Treatment Options

While many treatment options exist for Erectile Dysfunction, Boston Medical Group physicians can determine the most appropriate option, or combination of options, for you based on your own personal condition and preferences.  A list of generally available treatment options can be found below.

ED Treatments

Intracavernous Pharmacotherapy (ICP)

Considered the most effective treatment for Erectile Dysfunction, ICP involves a painless injection of a combination of FDA-approved vasodilators into the spongy tissue of the penis, using an auto-applicator.  This combination causes an expansion of the penile arteries and penile tissues, resulting in increased blood flow to the penis.  An erection typically develops within minutes.  The erection feels perfectly natural and normal; however, it will not subside after ejaculation until the effect of the medicine wears off.

Side-effects of ICP can often be avoided and are rare, but can include penile bruising, pain or tenderness, scarring, and a prolonged erection (known as a priapism).  Despite the highly effective results largely unparallel by other treatments, the general lack of expertise and resources have made its access limited, and its value ill-understood and underappreciated.

Boston Medical Group has developed a proprietary formula and unique approach to this method that yields unparalleled results.  The treatment induces an erection almost immediately and is easy to apply.  Because it is applied locally and is non-systemic, it is often highly recommended for men with diabetes, heart conditions, high blood pressure or other general debilitating illnesses. 

In the last 10 years ICP has emerged as an excellent treatment option for men who do not respond to common ED pills or suffer from unwanted side-effects.  Most men prefer to use ICP over other methods given its record of safety, quality, and highly predicable results.

Oral Medications (Viagra^®, Levitra^®, Cialis^®)

After its release in 1998, Viagra® became one of the well-recognized treatments for Erectile Dysfunction, though not necessarily the most effective.  Its convenience has made it the first-line treatment in many instances, yet studies indicate that between 30-70% of men do not respond to these drugs, and others experience many side effects including headaches, dizziness, blurred vision, and facial flushing.  Men who take nitrates for chest pain should not use Viagra® or similar medications, given the potential for an unsafe drop in blood pressure.  Reports of sudden loss of vision or hearing that develops soon after taking the drugs have prompted the FDA to enforce the Black Box Label ruling to warn patients of these potential side-effects.

Other oral pills include variations of compounded vasodilators given sublingually (under the tongue).  While often having a faster onset, they also have the same limited effectiveness, potential for side-effects, and other limitations.
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Intra-Urethral Suppository (MUSE)

MUSE contains a vasodilator known as Alprostadil (or Prostaglandine E1) prepared in the form of a pellet that is inserted into the urethra, via an applicator.  The medicine is absorbed through the urethral wall into the erectile chambers known as the corpus cavernosa.  While successful for some men, the effect is often limited given that it contains only one vasodilator which is poorly absorbed and rarely results in a complete erection on its own.
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Penile Prosthesis

Given the availability of less invasive, more effective treatments, penile prosthesis has become a treatment of last resort.  The best penile prosthesis is comprised of two inflatable tubes, a pump, and a reservoir.  The tubes are surgically inserted into the corpus cavernosa, the pump in the scrotum and the reservoir behind the pubic bones.  When the pump is activated, fluid flows from the reservoir into the tubes, which harden and become erect.  Pressing a valve on the pump mechanism deactivates it, and the fluid returns to the reservoir, resulting in a flaccid penis.  Complications can include infection, bleeding, pain and discomfort, mechanical failure, or extrusion of part of the prosthesis through a weakened wall of the erectile chambers.

Penile implant surgery is a major surgery that is considerably invasive and expensive.  Nonetheless, it can benefit men who do not respond to any other form of treatment.

These procedures are not performed by Boston Medical Group physicians.
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Vacuum Suction Devices (VSDs)

A VSD is a battery or manually-operated cylindrical pump which fully encloses the penis.  When activated, it creates a vacuum by sucking air out of the sealed chamber, which draws blood to the penis.  A firm rubber ring is placed around the base of the penis to trap the blood in the erectile chamber, which keeps the penis firm.  Disadvantages can include incomplete erections, discomfort, and the time required for operation, but VSDs are often valuable when used along with other treatments, like ICP.
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Arterial and Venous Surgeries

Approximately 2% to 5% of patients are candidates for vascular reconstructive surgery, which includes arterial bypass and venous ligation.  Risks include those related to other major surgical procedures.  Boston Medical Group physicians do not perform these surgeries.
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Hormonal Replacement Therapy

Similar to menopause in women, men can experience a condition called andropause, which is caused by low testosterone.  Symptoms can include, but are not limited to, feelings of sluggishness, fatigue, poor sleeping habits, weight gain, low sex drive, or erectile dysfunction.  For the appropriate candidate, hormonal replacement therapy can be extremely valuable in reversing these symptoms and even improve libido (sexual drive).

