Medical Options for Impotence


I have read the response on your website to questions about the morality of various acts in a marriage in which the husband is impotent. I was wondering, what are the medical options availabe for the treatment of impotence?  S


Last Updated: December 12, 2014
RE: Impotence/marital relations.

Today it is possible in almost all instances for a couple to achieve intromission (have the husband’s erect penis enter the wife’s vagina), excluding the most obvious situations that would make this impossible, e.g., absent penis or vagina.

A husband who is unable to get an erection has many choices. If his disorder is mild enough (he can achieve a partial erection) one of the oral medications will usually suffice (Viagra, Levitra, Cialis). All three are of the same family of drug and the inability of one particular medication to work does not mean one of the others will not. I would definitely try all three before concluding the pill route is not effective.

If tablets are ineffective the next two logical options would be to use a medication that is gently inserted into the urethra via a small applicator (it is little larger than a ballpoint pen ink cartridge and the medicine is like a tiny grain of rice) or to use a mechanical device (vacuum pump). The medication is called MUSE and is the drug alprostadil. The husbands empties his bladder, slides the little applicator into the urethra, pushes the plunger and flicks the device to get the pellet to release, and then removes the device, leaving the pellet behind in the urethra. 20 seconds of gentle urethral massage gets the pellet to melt, and then an erection ensues within a few minutes that will last, typically, for 20-40 minutes. The vacuum pump has been around for at least fifty years. It is simply a plastic cylinder that is open at one end. That open end is lubricated so that when placed over the penis it will create an air-tight seal against the skin of the pubis. A small hose at the other end of the cylinder is connected to a hand pump (or battery-operated motor) to evacuate the air from the cylinder, thereby creating a vacuum and drawing blood into the penis. Once the penis is erect a firm rubber ring is slid off the cylinder onto the base of the penis to hold the blood in and the cylinder is taken away. Again, this will typically allow an erection to be sustained for plus or minus thirty minutes.

The last resort is to place a mechanical gadget into the penis (penile prosthesis). This surgical procedure works well, but does not mimic a normal erection absolutely perfectly. Furthermore it destroys the normal erectile tissue, so there is no “going back” once a prosthesis is placed. There are several kinds of prostheses from simple plastic rods that hold the penis erect all the time or malleable plastic + metallic wire rods that create a “semi” that can be moved up or down; or very sophisticated inflatable cylinders that require placement of a fluid reservoir in the lower abdomen and both a pump and an “on/off” valve in the scrotum.

In conclusion, it is pretty unusual not to find an impotence solution that will allow a couple to enjoy true marital intimacy.

Dr. Gregory Polito

Answered By:

Gregory Polito, MD
Gregory Polito,MD, KM, Past President of CANFP, retired from a urologic practice, with a sub-specialty in vasectomy reversal

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