Frequently Asked Questions

The term “erectile dysfunction” generally refers to any interruption of the physiological processes that allow a man to get—and maintain—an erection. An erection happens when brain and nerve impulses respond to mental or sensory stimulation. Those organs act like switches to send a “turned-on” signal to the penis, which is full of fine and complex muscles called the corpora cavernosa. That “turned-on” signal then causes spongy muscle tissue inside the penis to relax and arteries to ramp up their blood flow to the spongy tissue. So, as blood flow increases, the penis lengthens and expands, and the veins that would ordinarily allow blood to drain back into the body close off so the blood has no choice but to stay inside the penis. Once the penis reaches its maximal size, the strong spongy tissue will hold its size and shape quite well, even as more blood flows into the penis. Like a bike pump, the penis will get bigger until it reaches it maximal size. If any of the processes leading to an erection are damaged or interrupted, a man may have difficulty in achieving or maintaining an erection. The pelvic nerves, spinal column, and brain have to work together to make sure the penis receives the “turned-on” signal. Additionally, the penis has to be in good shape to get an erection, too: its outer lining needs to be strong and smooth and its veins have to be healthy to close off blood flow when necessary. Sometimes, erectile problems stem from preexisting medical or psychological conditions. Illness or damage to neurological and vascular systems can result in erectile dysfunction. ED is often reported by patients who suffer from diabetes, kidney disease, multiple sclerosis, hormonal imbalances, or chronic alcoholism, as well as a few other diseases or disorders.

Erectile dysfunction is a problem more common among men than you may realize. In fact, most men experience it at some point in their lives. When it happens only occasionally, it’s no big deal, and probably nothing to worry about. Suffering from ED does not make you or your partner any less of a man, and it shouldn’t be a source of shame or embarrassment. However, if the inability to achieve or maintain an erection happens more than just occasionally, it may be time to consult a doctor for advice. Aaron Spitz, MD, is a Board Certified urologist with specialization in men’s sexual and reproductive health at Orange County Urology Associates in Laguna Hills, California. He treats patients with ED every day using the best, most innovative methods. He also offers a focus on overall health and wellbeing to assist in patients’ success.

Yes, there are several nonsurgical options for the treatment of erectile dysfunction. ED is typically an easily-treatable problem, and often changes in lifestyle are an effective method. Taking steps to end chronic drinking, quit smoking, or to lose weight can help. Some medications can also cause ED, so it is important to talk to your doctor. Beyond lifestyle changes, patients have a number of choices. Oral medications like Viagra have high rates of success, and even newer alternatives to Viagra are available through Dr. Aaron Spitz’s office. Injection therapy, in which medication is injected directly into the penis, is unique in that the dosage is customized to the patient’s needs. This procedure is also safe for men with different kinds of physical conditions or men for whom oral medications aren’t effective. Men can even learn to inject themselves to achieve erections. Another option for treatment is a vacuum device. An external pump is placed briefly over the penis to create a vacuum that draws blood into the penis. A constriction ring is then placed at the base of the penis to keep blood trapped there to maintain an erection. The ring can be kept in place for up to 30 minutes.

For men who don’t have much success with other treatments for erectile dysfunction, a penile implant may be the best option for sufficient sexual intercourse. Implants, or penile prostheses, are inflatable or malleable rods that are inserted into the corpora cavernosa, the complex muscles inside the penis. The patient can use a small pump, inserted into the scrotum, to fill the implant with water from a reservoir located in the pelvis until the penis is erect. The pump also allows water to transfer back out of the penis so it can become flaccid again. These implants are safe and very reliable. They offer a natural-looking, natural-feeling erection that the patient can control whenever he’d like. Most men say the implants are unnoticeable and that they’re very happy with them. The procedure has more than a 90-percent satisfaction rate among patients, and an even higher rate among their partners!

Peyronie’s disease is a condition in which plaques, or scar-like tissue, builds up along the tunica albuginea, the smooth casing inside the penis. Blood vessels and the penis’ spongy muscle tissue live inside this casing to create the pair of cylinders that act as the shaft of the penis. Ordinarily, this casing expands and can hold its size when more blood is pumped into the penis during an erection. However, for those with Peyronie’s disease, it isn’t that easy. When that scar-like tissue is distributed evenly across the penis’ shaft, an hourglass-shaped deformity occurs, and the length of the penis often shortens, too. Depending on which side of the penis is shortened, penile curvature happens. In these cases, erections are still possible, but Peyronie’s disease can directly cause erectile dysfunction in some men. The degree of curvature can make sex painful for some, though the pain associated with Peyronie’s disease usually subsides within 4-6 months. The “scar” tissue can feel like a lump in the shaft of the penis, but not always. The effects of Peyronie’s, including increased “scar” tissue and curvature, can continue to develop for up to a year and a half, and though 10-15% of patients say their conditions improve in that time frame, it is more common that Peyronie’s worsens with time.

