1. As most adults are aware, treatment for men unable to achieve a natural erection took a giant step forward when the first oral erectile dysfunction (ED) medication, Viagra, hit the market in 1998.

    Easy to use, fast-acting, and predictable in effectiveness, Viagra — followed by a whole host of similar drugs — has added an entirely new dimension to the sex lives of the many men (and women) who’d thought sex would have to remain just a pleasant memory of younger, more virile days.

    But as effective as Viagra has proven for countless men, it is not the answer for all men, for a variety of reasons. And for those reasons, science continues to explore other options — vastly improving less effective options from the past — while seeking new approaches that may be effective for every man in the future.

    From injections to suppositories to over-the-counter pumps, science continues to seek new ways for man to maintain or recapture an active sex life, and, of course, bring pleasure to that certain special someone.


    Prescription Pharmaceuticals

    Drugs like Viagra (sildenafil), Cialis (tadalafil), and Levitra (vardenafil) enable men to achieve erections by increasing blood flow to the penis by relaxing smooth muscles in the penis. With a documented 70% effectiveness rate, these popular pills are considered safe for most users.

    However, a small percentage of users will experience a number of unpleasant side effects including headaches, sinus congestion, indigestion, heart palpitations, blurred vision, and a prolonged erection — sometimes lasting several hours — but seldom severe enough to prompt discontinued use. (Manufacturers do warn against combining these drugs with nitroglycerine pills for chest pain, or recreational drugs known as "poppers," which can not only lower blood pressure to dangerous levels, can even cause heart attacks.


    Herbal Alternatives

    The area of erectile dysfunction curatives gaining perhaps the greatest attention in recent years, herbal remedies is also, of course, the oldest. With at least 2000 years of tried-and-true testimonial, herbs like maca root, yohimbe, horny goat weed, damiana, Spanish fly, caterpillar fungus, and tongkat ali have all proven amazingly effective for countless men who want to stick to something nature provides.


    Intracavernosal Injection Therapy

    If you’re among that 30% of men for whom oral medications like Viagra are ineffective, some doctors recommend an injectable medication that is introduced into the base or side of the penis via a tiny needle. Alprostadil, a synthetic version of prostaglandin E1 (a hormone-like substance that functions similarly to erectile dysfunction pills) is one of the more common, and effective. (A doctor generally teaches patients –including wives — how to perform the injections themselves.)


    Intraurethral Suppositories

    For men who are queasy about the prospect of repeatedly inserting a needle into their manhood, a suppository called MUSE (containing the drug alprostadil) is also available, though it is reported to be less effective than injections. Inserted into the urethra where it is slowly absorbed, clinical urologists concur that it often loses some of its strength due to unpredictable absorption rate, making injections the more preferable in terms of reliability.

    Additionally, as with injectable erectile dysfunction medications, MUSE carries the same primary complaint: men say the time it takes to prepare and administer often takes away from the spontaneity of sex and tends to make the sexual experience less enjoyable for both their partner and themselves.


    Penis Vacuum Pumps

    Before the advent of Viagra and similar drugs, the most popular erectile dysfunction remedy was the penis vacuum pump. Considered quite effective in its time (and still the method of choice for some men), the tubular mechanism increases blood flow to the penis by forcing air out of the cylinder, thus pulling blood into the erectile tissue of the penis. Available over-the-counter at relatively low cost, the one drawback is that a constriction ring often needs to be slipped over the base of the penis to maintain an erection, and that an erection sometimes remains even after climax (which can be good or bad).


    Penis Constriction Rings

    Penis constriction rings and tourniquets (which have been in existence for hundreds of years) are worn around the base of the penis to slow down the speed at which blood leaves the penis. While constriction rings won’t increase blood flow to the penis, they can prolong an erection once one is achieved (using a vacuum pump, or manual or oral stimulation, for instance).

    Doctors warn that penis rings should not be worn for more than 30 minutes and should be removed immediately if you experience cold, numbness, or pain in the genital area.


    Penile Implants

    In use for several decades now, penile implants come in two varieties: inflatable and malleable–and reported to be increasingly more effective in recent years with design improvements.

    Inflatable implants are expandable cylinders surgically implanted directly into the erection chamber of the penis, which can then be blown up via a hydraulic pump implanted in the scrotum; some models utilize a reservoir for feeding saline solution through the pump.

    Malleable implants, on the other hand, are semi-rigid, bendable rods that are implanted inside the penis, which can then be manipulated manually into an erect or flaccid position.


    Vascular Surgery

    While vascular, penile surgery is rarely necessary, for about .01% of men for whom other medicines and mechanisms are ineffective, it is currently the only option. Performed by only a handful of surgeons in the US, the operation does not have a high rate of success, but does offer an option for men willing to take the risk.


    A Look Toward the Future . . .

    Testosterone replacement therapy, subcutaneous computer chip implants, topical erections creams, even robotic surgery are all areas currently being explored by the scientific community, though with far less success at this point in time. But if there’s one thing we can be certain of, if there is a way to engineer a better erection, science will find it.



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