Question:
Hello, my name is Shaad and If you don’t want to go thru my long history that I’ll share below my questions, you can skip that part, and I ask to review the questions I have near the top here:
Hope all’s well. My name’s Shaad, 34, from NY. I feel that after years without success with typical treatments of erectile dysfunction, penile implant may be on the table now. Any useful advice is appreciated thru here or any form of contact. In respect of your time, I’ll try to describe years of ED as shortly as I can.
1) I’ve mostly seen data of high satisfaction rates reported by mostly elders, and not much data on how satisfied a young person still is with implants 15-40 yrs later. Are you aware of such data? Is there anyone out there who got a implant while young, and can report how satisfied they are 15-40yrs later?
Answer:
Hi Shaad,
I have gone through your whole story to be able to give you the best possible advice.
Now regarding your first question, the reason for this is we use a penile implant as a last option and around 85% of patients show good improvement before we come down to this last option. And that’s why you found more data from elders.
It’s not common to use implants for young males. So please read my answers on your following questions before considering the implant.
2) Being young, I’ll likely do more revisions as I get older than elders, so the impact from multiple revisions will effect me more. Does pain, penis shrinkage, & infection chance ACCUMULATE after EACH revision? If so, how much should I worry about it?
Revision or re-implantation surgery has been associated with an increase in infection rates. Also, discomfort/ pain, reduced penile length, cosmetic appearance, or insufficient rigidity all increase relatively with revisions although they could be the reason for the revision. Complications have also been seen where tissue in-growth into the prosthesis occurs.
Unfortunately, there are no predictable outcomes when it comes to these complications, however, patients with high-risk characteristics and co-morbidities are at increased risk of these issues. But it’s also important to mention that in the majority of cases these complications can be managed successfully and maintain a high patient satisfaction
3) How do most patients describe their pain level and how long it took before they can satisfyingly use the implant with none-moderate pain?
Most patients regain sexual function 6 weeks after surgery with no or minimal effect on the orgasm. However, some may still have a level of discomfort.
Pain is an important factor in determining the success or failure of the implantation but it’s very subjective.
Most patients report postoperative pain in up to 4-6 weeks after surgery, after which patients can restart their sexual activities. The pain is at the its highest level during the 1st week after the surgery, therefore Ice packs may be put on the scrotum and penis to limit swelling after surgery in the first 48 hours. And After 48 hours, most patients can take extra-strength Tylenol or ibuprofen for pain.
The penile prosthesis can be activated at 4 weeks after surgery, and although an earlier activation is possible, it is mostly discouraged because of pain or residual swelling.
4) I’ve heard a mix of good/bad stories on penile prosthesis. Most forums and medical studies I’ve came across show positive data, but then I’ve seen some places share bad stories. There’s no financial benefit to sharing bad stories, but good stories can be marketing. The bad stories makes me question if the good stories might be marketing?
Penile implant surgery is a well-established treatment for medically refractory erectile dysfunction, with long-term reliability. But the point here is it may be a good treatment for selected, well-informed young patients with conservative therapy-resistant erectile dysfunction, because being young will require multiple revisions over time and that can increase the risk of complications.
The bad stories you read would be mostly due to complications such as mechanical issues, patient dissatisfaction, corporal deformity. But with a good medical assessment and preparation before the surgery and informed the patient about the expected results and risks of the procedure, we can minimize these complications and/or at least manage them successfully if they occur.
5) I’m considering Dr. Francois Eid or Dr. Andrew Kramer, but am open to researching more doctors. Recommendations? Anyone regret getting penile implants, especially from these 2 docs?
Both are very good specialist and I didn’t hear of any complaints.
6) Is there any other advice you can give for someone young considering an implant who exhausted usual treatments?
7) My history of treating ED naturally and thru typical treatments have been a failure. I’m at a decent weight (180lbs, 5’11), decent diet, and some muscle from exercising moderately. There is one thing I haven’t tried, more weight loss. I’m wondering if I should spend the next 2-3 months eating less to reach 155lbs to see if that resolves ED. Do you think it’s worth the time to try that 1st, before trying an implant that disables my natural function forever? Genetically, I have borderline high cholesterol since young, so I was thinking more weight loss while maintaining a decent diet might help.
For questions 6 & 7
As you might already know, Erectile dysfunction could be due to many underlying causes. For the best treatment option, we need to identify the cause first. It could be due to causes, such as; Anxiety, diabetes, high blood pressure, alcoholism and smoking tobacco, acute stress disorder,…etc.
Making good lifestyle choices is a very important factor along with the medical treatment, and that should include:
• Avoid/Quit smoking and/or alcohol
• Losing any excess weight, and yes lose extra weight could be very helpful, especially because of your cholesterol problem. You said you eat healthier than the average American, and that’s good, but not enough. I would suggest you reconsider your nutrition habits and choices, especially those that may contribute to your cholesterol levels.
• Include physical activity in your daily routine. Exercise can help with underlying conditions that play a part in erectile dysfunction in a number of ways, including reducing stress, helping you lose weight and increasing blood flow. Some weight training can also help with testosterone.
Now regarding the medical treatment, many options are available, but first I would suggest a complete assessment of your overall health and other health problems/current medications which may affect sexual function. (the main 3 problems you have are organic erectile issue, testosterone, and cholesterol)
And focuses should be on the organic causes of erectile problems, because you could be having a penile arterial insufficiency (should be evaluated) because this would be the most known reason for your ED, and it could also be the reason behind your testosterone levels (e.g. interrupted blood supply to the testes).
