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Prof. Shariat has published over 1400 scientific papers in peer-reviewed journals. In 2014 he received the Matula Award from the European Society of Urology (EAU), and in 2017 the Gold Cystoscope Award from the American Society of Urology, probably the most important urologist award worldwide.
What we want to talk more about today is the treatment options available for erectile dysfunction. This is a sensitive subject, so it’s intended for mature readers unless of course you’re young but still suffering from erectile dysfunction. In that case, you’re also welcome to read…
What Are The Treatments In General?
We are going to cover these first before we get to the specifics, but in general, there are medical-type treatments and nonmedical therapies. The medical procedures that most people are familiar with are prescription pills such as Viagra, Levitra, Cialis or herbal supplements such as VigRX Plus, Male Extra, ExtenZe, and ProSolution Plus Pills.
There are other kinds of medical treatments such as injections and suppositories, and then there are non-medical treatments such as using a vacuum pump or penile prosthesis.
We will cover each of these in turn shortly.
Let’s Say You Have Erectile Dysfunction, And You Don’t Do Anything About It, What Would Happen?
What happens, unfortunately, is that the penis, just like with a lot of other things in the body is a use-it-or-lose-it organ. Just like somebody who goes to the gym actively and is building muscle, lifting weights and doing cardio will shrink and muscle atrophy will take place if he stops.
The penis is no different, for example, men who have had prostate cancer surgery and have had the prostate removed have profound erectile dysfunction as a result. You will find an average of about 2 cm plus in shrinkage and the longer they go without having erections they tend to lose some more size as well.
This is why a lot of men can gain erect length and girth by merely doing edging/ballooning exercises. They allow their penis to remain in an erect state, fully engorged with blood to the maximum level for extended periods. This will inevitably expand the spongy tissue chambers within the penis over time making it bigger and more accommodating to larger volumes of blood.
Likewise, as we have mentioned the opposite is also true. The lack of erections will over time begin to shrink the spongy tissue chambers because they will no longer need to be the size that they were as there is no use for them holding that much blood.
We do not recommend doing absolutely anything if you suffer from erectile dysfunction and if you want to preserve your erectile size and this has been true in animal studies and human beings.
Erectile Dysfunction Pills
The thing that most people are familiar with is Viagra, which was introduced to the prevailing market in the late 90s, and then Cialis and Levitra came out in 2003, and they do work pretty well. If you look at studies that investigate how much they improve the erection, about 80% of men will say that their erections were enhanced versus about ¼ of men who had just taken a placebo.
If you asked the question of how many men can have satisfactory intercourse, of course, that’s not as good as 80% because you cannot just have a better erection, you have to have an erection that sustains long enough for intercourse. And one that remains hard, sufficient for sex, but it’s still pretty reasonable.
These prescription medications are not for everyone; certain medications will not allow a man to take one of these pills for ED, such as certain drugs that I used for high blood pressure that can be dangerous.
Additionally, about 30% of men have side effects from using these pills, whether it’s a headache or feeling flushed or nasal congestion, but only about 5% of men stop using the tablets as a result of side effects. But, it is important to note that many people suffer from extreme side effects such as blindness and stroke.
There are some keys to using these pills successfully; they are amplifiers, they are not magic pills. We always tell men that if you take these pills and watch a baseball game, you will not have an erection unless you love baseball and are turned on by it.
Another critical element is that they work best if you have an empty stomach so that you would take the pills either before dinner or after a snack but not after a big meal. Especially if that meal is high in fats. Fatty meals slow down and hinder the ability of the pills to work due to the pathway that they run on.
The third thing is that often, they don’t work the first couple of times, so you will have to try them several times before you even decide whether they’re worth it for you or not.
It is better to use herbal alternatives such as VigRX Plus, Male Extra, ExtenZe, or ProSolution Plus Pills instead of using prescription medications. Herbal supplements come with zero side effects as they are herbal and not synthetic. You do not need a prescription, and you can save yourself the embarrassment of visiting your doctor.
Research also shows that many herbal ingredients have much more potent effects on erectile dysfunction and prescription medications such as Viagra. The plus side is that the herbal alternatives, with zero side effects, even work on the same drug pathway. It seems like Viagra etc. mimics the way that natural supplements work anyway, it’s just filling the pockets of multibillion-dollar pharmaceutical companies.
