Erectile dysfunction (ED) is common, affecting approximately 30 million American men. There are several treatment options available that can help restore erections, including oral medications, vacuum devices, injections, penile implants, and counseling. While some treatments have potential side effects, finding an effective individualized treatment can significantly improve quality of life for men and their partners.

1. Your Treatment Options
For Erectile Dysfunction

2. Physician Presenter Disclaimer
• Products, services or therapies discussed in this presentation may
be subject to regulatory approval/ clearance and therefore labeling
may change. Opinions given during this presentation are my
personal, professional opinion.
(Note to physician: Review disclaimer and insert appropriate language
and/or content changes to fit your individual circumstances)

3. Erectile Dysfunction
What is Erectile Dysfunction (ED)?

4. Erectile Dysfunction
What is it?
• The persistent inability to achieve or maintain an erection firm
enough to have sexual intercourse
How prevalent is it?
• Approximately 1 in 5 American men ≥ 20 years old1
• Approximately 30 million American men2
1. Selvin E, Burnett A, Platz E. Prevalence and risk factors for erectile dysfunction in the U.S. Am Jour of Med 2007 (120) 151-157.
2. National Institutes of Health (NIH) website. http://kidney.niddk.nih.gov/kudiseases/pubs/ED/index.aspx. Downloaded 5/14/12.

5. Main Physical Causes of ED3
3. Ridwan Shabsigh, MD, Tom F. Lue, MD. A Clinician’s Guide to ED Management. New York: Haymarket Media Inc.; 2006.
Vascular
Diabetes
Vascular
40%
30%
6%
5%
3% 1%
Vascular
Diabetes
Medication
15%
Vascular
Diabetes
Medication
Pelvic Surgery
or Trauma
Endocrine Problems
Other
Neurological Causes

6. Erections and How They Work
To learn more about ED, it is important to understand how the penis
normally works. The erection process includes the following 5 stages:
1. Initial Filling
With psychological or sexual
stimulation, neurotransmitters
cause penile smooth muscles
to relax, increasing blood flow
to the corporal bodies (the 2
chambers within the shaft of
the penis).
2. Partial Erection
Penile arteries expand to
accommodate the increased
blood flow needed to elongate
and expand the penis.

7. Erections and How They Work
3. Full Erection
The increased volume of blood
within the penis is prevented
from draining, thus expanding
the penis to full erection.
4. Rigid Erection
Maximum rigidity is attained.
The glans and spongiosum (tip
of the penis and penis body)
enlarge until penile veins are
forcefully compressed. This
increases engorgement and
maintains maximum penile
rigidity. Release of semen
(ejaculation) occurs.
5. Return to Flaccid
State
Muscle contractions
result in increased
blood outflow from the
penis, thus decreasing
penile length and girth
until flaccid.

8. Erectile Restoration
Treatment Options
* The information provided in this presentation provides an overview of several different treatment options. Please keep in mind
that the studies used to evaluate each treatment option may have included different types of patients, been studied over different
periods of time, or included different outcome measures.

9. Oral Prescriptions4-5
There are a number of prescription
medications available that may improve blood
flow to the penis. Combined with sexual
stimulation, this can produce an erection.
4. Carson, Culley C. "Sildenafil: First in the Therapeutic Class of Phosphodiesterase Type 5 Inhibitors" Textbook of Erectile Dysfunction. 2nd ed. New York: Informa Healthcare, 2009. 231-35.
5. Evaluation and Management of Erectile Dysfunction. www.expertconsultbook.com/expertconsult/b/book.do?method=display. Website. Downloaded October 8, 2013.

10. Oral Prescriptions4-5
• Works in response to sexual stimulation
• Usually taken within 1 hour before anticipated sexual activity
• Typically works for up to 4 hours
• Some oral medications’ efficacy can be affected by food
4. Carson, Culley C. "Sildenafil: First in the Therapeutic Class of Phosphodiesterase Type 5 Inhibitors" Textbook of Erectile Dysfunction. 2nd ed. New York: Informa Healthcare, 2009. 231-35.
5. Evaluation and Management of Erectile Dysfunction. www.expertconsultbook.com/expertconsult/b/book.do?method=display. Website. Downloaded October 8, 2013.

