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Dr. Schwartzwald - Dipolmate American Board of Urology

Book by Dr. Schwartzwald

Reclaiming your sexual life.

Losing the ability to perform in the bedroom causes a tremendous amount of anxiety, frustration, and depression. Any male who is physically mature enough to experience sexual desire can suffer from erectile dysfunction. Because the image of a desirable American male includes not only being healthy, wealthy and attractive, but also sexually active, the pressure on a man to perform adequately can be tremendous. The inability to perform sexually can attack men deeply. This can lead to feelings of inhibition, lack of self-esteem and self-condemnation. The inability to have or maintain an erection can grow to be a constant source of unhappiness.

Causes of sexual performance failure can be traced to a physical problem about 75% of the time. Improper functioning of nerves, blood vessels, hormones, or body chemicals can result in failure to achieve an erection. Penile blood flow increases over seven fold in order to achieve an erection. The blood vessels must dilate to handle the additional volume. Arteriosclerosis decreases the elasticity of the small arteries. The arteries are then unable to respond adequately to allow the penis to fill with blood. Diabetes, years of heavy smoking, and elevated cholesterol will accelerate arteriosclerosis. Thus ED in vigorous men fifty to sixty years old may portend future trouble in other larger arterial vessels such as their coronary arteries.

Sometimes the source of the erectile dysfunction is related to other forms of vascular insufficiency resulting in the failure of the penis to store sufficient blood. A steal syndrome can occur when the blood flow to the lower body and pelvic area is restricted and thus can be accentuated or improved in different sexual positions. Erections which are poorly maintained and which disappear quickly prior to satisfaction may be a result of abnormal venous drainage.

Over 20 million men in the U.S. are affected by erectile dysfunction. The majority of these men have some abnormal flow of blood into the penis. Although Viagra is successful in restoring some of men's erections, approximately 1/3 of all sufferers will require a more advanced treatment option.

Currently the best option for men who do not respond to oral treatments such as Viagra is the internal penile pump. The internal penile pump makes patients feel as normal as possible, enabling them to enjoy spontaneous lovemaking again. For most men, it represents a cure for ED. All sexually motivated, active men between the ages of 50 and 90 are candidates.

The internal penile pump is a soft fluid filled device that can be inserted through a one-inch opening in the scrotum. It consists of three components: very thin tubes, a pump, and a reservoir. Squeezing the pump (which is completely hidden in the scrotal sac) for about one minute brings fluid into the penis causing a lasting erection. When the erection is no longer desired, the patient squeezes and holds the pump, which releases the fluid back into the reservoir and brings the penis back to a flaccid state. The duration of the erection is controlled by the patient. Once in place, there is no maintenance required for the pump, which can remain inserted for a lifetime. Once inserted, the internal penile pump is invisible and the penis looks normal both in the flaccid and erect positions.

The internal pump is completely under the skin, totally concealed, and eliminates self-consciousness. It restores normal function and anatomy and provides an opportunity for spontaneous sexual activity. The penis feels and performs naturally, looking fuller and more youthful. Both patients and partners praise the improved quality of life because the patient is able to maintain his erection until his partner is satisfied. The internal penile pump is covered by most insurance carriers including Medicare and Medicaid. Surgical correction of ED has certainly come a long way since the first penile implant was performed in 1936. At that time, a surgeon took a piece of rib cartilage and implanted it in a mans penis as a stiffening device. It was eventually absorbed by the body and stopped working. Later, around 1960, rigid rods were placed within the corporal chambers and thirteen years later, the first inflatable device was made. Over the past 30 years, inflatable implants have undergone continual improvement. Many of the devices have a remarkable mechanical reliability rate of 96%. Erection, orgasm and ejaculation are three independent functions. Men who have ED from vascular causes continue to have an orgasm and ejaculation with a soft penis. Therefore restoring erections with the internal penile pump in such individuals will result in patients who continue to have an orgasm and ejaculation. A patient suffering from ED following radical prostatectomy or radiation therapy loses the ability to have erections and ejaculation. Therefore, with the internal penile pump such a patient will have an erection and orgasm, but no ejaculation. The internal penile pump provides the most successful imitation of a natural erection. Patient satisfaction is among the highest of any available treatment for erectile dysfunction. David Schwartzwald, M.D., F.A.C.S., is a board certified urologist, a member of the American Urological Association, and a Fellow of the American College of Surgeons. He has focused on the diagnosis and treatment of erectile dysfunction for over 10 years, and is a frequent lecturer to both physicians and patients.