Stay well clear and opt for more natural remedies if they are available for any condition you may suffer from. Natural is always the way to go, but pharmaceutical companies will never admit to that.
One option for patients if the pills are unsuccessful is to use what’s called a vacuuming device. A vacuum device is not a drug at all; it’s a mechanical object. You probably know it better as a penis pump.
There are a lot of older models that use air as their vacuum medium. The newer and improved penis pumps no longer use air, they use water. There are many variations, but in essence, they consist of a plastic cylinder and a pump. The penis will enter the tube, and the pump will be utilized to create a vacuum seal.
This vacuum that will surround the man’s penis will begin drawing in blood. As long as the vacuum remains, the blood will enter the penis, engorge, and it, and stay there. Because vacuum pumps are not a drug, they do not have any drug-related side effects, and that’s a positive thing. They are also relatively inexpensive. In America, insurance even covers them, and they work reasonably well for the first use, and they are easy to get the hang of.
Some may argue that it’s very unnatural, the erection is induced in an unnatural way itself, but there is nothing natural about Viagra, is there?
The few drawbacks are nothing to worry about and will begin to subside after regular use. In the beginning, you may experience erections that feel a little bit cold or have slightly abnormal coloration or bruising, etc.
This is nothing to worry about, and your penis will become accustomed to this after only a few pumping sessions. It is similar to any other form of exercise, your body has to build up its resistance, and it builds itself back stronger which will result in harder erections, better erection quality, longer-lasting, and a more engorged penis.
Another side effects of using a penis pump are that over time it will make your penis bigger. For erectile dysfunction, penis pumps have been FDA approved, but for penis enlargement, they have not. People who have used penis pumps to treat erectile dysfunction have noticed that they have been able to make their penis bigger by pumping which is a good side effect, I’m sure you’d agree!
The success rate of penis enlargement using a penis pump like the BathMate or Penomet is very high even though men had primarily used it for ED and not penis enlargement.
Injection Therapy
This is another alternative to medication. The two cylinders in the penis called the corpora cavernosa are located towards the side of the penis at the top when you’re looking down. They communicate with each other, and so if a man takes a pill, of course, the drug goes everywhere in the body including their penis.
But, if they want to get a drug in very efficiently then they can resort to injecting medication directly into the penis. The needle is tiny, it’s a similar needle used by people with diabetes for their insulin syringe, and they can place the needle and body on either side.
This is not painful, they put it right in and inject the drug and pull the needle out. The drug diffuses throughout the penis and gives a very natural erection, usually in about five minutes, and so men are thrilled with this treatment.
You may argue that this is an even more unnatural process than using the penis pump and you would be right. The downside is what you would expect. Is that a man who is feeling frisky would have to grab the needle and inject it into their Dick’s. It’s not the most natural process, is it?
Also, wouldn’t that just put a whole downer on the entire sexual experience? These are some of the reasons for the massive drop out which is about 50%.
Another option for those of you who would be needle-phobic or don’t want to use a needle, you can use what’s called a urethral suppository.
Urethral Suppository
This is a suppository that goes directly into the urinary channel. This is unnatural, and a small tube enters the hole in which you urinate (Ouch… Makes me cringe just thinking about it), and the medication is deposited inside.
You would have to wiggle it out to remove it. The medication is left inside, and it diffuses quite well. The plus side of this is that it avoids great needles, and it’s straightforward to use, but the downside is that it’s costly, and there is a certain amount of penile pain and discomfort that can accompany the drug-dissolving.
About 30% of men who have had prostatectomy experience that. It doesn’t work quite as efficiently as the injections though.
You can imagine another problem with either this or the injection is that the man has to have excellent hand function, hand-eye coordination, and manual dexterity. He must have a decent vision and be able to see pretty well, and he can’t be too fat because he has to be able to see what he’s doing and he can’t afford to miss.
What about men who don’t have success with these other modalities? Or those who are unhappy using them because they can’t tolerate the needles etc.?