11. Oral Prescriptions4-5
Common Side Effects
• Headache, facial flushing, stuffy nose, upset stomach
Contraindication
• Cannot take with NITRATES
Some Cautions
• With alpha-blockers: Generally, you should be stable on your alpha-
blocker therapy before using an oral medication
• Should not use these medications if sex is inadvisable because of
cardiovascular status
Tell Your Doctor if You:
• Have ever had any heart problems, stroke or low or high blood
pressure
• Have ever had liver or kidney problems
4. Carson, Culley C. "Sildenafil: First in the Therapeutic Class of Phosphodiesterase Type 5 Inhibitors" Textbook of Erectile Dysfunction. 2nd ed. New York: Informa Healthcare, 2009. 231-35.
5. Evaluation and Management of Erectile Dysfunction. www.expertconsultbook.com/expertconsult/b/book.do?method=display. Website. Downloaded October 8, 2013.

12. Vacuum Erection Devices4
In use since the 1980s, a vacuum
erection device consists of a hollow
plastic tube, a hand or battery-
powered vacuum pump, and a
tension ring. The tube, placed over
the penis, creates a vacuum that
pulls blood into the penis. Once an
erection is achieved, an elastic
tension ring is placed at the base of
the penis to help maintain the
erection.
4. Carson, Culley C. “Vacuum systems for erectile dysfunction" Textbook of Erectile Dysfunction. 2nd ed. New York: Informa Healthcare, 2009. 291-296.

13. Vacuum Erection Devices
Most Common Side Effects6-9
• Blocked ejaculation
• Bruising of penis
• Penile discomfort
• Penile numbness or coldness
Most Common Reasons for Discontinuation8, 10
• Erections of insufficient rigidity or duration, difficult mechanics, penile
bruising
6. Hellstrom WJ, Montague DK, Moncada I, et al. Implants, mechanical devices, and vascular surgery for erectile dysfunction. J Sex Med. 2010;7(1Pt 2):501-523.
7. Brant WO, Bella AJ, Lue TF. Treatment options for erectile dysfunction. Endocrinol Metab Clin North Am. 2007;36(2): 465-479.
8. Turner LA, Althof SE, Levine SB, et al. Treating erectile dysfunction with external vacuum devices: impant upon sexual, psychological and marital functioning. J Urol. 1990;144(1):79-82.
9. Turner LA, Althof SE, Levine SB, et al. External vacuum devices in the treatment of erectile dysfunction: a one-year study of sexual and psychosocial impact. J Sex Marital Ther. 1991;17(2):81-93.
10. Derout H, Caspari D, Rhode V, et al. Treatment of erectile dysfunction with external vacuum devices. Andrologia. 1993;31(Suppl 1):89-94.

14. Intraurethral Suppositories5
In use since the 1990s, intraurethral
suppository treatment for ED uses an
applicator containing a small pellet
that is inserted into the urethra. Once
the pellet is released, it dissolves to
increase blood flow to the penis to
form an erection.
5. Evaluation and Management of Erectile Dysfunction. www.expertconsultbook.com/expertconsult/b/book.do?method=display. Website. Downloaded October 8, 2013.

15. Intraurethral Suppositories
Most Common Side Effects7
• Penile pain
• Urethral pain or burning
Most Common Reasons for Discontinuation11
• Insufficient erections suitable for intercourse
• Urethral pain and burning
7. Brant WO, Bella AJ, Lue TF. Treatment options for erectile dysfunction. Endocrinol Metab Clin North Am. 2007;36(2): 465-479.
11. Nandipati KC, Raina R, Agarwal A, et al. Erectile dysfunction following radical retropubic prostatectomy: epidemiology, pathosphysiology and pharmacological management. Drugs Aging. 2006;23(2):101-117.