Blood tests are required for the purpose of diagnosis, monitoring the treatment effectiveness, as well as any other adverse side-effects.
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Sex Therapy

Sex therapy is often the treatment of choice for patients with psychological Erectile Dysfunction.  It demands the cooperation of the sexual partner, multiple sessions, and an experienced sex therapist for the best results.
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Intranasal Medications

Intranasal medications offer a non-traditional method of administering different combinations of vasodilators.  Their effectiveness is questionable is not endorsed by mainstream medical communities.
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PE Treatments

While many different treatment options exist for Premature Ejaculation, Boston Medical Group physicians can determine which treatments are most appropriate for you based on your personal condition.  A list of generally available treatment options is detailed below.

Intracavernous Pharmacotherapy (ICP)

ICP involves a painless injection of a combination of FDA-approved vasodilators into the spongy tissue of the penis, using an auto-applicator.  The erection feels perfectly natural and normal; however, it will not subside after ejaculation until the effect of the medication wears off.  Side-effects of ICP can often be avoided and are rare, but can include penile bruising, pain or tenderness, scarring, and a prolonged erection (known as a priapism). 

Boston Medical Group has developed a proprietary formula and a unique approach to this method that yields unparalleled results.  The treatment maintains the erection regardless of the occurrence of ejaculation.  It is easy to apply, and can be formulated to last up to an hour or longer if necessary.  With a greater ability to endure longer sexual experiences, men are able to completely satisfy their sexual partner without fear of losing their erection. 

With prolonged sexual encounters, men become less and less sensitive to sexual stimulation; ejaculatory control can then be learned and becomes second nature.  Over time, the body will react to sexual stimulation in a more controlled and reliable fashion.
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Start and Stop Technique, Squeeze technique, and Kegel Exercises

The Start and Stop technique involves trying to delay ejaculation by withdrawing the penis or stopping the thrusts right before climax.  The Squeeze technique involves having the partner firmly squeeze the head of the penis just before ejaculation.  These techniques require a great deal of dedication and cooperation on the part of the partner but have been found to have limited overall success on their own.  However, these techniques can be effective with proper guidance from a qualified sex therapist

Pelvic floor exercises, known as Kegels, involve repetitive contractions of the pelvic muscles that control the flow of urination.  Strengthening these muscles can help improve ejaculatory control, but this method is best used in conjunction with other treatments, such as ICP.
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Local Anesthetic Gels, Sprays, and Creams

The goal of local anesthetic products, such as lidocaine and prilocaine, is to numb the head of the penis to reduce sensation, and thus, reduce the likelihood of uncontrolled ejaculation.  The effects of these creams have been found to be minimal and temporary, as numbing the penis does not allow a man to acclimate to the sensation of lovemaking, and hence, his ability to control the urge to ejaculate.  If a condom is not used, the female partner often complains of reduced sensation in the vagina, resulting in reduced pleasure.
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Central Nervous System (CNS) Suppressants

The most commonly used CNS suppressants are anti-anxiety or anti-depression medications such as Tricyclic Antidepressants or Selective Serotonin Reuptake Inhibitors (SSRIs).  Examples include sertraline, paroxetine, and fluoxetine.  The main purpose of these drugs is to restore a neurotransmitter imbalance in the brain, but because they can have a feeble inhibitory effect on ejaculation, they are sometimes employed as an off-label treatment for PE.  Ongoing therapy is required and usefulness is often limited by a number of side-effects such as nausea, vomiting, dry mouth, drowsiness, reduced libido, and even Erectile Dysfunction.  Rarer cases of serious complications such as mania, withdrawal symptoms, and harmful drug interactions have also been associated with certain SSRIs.

A new SSRI known as dapoxetine has undergone clinical trials but is not yet approved by the FDA for the treatment of Premature Ejaculation.
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Alternative Therapies

Antiquated techniques such as pulling down the testes or applying pressure on the engorged prostate during arousal have been found to cause potential damage to the testicular structures and prostate, respectively.  Weakened erection is another common side-effect.

Dietary or herbal supplements, whose names often sound very medical, have been touted as having remarkable effects on sexual vigor and stamina.  Some men may experience limited results from these supplements, most likely due to a placebo effect. 

Boston Medical Group physicians do not employ or recommend alternative methods. 
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