo effect  which is when you take a pill that you think is  

going to improve your erections is quite high in  studies for erectile dysfunction that's why we do  

randomize controlled trials because when you take  something and you think it's going to improve your  

erections it actually does by up to 30 percent and  so when you see people saying they've had these  

great results with certain supplements well a lot  of it can be from that placebo effect let's move  

on to medical treatment so i talked a lot about  medical treatment in my last video comparing to  

dalophil and sildenafil so go check that one out  i talk all about how our body makes erections and  

how exactly these medications work to help improve  erections if you hate going to the doctor or you  

can't swallow pills there's a super convenient  option available to you called bluetooth it's  

an entire service it's so so easy first step is  you fill out a medical form online and within two  

days it's reviewed by the blue chew team you're  connected to a licensed medical professional right  

on the platform no extra software is needed then  if you meet criteria for treatment with medication  

you'll receive a prescription of specially  compounded sildenafil and todalophil in chewable  

form these are made by specialized licensed  compounding pharmacies and delivered direct  

to your door in discrete packaging just like this  it's delivered right to your door for as little as  

twenty dollars a month blue chew is available in  all of the united states except for north dakota  

and south carolina and to top it up they have  great 24 7 customer service if you're interested  

in trying blue chew make sure you check out the  link in the description below as well as the  

coupon code for a free one month trial of 20 off  your first prescription of blue chew okay outside  

of medications there are actually other options  that can help treat erections and i'm going  

to talk about a few of them in this video the  first one is called an intraurethral suppository  

this uses a medication called prostaglandin which  after you insert it inside the urethra it diffuses  

across the urethra to get into the corporal tissue  or the erectile tissue of the penis this increases  

the amount of cyclic adenosine monophosphate this  is very similar to cgmp that i talked about in my  

last video about suldenophyll and tadallophil  essentially it increases the smooth muscle  

relaxation within the penis to allow erections  to last longer it comes in multiple doses from  

125 micrograms up to a thousand micrograms it's  recommended to urinate before you administer it  

and once you put it in the urethra do it standing  and then massage the penis to help absorb the  

agent into the tissues the side effects for this  include 32 percent of people complain of penile  

pain 12 complain of some burning pain in the  urethra and about five to six percent complain  

of minor bleeding or pain testicular pain or their  female partners may have some vaginal discomfort  

and in a very small percentage about two percent  will get dizziness because this medication can  

cause a drop in your blood pressure and lastly  make sure that if your partner's pregnant that  

you do not use this because the prostaglandin in  the medication can transfer to your partner and  

induce premature labor another option is a vacuum  erection device and i'm going to make a dedicated  

video about this later but let me know if you've  used one before in the comments below and how  

well it worked for you and the last non-surgical  option is an intracavernosal injection these are  

probably the most effective option for erectile  dysfunction and this is usually a mix of one to  

three different pharmacologic agents that are  injected directly into the penis and yes this  

sounds super scary but the needle is really tiny  a lot of times when patients do the injection the  

first time they'll actually look at me and say oh  that's it that's all it was so really it's not as  

bad as it sounds it's a lot of fear and anxiety  because of course it's injecting something into  

your penis but it works very very well and how it  works is it relaxes the smooth muscle of the penis  

and increases blood flow to the penis to help  improve erections as i mentioned they come in  

one to three agents combined the ones that are  a single agent are typically prostaglandin e1  

these are exactly the same mechanism of action  as the medication that's in the intra-urethral  

suppository we just talked about another agent  that's used or medication that's used in the  

injection is called papaverin and this works very  similar to the medications sildenafil and tadalpha  

and other phosphodiesterase inhibitors because it  has the exact same mechanism it's a non-specific  

phosphodiesterase inhibitor phantolamine  is the last agent and how that works is it  

relaxes blood vessels to allow increased blood  flow the agents usually are called biomix when  

they have two agents or tri-mix when they have  three agents we typically recommend the first  

dose is done in the office so that you learn how  to do it and you can see if you have a response  

the efficacy of these is very very high as i  mentioned up to 80 to 85 percent of people will  

see a response with this however there are some  side effects 50 of men who use the single agent  

of prostaglandin e1 which is called cava reject  or edex most commonly as a brand name will report  

some penile pain however that can be fixed by  switching to a bi-mix or a tri-mix formulation  

three percent of people may notice some nodules  on the penis where they're doing the injection  

after using it for greater than 18 months two  percent will see some bruising and eccomosis and  

three percent can have what's called a hematoma or  bleeding underneath the skin of the penis and one  

to two percent will have headaches or dizziness  the most serious complication that we worry about  

is called a priapism or an erection that lasts  longer than four hours i've talked about this  

previously so check out some of my other videos  where i talk about priapism or what to do when you  

get an erection that won't go away ultimately  if you've tried all these options or some of  

these options and you're still not having success  there are other surgical options available namely  

penile prostheses and i've made a couple videos  about these so check those out for now and if  

you want a more in-depth video about the different  types of penile prostheses comment below and i'll  

make one of those as well as always i'm going to  take care of yourself because you are worth it