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3525 Prytania St, Suite 614 - New Orleans, LA 70115 - 504-891-8454

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"You have turned my life around"
 

I am 87 years old, with a problem of the prostate gland. Before I met Dr. Baum, I went to the bathroom every 30-60 minutes. After Dr. Baum's treatment on my prostate, I go only 5 times per day and only 1 time at night! You turned my life around. I am so very grateful!

-Sidney Daigle


I want to thank you for your due diligence. You saved my life. I highly recommend you!

-Dwight Bastian


Thank you Dr. Baum! Because of you I'm back in the "rodeo"!

-Gerald Wallace

 


Disadvantages of Implants
Once an implant has been placed, natural erections usually no longer occur. If the prostheses were then removed the normal erections are unlikely to return. There is a small chance of infection which would require removal of the prosthesis. Some patients can develop surgical complications or anesthetic complications. Occasionally patients will notice numbness at the head of their penis and intercourse can be uncomfortable. Because the erection is not caused by increased blood flow to the penis, the head of the penis is not part of the erection, and this softness may be bothersome to some patients.

Recently the safety of silicone and silicone products such as silastic have been questioned. Breast prostheses using liquid or gel forms of silicone were removed from the market by the FDA. Concerns raised were the inflammatory responses to this type of silicone which included pain, scarring and disfigurement. In addition, possible associations were raised among silicone and the development of immune disorders like rheumatoid arthritis and a possible association to an increased development of cancer. It is noteworthy that the solid silicone breast implants that are filled with water were not removed from usage. In May, 1994, a class action suit was filed against the major manufacturer of penile prostheses claiming many of these same issues. The penile prostheses are all of the solid variety and use water as a filling. Most observers feel the suit to be without basis, but of course, only time will tell and more research and follow-up needs to be done. Solid silicone products are used extensively in medicine and include cardiac pacemakers and brain shunts. Thousands and thousands of implants of all types have been used for years with very little and predictable risks and side effects.

Costs
Some insurance policies will cover the cost of prostheses and this can be established through our business office. Patients who are considering a prosthesis should be aware that other types of therapy might be available, including vacuum devices and self-injection therapy.

Vascular Reconstructive Surgery
A small percentage of patients may be candidates for some form of reconstruction of the penile blood flow. This includes patients with poor arterial blood supply and those also with venous leaking. The long-term results from this type of surgery have been generally disappointing with even the best of results showing only 1 out of 20 men being helped. Surgery is technically difficult, relatively expensive, and includes complications of nerve damage and scar tissue formation. Given the relatively low success rate, along with the technical difficulty and expense of this type of procedure, vascular reconstructive surgery has not been generally accepted widely.

Sex Therapy
For many years physicians believed almost all of the sexual dysfunctions to be caused by psychologic reasons. As we have gotten a better understanding of the physiology of erections, it has become known that many of the problems with impotence are caused, in fact, by physiologic reasons that are uncontrollable by the patient. However, a significant number of men still develop erectile problems purely on the basis of psychologic causes. In addition, men with an underlying physical disorder often develop psychologic problems as well because of their lack of performance. Even if the physiologic or as physicians often say "organic" problem is corrected, the man's self-image and confidence may be affected significantly enough that return to normal functioning is difficult.

Among the problems in dealing with psychologic problems is the fact that the topic is difficult to talk about or even bring up in front of a physician. Once the lack of confidence is deeply imbedded in the man's psyche, the subsequent lack of confidence becomes very difficult to remove from the man's thinking. Other emotions that may be felt include deep frustration, anger, depression and a sense of inadequacy.

Whether the cause of the difficulty with maintaining or achieving erections is purely psychologic or secondary to another physiologic cause, the end result creates a lack of confidence which results in a "self-fulfilling prophecy". The patient is so fearful of not obtaining an erection that the worry becomes so overwhelming that fears are born out -- no erection or loss of erection.

Sex therapists are trained professionals who deal with sex problems uniquely, and are very goal oriented to provide techniques, advice and counseling on dealing with the sexual problem only. They may provide reading and videos for help in their training. Usually only a few visits will provide definite improvement, and it is usual not to require more than a few months of treatments before seeing some definite results. Other causes of stress, obtaining adequate expectations from your partner and looking at relationships are also essential to effective sexual counseling. Some of the more specific treatments include exercises or treatment plans that are carried out in the privacy of one's home and does not require in-hospital or in-office treatments. The patient's partner is definitely brought into the technique training. Working together to reduce anxiety and increase confidence, both partners can help each other to relieve some of the anxieties and reestablish normal sexual relationships.

Sex therapy is also helpful in patients who have premature ejaculation or difficulty in obtaining an ejaculation.