16. Self-injections4
In use since the 1980s, injection
therapy uses a needle to inject
medication directly into the base or
side of the penis. These medications
can create an erection by improving
blood to flow into the penis.
4. Carson, Culley C. “Intracavernosal therapy for erectile dysfunction." Textbook of Erectile Dysfunction. 2nd ed. New York: Informa Healthcare, 2009. 281-284.

17. Self-injections
Most Common Side Effects7,11-13
• Penile pain
• Penile fibrosis
• Priapism
• Prolonged erections
Most Common Reasons for Discontinuation11,13
• Unsatisfactory erections
• Pain
• Dislike of injections
7. Brant WO, Bella AJ, Lue TF. Treatment options for erectile dysfunction. Endocrinol Metab Clin North Am. 2007;36(2): 465-479.
11. Nandipati KC, Raina R, Agarwal A, et al. Erectile dysfunction following radical retropubic prostatectomy: epidemiology, pathosphysiology and pharmacological management. Drugs Aging. 2006;23(2):101-117.
12. Wespes E, Amar E, Hatzichristou D, et al. EAU Guidelines on erectile dysfunction: an updated. Eur Urol.2006;49(5):806-815.
13. Prabhu V, Alukal JP, Laze J, et al. Long-term satisfaction and predictors of use of intracorporeal injections for post-prostatectomy erectile dysfunction. J Urol. 2013;189(1):238-242.

18. Penile Implants4-5
In use since the 1970s, a penile
implant is a medical device that is
implanted into the penis during an
outpatient surgical procedure. The
device is entirely contained within
the body. To operate the product
pictured, one squeezes and
releases the pump in the scrotum
to achieve an erection.
4. Carson, Culley C. “Mechanical, malleable, and soft semi-rigid penile implants for erectile dysfunction" Textbook of Erectile Dysfunction. 2nd ed. New York: Informa Healthcare, 2009. 323-327
5. Evaluation and Management of Erectile Dysfunction. www.expertconsultbook.com/expertconsult/b/book.do?method=display. Website. Downloaded October 8, 2013.

19. Penile Implants
Types of Penile Implants5
• 3-piece inflatable implants (pump, cylinders, reservoir)
• 2-piece inflatable implants (pump, cylinders)
• 1-piece malleable implants (cylinders)
Most Common Side Effects/Complications or Reasons for Removal5,7,11-12
• Post-operative genital pain
• Mechanical malfunction, including auto-inflation
• Infection
• Repeat surgery
5. Evaluation and Management of Erectile Dysfunction. www.expertconsultbook.com/expertconsult/b/book.do?method=display. Website. Downloaded October 8, 2013.
7. Brant WO, Bella AJ, Lue TF. Treatment options for erectile dysfunction. Endocrinol Metab Clin North Am. 2007;36(2): 465-479.
11. Nandipati KC, Raina R, Agarwal A, et al. Erectile dysfunction following radical retropubic prostatectomy: epidemiology, pathosphysiology and pharmacological management. Drugs Aging. 2006;23(2):101-117.
12. Wespes E, Amar E, Hatzichristou D, et al. EAU Guidelines on erectile dysfunction: an updated. Eur Urol.2006;49(5):806-815.

20. Insurance Coverage

21. Insurance Coverage
Fortunately, many of these treatment options are covered by insurance.
It is the responsibility of patients to ensure they understand their
individual insurance coverage and the potential out-of-pocket costs
associated with different treatment options.

22. Who Can Treat Erectile Dysfunction?
• General Practice Doctor/Family Doctor
• Urologist
– A doctor who has specialized training that focuses on the surgical and
medical diseases of the male and female urinary tract system and the
male reproductive organs
• Prosthetic Urologist
– Prosthetic urologists have specialized training and experience in implant
procedures
• Finding a satisfying solution to erectile dysfunction can be a life-
changing event for many men and their partners

23. Summary
• ED is a common problem
• There are a variety of treatment options
• Talk to your partner
• Talk to your doctor about what treatment option is right for you

24. ©2014 American Medical Systems, Inc. (“AMS”). The grant of permission to use AMS’ copyrighted materials
does not constitute endorsement by AMS of any persons, products, services, or organizations.
Questions on ED?
ED-01156(1)/July 2014