A new kind of penis pump called Penomet helps a man achieve a hard enough erection for sustained intercourse. Another man uses oral medications that didn’t exist until recently.
Treatment of impotence is in a revolutionary period. Several excellent options exist, and numerous researchers are investigating new medications. Men and their partners can almost be assured to find one method successful and acceptable for them.
* Penile implants
Surgical implantation began in 1966. It was the more popular option for individuals with SCI before discovery of penile injections or vacuum devices. The surgical procedure involves inserting an implant directly into erectile tissues. The three types of implants are malleable or positionable rods, fully inflatable devices, and self-contained inflatables.
Newer implants are reliable but destroy erectile tissues. The devices are bent or pumped into position. Erection lasts until the device is unbent or drained. Generally a four-to-eight-week postoperative recovery period is necessary before the prosthesis may be used for sexual activity.
Implants have a risk of mechanical breakdown as well as a danger that they could push out through the skin. Individuals with SCI usually do not have good genital-area sensation. They would not experience pain to indicate the implant has broken through the skin.
All surgical implants carry a risk (approximately 2-5%) of infection. If an infection develops, prosthesis removal may result.
Penile implants are the most expensive option. Some health-insurance plans want men to try the lesser invasive options first. These devices help men achieve erections, but the treatments are not recommended until other methods have been considered or tried.
* Penile Injection
In 1995, Caverject (alprostadil) became the first FDA-approved penile-injection drug. It is effective for more than 60% of the men who try it. Injected 10 to 15 minutes before sex, it is usable up to three times a week but never more than once in a 24-hour period. An erection usually lasts 30-60 minutes.
Alprostadil’s most common side effect is mild to moderate pain after injection. About one third of all patients using the drug reported such pain, although only 3% discontinued use for this reason.
Doctors determine the proper dose of Caverject. It is essential that physicians or nurses teach proper use.
FDA approved Edex, a slightly different formulation of alprostadil, in 1997. It is less expensive than Caverject and is injected with a smaller needle. Users inject it ten minutes before sex; erections can last more than one hour.
Sometime this year, FDA will evaluate another injectable medication, Invicorp. It consists of the protein VIP and phentolamine, which help relax smooth-muscle tissue. It may be more effective than alprostadil and is not expected to cause the pain associated with Caverject and Edex.
* Transurethral therapy
A relatively new product approved in 1997, alprostadil is administered by means of a small applicator that delivers a soft, tiny, medicated pellet to the urethra [the opening at the end of the penis]. The urethra absorbs the drug and distributes it to the surrounding erectile tissues. This causes blood vessels to relax and allows the penis to fill with blood. Erections begin approximately ten minutes after the pill’s insertion.
* Penis Pumps
A mechanical, nonsurgical method of producing penile engorgement and rigidity sufficient for intercourse in most individuals, penis pumps employ the principle of negative pressure. Air pumped out of the penis pump causes blood to be drawn into erectile tissues. Erections are maintained by placing constriction (tension) rings around the penis’s base. (The rings also can prevent urinary leakage that may occur in someone who has not emptied his bladder before sexual activity or anyone who has a reflex bladder.)
Tension bands may remain in place for up to 30 minutes; men may use penis pumps daily. This technique is generally easy to learn, and the majority of users feel comfortable after 7-14 practice sessions.
Most of these systems, such as the Penomet penis pump (https://www.penometreviewpump.com), come with an instructional videotape and manual, a return option, and toll-free customer-assistance. A few companies will send representatives to meet with you at your doctor’s office if you experience.
Although vacuum devices are the safest and least invasive treatment option, some people think the devices are clumsy and cumbersome. However, these systems continue to be a popular treatment option with few if any side effects.
* Venous flow constriction therapy
This treatment may be helpful for men who achieve good reflex erections but are unable to sustain them for any reasonable period of time. This therapy consists of bands of various designs and materials that are placed around the erect penis’s base.
The bands are designed to slow down blood flowing out of the penis. They can be easy to use, comfortable, and fully adjustable.
* Professional counseling
Establishing a healthy sexual relationship may require professional help. Couples or individuals can learn effective ways to communicate feelings.
Studies have shown that males with SCI want to be more informed about sexual issues. Those who get the proper information have more positive sexual relationships. This can help ease some of the stress associated with impotence.
Using impotence aids may require assistance. Males may find it difficult to admit they have difficulty having an erection and need assistance. Sexual counseling can help people learn to communicate needs and feelings concerning sexual issues.
* Oral medications
Researchers are investigating several new oral medications, but at present FDA has not approved any of the drugs. Their effectiveness for people with SCI is yet to be determined.
Under FDA review, Viagra (sildenafil) is expected to be released in spring 1998. It relaxes smooth-muscle cells, the first step in achieving erection. Pfizer, the drug’s manufacturer, has reported minor side effects including headaches and diarrhea. Viagra may help most men with partial impotence. Taken one hour before sex, erection requires stimulation.
Spontane (apomorphine) is in its final trials by the manufacturer, Tap Pharmaceuticals. The process by which it works is unclear, but the drug affects part of the brain that triggers erections. Studies indicate it will help men with mild cases of impotence. Like Viagra, it works only in response to physical stimulation.
Vasomax (phentolamine) is under final FDA review. It appears to block adrenaline, relaxing smooth-muscle tissue and dilating arteries. Studies show it helped 60-80% of those tested, and it appears to have fewer side effects than Viagra. Like the other drugs, it requires stimulation to result in erection and should be taken 20-40 minutes before sex.
Before using any of the impotence treatments discussed here, get a thorough physical examination from a physician familiar with each option’s benefits and side effects as related to SCI. Treatment options described in this article will not affect sexual desire, ejaculation, orgasm, or sensation. They will not solve unrelated relationship difficulties.
A TREATABLE CHALLENGE
While impotence presents a challenge to SCI males and their partners, it is a common, treatable medical condition. Honest communication allows couples to face their problem. For better intimacy, consider the following tips:
* Talk to your partner about sex.
* Show and tell your partner what you like.
* Ask your partner to show you how he or she wants to be touched.
* Take your time; relax; give both of you a chance to become aroused.
* Try being intimate without intercourse. Focus on touching and cuddling.
* Don’t worry that your bodies aren’t perfect. Focus on the things you like about your partner.
RELATED ARTICLE: MYTHS AND MISCONCEPTIONS
Today, spinal-cord injury (SCI) does not automatically banish a person to “The World That Forgot About Sex.” Facts have replaced untruths and false notions.
Myth: It is not fitting for hospital staff to discuss sex with patients. Fact: Sex is a natural part of life. It deserves equal attention in rehab programs.
Myth: People with disabilities are no longer sexual beings.
Fact: We all are sexual beings. This does not change after spinal-cord injury.
Myth: Marriage and parenting are no longer options for people with SCI. Fact: People with SCI meet people and fall in love. Marriage often follows.
Women with SCI usually have no trouble getting pregnant. On the other hand, men’s reproductive functions are more complex.
In the long run, SCI’s effect on sexuality has a lot to do with self-esteem. Your skill and confidence in close relationships make up part of your ability to function sexually. You must accept yourself as a sexual being and use your learned skills.