It’s recommended to have a pharmaco penile duplex ultrasonography with Prostaglandine E1, MRI of the genital region, and selective arteriography of the pelvis.
On the other hand, you should know it may take time and that’s why it is called a rehabilitation program. The use of a vacuum erection device (VED) along with Viagra or Cialis before sexual activities usually gives the best results (And I do recommend you get the brand name or at least get the generic from trusted source). However, if that doesn’t work, we then consider adding a daily low-dose of Viagra or Cialis for at least 12 weeks (it shows some benefits in some cases), if it doesn’t work, we then consider alprostadil pellets, injections (intra-urethral and intra cavernosal prostaglandins) or topical alprostadil, venous constriction devices (for venous leak), and lastly a penile implant.
There are also other options such as Venous constriction devices, shockwave therapy, but again it all depends on your overall health and any medical conditions you may have, and it should be included as part of a systematic treatment program under the supervision of your doctor and not randomly tried.
I see there is still room for improvement in your case by addressing the aforementioned factors, so I wouldn’t rush the penile implant without fixing the above problems first.
I hope this helps you form a complete picture of how your ED management should be like.
To best understand why I feel penile implant is my best option now, I would need to share my long history. This part can be ignored if you don’t have the time:
I’ve had ED at least since around 19. None-minimal morning wood. I get an erection when desired about 65% of the time, and can hold it successfully for intercourse about 33%. Oddly, my libido and ability to hold an erection appears to get worse if I’m standing, which I read may be venous leakage.
I tried eating better and exercise even though I was a good weight. As it didn’t help much, I visited local doctors. In my mid 20s, I was prescribed tadalafil. As it was expensive back then compared to now, I bought tadacip (generic tadalafil) online from an indian pharmacy. I wasn’t sure if pills were real, but they likely were as reviews from many sites were good. It worked well, but then stopped working after 2 weeks. Not even 20mg of generic tadalafil a day helped at that point. Maybe I built up tolerance & needed a break. Although I’m unsure if it was the pills, the high dose probably bothered my back badly, but it’s ok now.
Later, doctor did a penile doppler scan that shows arteriogenic dysfunction. He believed the cause to be congenital or due to a penis injury, but I don’t recall any. He recommended bimix/trimix. Tried it and wasn’t happy for the usual reasons. Also, the response was unpredictable. Sometimes I’d stay hard longer than I wanted to, which was a problem if I needed to be in public.
My testosterone labs often came back on the high end of low – low end of normal, and my estradiol often came back low. I did some thorough research online and found a TRT specialist with positive reviews. While he wasn’t an ED specialist, the idea was that if my levels increase to a therapeutic level, EDmay go away. He honestly told me TRT may be a 6-12month process before it fixed ED, if it does at all. He tried testosterone and hcg shots, plus Anastrozole. The dosage was similar to standard therapy, usually around 28-32cc (56-64mg) testosterone cypionate twice a week, HCG 400-500iu twice a week, 0.3mg anastrozole twice a week, and 7mg tadalafil a day as needed. This combination improved my ED only somewhat. He routinely checked my blood work every 3-6 months. Generally kept my lab values of testosterone near the high end of normal – low end of high. After 1-2 yrs, I realized this protocol wasnt helping enough so I tapered off.
Based on my research, I think my plan will be:
-Retry tadalafil one more time, but this time from a source I’m sure is legit as I know generic is now available legally in the states.
-I’m already at a decent weight of 180lbs at 5’11, but I can spend the next 2 months slowly dropping my weight to 155lbs and see how my ED is.
-If no success, consider a penile implant.
If you know of any other better alternatives, or new better treatments that are coming out fairly soon, let me know.
Medical conditions that may be causes/contributors to ED:
I know I had high cholesterol since youth, and maybe that led to ED. I recall my primary checked cholesterol around my late teens. He told me it was high for someone young. It may be genetic as my skinny mom has high cholesterol too. I eat better than the average american and exercise, but total cholesterol and LDL results still often come back on the low end of high these days.
Moderate pain and occasional involuntary spasms, mostly on the left side of my body only, mainly near core/pelvic regions and head. Possibly from playing alot of basketball in my youth and heavy lift exercises in my 20s. Had 1 MRI that stated mild spinal stenosis (dad has severe spinal stenosis) with disc herniation at L5-S1, and another that only mentioned disc herniation at L5-S1 and no spinal stenosis. Tried PT without much success. Managed thru exercise.
As explained earlier, I’ve had testosterone tested multiple times that often came back on the high side of low. Not sure why it’s low as I’m muscular. Most likely genetic as my brother’s is low too, but his sex life appears normal.
Medical conditions less likely related:
Irregular bowel movements for yrs. Powdery/loose stool 1-2x a week on avg for probably a decade. About 5 yrs ago, doctor did a colonoscopy and found nothing. He believed it to be diet related. Recently, I think I noticed that once I stop eating probiotic foods and oatmeal for awhile, the irregular bowel movements returned, so that’s how I manage.
Eczema flareups every few yrs. Sometimes moderate or severe. When severe, I used to resort to steroid creams or prednisone more when I was younger, but now I try my best to manage naturally.
I hope these answers your questions.