Penile Prosthesis
The prosthesis has been around since the early 70s, and there are several different types. Each prosthesis is a device that stays within the body, and in that sense, it’s concealed entirely. It looks very natural from the outside of the body; the most straightforward kind is what we call a semi-rigid, so it’s not precisely rigid and it’s not exactly flaccid. It’s a little hard to conceal to have intercourse.
For men who have inferior hand function or who want the simplest type of procedure, this would be a very nice way to go about this.
For men who want a more natural feeling erection, there is a prosthesis called a three-piece device. In this, there are hydraulic cylinders within the penis, and there’s a pump in the scrotum (think of it as a third testicle). There’s a reservoir with fluid that’s hidden in the abdomen, so when the man wants to have an erection, they just pump on this so they can get a solid erection. When it is pumped up all the way, it’s just as rigid and feels just as natural as a normal erection.
But as we know, it’s an entirely unnatural process and involves surgery. When the man has had enough, there is a little button that he can locate in his scrotum to deflate it, so his penis returns to its flaccid size. There are no external parts; everything is hidden within the body.
The Positive Side Of This Prosthesis
It is that they have been around for a long time, we have lots of clinical data on them. Indeed, from the point of view of naturalness, these are internal, there are no issues with spontaneity, but it involves surgery. They are very discrete and people like them. If you are in the shower or you had one of the inflatable ones, or at the gym, nobody would notice you had anything like this. You can even be on the swim team with this.
The downside of a prosthesis comes down to three things. The first is that they are mechanical objects and so if you give them 10 or 15 years, they are going to break and need to be replaced which can be done but involves another procedure.
The second is the thing that we are worried about the most is an infection. Just like any foreign object like a knee replacement or a hip replacement. If a prosthesis gets infected, the bacteria live on the device, and the device has to be removed, at least temporarily to get the infection to resolve. Luckily the infection rates for penile prostheses are quite small, but there is still a risk. So it’s always something to worry about.
The Third Thing Has To Do With Patient Expectations
If a guy comes in and says’s “Hey Doc, I used to be a lot bigger!” No matter what size it was, that’s not what this prosthetic or any of the treatment for erectile dysfunction gives you (except a pump) it’s just to restore regular function.
So, if a guy thinks that this is a penis lengthening procedure, it’s not that, it’s not going to do anything other than restoring proper function, and if a man thinks of that realistically, they’ll be delighted and if they don’t then, they probably won’t.
If it is penis enlargement that they are after, other surgeries take care of that or they could resort to using a penis extender device such as a Phallosan Forte or SizeGenetics and for even better results he should use it in conjunction with a penis pump (preferably the BathMate or Penomet).
Manual exercises will also help, but you will need specific guidance and a trustworthy guide to follow with detailed instructions and a well set out regime similar to those outlined in the Penis Enlargement Bible, Penis Enlargement Remedy, or Penis Advantage programs.
If you look at naturalness, noninvasiveness, and overall patient satisfaction you will see that herbal supplements and penis pumps give erectile dysfunction sufferers the most happiness. Supplements Such as Male Extra, VigRX Plus, ExtenZe, and ProSolution Plus Pills and penis pumps such as BathMate and Penomet provide the best options.
You can use both methods at the same time for the best results or choose the one which you would feel more comfortable with. You could even try both and decide for yourself which one you are having the most success with and then continue with that.
The penis is no different, for example, men who have had prostate cancer surgery and have had the prostate removed have profound erectile dysfunction as a result. You will find an average of about 2 cm plus in shrinkage and the longer they go without having erections they tend to lose some more size as well.
This is not painful, they put it right in and inject the drug and pull the needle out. The drug diffuses throughout the penis and gives a very natural erection, usually in about five minutes, and so men are thrilled with this treatment.
This is a suppository that goes directly into the urinary channel. This is unnatural, and a small tube enters the hole in which you urinate (Ouch… Makes me cringe just thinking about it), and the medication is deposited inside.
The prosthesis has been around since the early 70s, and there are several different types. Each prosthesis is a device that stays within the body, and in that sense, it’s concealed entirely. It looks very natural from the outside of the body; the most straightforward kind is what we call a semi-rigid, so it’s not precisely rigid and it’s not exactly flaccid. It’s a little hard to conceal to have intercourse.