In some patients the problems are so deep-seated that the pure psychologic techniques are not effective. In these cases the sex therapist might work with the physician in concert using a technique such as a vacuum erection device or self-injection therapy to aid in the early achievement of erections. As the patient's self-confidence improves, these therapies might be discarded, although they can be used in the future as well. On occasion, medications or injections of hormones can be used to also help initiate or stimulate early sexual functioning. Sex therapy is usually not covered by insurance policies, but it is unlikely that the counseling will need to continue past six months or so, which should keep the costs within most people's budgets.

External Supports
Some men have had success using external support devices. The most popular of these is called Rejoyn. These devices are essentially a semi-rigid condom. They are placed over the penis and provide the necessary rigidity without the need of an erection. These can be purchased without a prescription at many pharmacies or by calling 1-800-297-9329 for more information.

What Does Work
At this point there is no evidence that nutritional supplements or vitamins have any significant bearing on sexual performance. The Food and Drug Administration has currently banned the sale or advertising of all nonprescription products for the treatment of male impotence because none had been scientifically shown to be effective. Nitroglycerin patches and minoxidil (the drug for baldness) have not been shown to be effective for impotence when used as penile patches.

What's New
Another new oral (taken by mouth) drug is apomorphine. This drug also seems to promote erections in men with psychogenic problems Apomorphine may also work in men having difficulty maintaining erections. Large studies are currently underway in the US to determine the safety and effectiveness of these drugs. We do not expect release of this drug until late1998.

Yet another oral drug is Vasomax (phentolamine). This medicine is still being tested and does not seem to have the effectiveness of Viagra with a 40% response in men tested. At higher doses, a lowering of blood pressure may be problematic.

All of the oral drugs have different modes of action and if one does not work, the others may. Combinations of drugs, (e.g. Viagra and ?) and other techniques may also be possible.

In recent European studies, a new injectable drug called VIP is being tested. VIP stands for vasoactive intestinal peptide. When mixed with phentolomine (Regitine), an older injectable drug, 80% of men had successful erections, even if they had failed other injectables. Studies are just beginning in the US.

Two other injectables being researched abroad are called moxislyte and forskolin Initial success rates of 80% are being reported. No US studies are yet completed.

North American studies of creams containing nitroglycerin that are applied to the penis have shown modest success in mild to moderate erectile dysfunction. Plans to study this drug in the US are planned. South American studies of creams containing prostaglandin (Alprox-TD) that are applied to the penis have shown modest success in mild to moderate erectile dysfunction. No plans to study this drug are planned in the US for now.

Summary
Impotence is a treatable problem, and is not the inevitable consequence of aging. Almost all patients with impotence can be treated. A thorough evaluation looking for the causes of impotence can be followed by the appropriate diagnostic testing, and then a multitude of treatment choices become available to assure that each patient has a successful outcome. In terms of determining which therapy is best for each individual, one must be informed of all the various possibilities, both about the cause of the impotence and the type of treatments that are available. None of the treatments will significantly affect the ability to have an orgasm. About 35-50% of men that start with self-injection therapy or vacuum devices will not be satisfied and will seek other treatments. Some men will, unfortunately, give up and not seek additional help from their urologist. Penile prostheses have an acceptance rate of 90% or more but requires a procedure. MUSE suppositories are too new to give long term follow-up.

If needed, psychologic support and counseling by a professional sexual counselor should be considered in many patients regardless of the cause of the impotence to help with any adjustments. Sex therapy is often helpful and can be done by a qualified psychiatrist, psychologist, physician, or sex therapist with training and experience in this specialty area. In addition to counseling, exercises and reading to help increase sexual skills and reduce anxiety and improve communications can be very helpful.

Points to Remember

  • Impotence is a consistent inability to sustain an erection sufficient for sexual intercourse.
  • Impotence affects 10 to 15 million American men.
  • Impotence usually has a physical cause.
  • Impotence is treatable in all age groups.
  • Treatments include psychotherapy, drug therapy, vacuum devices, and surgery.

Resources for More Information

  • Impotence Information Center
    P.O. Box 9
    Minneapolis, MN 55440
    (800) 843-4315
  • Impotence Institute of America
    8201 Corporate Drive
    Suite 320
    Landover, MD 20785
    (301) 577-0650
  • Sexual Function Health Council
    American Foundation for Urologic Disease
    300 West Pratt Street
    Suite 401
    Baltimore, MD 21201
    (800) 242-2383
  • The Geddings Osbon, Sr. Foundation
    P.O. Drawer 1593
    Augusta, GA 30903-1593
    (800) 433-4215

This monograph uses parts of NIH Publication No. 95-3923, September 1995