There isn’t one simple answer to this question, unfortunately. Causes of Peyronie’s are largely unknown, but it is believed that trauma or an injury to the penis can result in the disease—even fairly minor “micro injuries” might be enough to develop Peyronie’s. These injuries can happen in ordinary sexual intercourse, sports, or accidents. When the penis sustains an injury, the elastic tissue around the corpus cavernosa can be damaged. If that tissue heals properly, the patient won’t usually experience any other symptoms, but if the tunica albuginea do not heal properly or if the healing process is interrupted, there may be scar tissue. Peyronie’s disease does not always result in erectile dysfunction, but it is possible.

Many of the treatment options for erectile dysfunction can be used for Peyronie’s, including oral medications like Viagra and Cialis, or penile injections. Sometimes, surgery to shorten the unaffected side of the penis, or to lengthen the affected side, is the best option. There is a risk of developing erectile dysfunction with corrective surgeries, but if the patient suffers from significant curvature and ED already, surgery or a penile implant might be the right decision. A newer nonsurgical treatment is Xiaflex, an FDA-approved injection that breaks down the Peyronie’s “scar” tissue because it is comprised of a collagenase, which is a chemical that breaks down collagen. It is administered over 1 to 4 treatment cycles each 6 weeks apart. It is the most potent nonsurgical treatment available. Other injections include verapamil and interferon-alpha. These injections are also administered in several cycles. They are not FDA approved but are still considered standard of care and can provide improvement. Traction devices can also alleviate Peyronie’s symptoms and help a penis return to normal. For this procedure, a traction device pulls at the penis for several hours a day to loosen the “scar” tissue in the tunica albuginea. This helps to straighten the penis. It usually takes between 4 and 6 months for this process to be effective as the “scar” tissue is very dense, but many patients have had success with this method when other methods didn’t work for them.

When testosterone production decreases in the body, it can lead to erectile dysfunction. Testosterone, generated in the testicles, is the hormone responsible for sexual development in men. It helps maintain muscle mass, stimulates bone growth and skin integrity, and keeps up red blood cell levels. But as production of this hormone slows, usually around the age of 30, erectile dysfunction can set in. In addition to erectile dysfunction, low testosterone can result in a lowered sex drive, an inability to concentrate, or depression. Over time, the body may also experience other changes, like a loss of muscle mass, increased body fat, anemia, and fragile bones, so testosterone loss does present some health risks. For men affected by testosterone loss, testosterone replacement can help. Patients with a history of prostate cancer should proceed with caution, but testosterone replacement is a safe option for most men. Testosterone loss can be the result of testicle injury, certain illnesses or medications, alcoholism, stress, or congenital disorders. There are a number of different ways to treat testosterone loss. Injections given every one or two weeks can be administered in Dr. Aaron Spitz’s office or by the patient on his own. Other patients may choose to have implants of testosterone pellets inserted into the buttocks in a minor procedure to help boost testosterone production, while other patients are prescribed oral medications in certain situations. Testosterone patches, applied every 24 hours, can also provide necessary doses of the hormone.

Generally speaking, testosterone is a safe treatment with very few side effects. It is intended for long-term use for men who do not anticipate stopping therapy. The largest side effect is that testosterone replacement can stop a man’s body from producing his own testosterone, which can also end sperm production. Luckily, this is reversible for 90% of men who experience it. It could take 6 months or a year for men to regain optimal sperm levels, but it is likely to happen. However, men who abuse testosterone or take very high doses of it are more at risk for side effects. These patients are less likely to see their ordinary sperm production return. Because testosterone is a hormone, it can affect mood and behavior. Some side effects of treatment include increased agitation or acne. Treatment can also worsen sleep apnea for some men because testosterone can enlarge the voice box. If the sleep apnea goes untreated, blood can thicken enough to cause a stroke, though this particular side effect is very rare. High levels of testosterone can also cause tenderness in the nipples or even gynecomastia. A prostate enlarged by testosterone therapy can make it difficult for some patients to urinate. While testosterone does not contribute to prostate cancer, it can allow the cancer to grow if it is already present. Testosterone therapy should be closely monitored when given to patients with a history of prostate cancer, and therapy should be avoided for men with a history of breast cancer.