Erec Aid

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EREC AID SYSTEM

Dr.Joe's Data Base

The purpose of this site is to provide comprehensive information on

impotence, and objective information on all currently acceptable medical

treatments. However, readers should understand that like most publications

distributed by a medical supplier, this one has a bias for the treatment

therapy and products it is most familiar with, in this case external vacuum

devices and Osbon ErecAid® System.

For more information on external vacuum devices, a list of the published

clinical studies on ErecAid® System, or referral to a physician in your

area who is familiar with vacuum therapy, please call

Medic Drug's Impotence Information Center at 1-800-686-8886, ask for Bill

at Ext. 118.

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Forward:

Until a few years ago, men had few choices for erectile dysfunction. This

is not the case today. Thanks to a large amount of creative work

accomplished recently, virtually every impotent man can now be treated

successfully. The choices range from oral medications to injections, from

psychological therapy to surgery, and from external devices to internal

ones.

Most of these treatments are found in the urology area, where they have

been for 15 years. But this is starting to change. General practitioners

have discovered that they can safely prescribe many of the treatments

available. This is important because erectile dysfunction is often the

first overt symptom of serious conditions like diabetes, high blood

pressure and vascular disease.

Ten to fifteen percent of all men have some degree of impotence; this

statistic includes one out of every three men over age 60. Most of these

men visit a family doctor on occasion which means that if the physician is

alert and inquisitive about sexual function a golden opportunity exists to

discover the impotence, determine its underlying cause and offer successful

treatment.

Because of the availability of many good treatments, no man has to live

with impotence any longer. By investing one hour of your time to read this

guide, you will learn about treatments that could dramatically change your

life.

The choice is up to you. The information contained in this booklet is

presented in layman's language for easy understanding. Good luck with

whatever treatment you select.

J. Douglas Trapp, M.D.

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Table of Contents:

1. Admitting Impotence to Yourself

2. Three Tough Questions

3. Understanding the Erectile Process

4. What Causes Impotence?

5. Choosing Your Doctor

6. What Happens at the Doctor's Office?

7. Current Treatments for Impotence

o Yohimbine Tablets

o Hormone Medication

o External Vacuum Therapy

o Injection Therapy

o Types of Implants

+ Rods

+ Multi-Component

+ Self-Contained

o Vascular Surgery

o Sex Counseling and Therapy

8. Choosing Your Treatment

9. Health Insurance and HMO's

10. Medicare Coverage

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Admitting Impotence to Yourself

A lot of men become sexually impotent, but never admit it to themselves.

Sadly, this denial prevents them from enjoying sexual activity on a regular

basis again. A man who behaves this way has a lot of company. Up to 30

million American men are impotent, but fewer than 5 percent have ever been

treated.

Ignoring the problem was normal behavior years ago, but today sexual

wellness is often viewed as an indicator of total health. As more men are

living longer, they have an interest in treating impotence. The pride

factor does not inhibit treatment as it once did. Today, there are many

effective treatments to choose from, both surgical and non-surgical. But

the first step is admitting the problem.

We begin by defining what impotence is:

Impotence is the inability to have an erection that is rigid enough and to

maintain it long enough to complete sexual intercourse.

If your erections do not become firm enough to allow vaginal penetration,

you are impotent. If your erections have the necessary rigidity, but are

only firm briefly, you may have an impotence problem. If your erection

loses its strength upon penetration, you probably have the problem. If any

of these scenarios fit you, it may be time to admit it and take the first

step toward a treatment that can change your life.

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Ask Yourself Three Tough Questions

The answers to these three questions may determine whether you should

seriously seek impotence treatment.

1. What is your degree of motivation? After long periods without sexual

activity, men and women fall out of the habit of having sex. Mere

curiosity about a particular treatment is not enough. To stand a

better chance for success, you should define yourself as eager or

extremely eager to resume sexual activity on a regular basis.

3. What is your willingness to learn new techniques? In order to

successfully use any of the treatments discussed here, a man must take

some physical action to make the erections happen. If you learn how to

perform this action, you should get a consistent erection every time.

Your willingness to perform this action and to work your way through

the learning curve is vital. If you resist using new methods to

achieve an erection, you will probably not be successful with these

treatments.

5. What is the degree of your partner's support? Asked more directly, the

question is, "Does your partner also want to become sexually active

again?" Is she willing to help you decide which treatment to use? Is

she willing to have sex with you using the treatment you both

selected?

Conviction, strong emotion and basic masculine motivation are needed to

resolve sexual dysfunction problems. If your three answers are negative,

you should lower your expectations of success with any of the impotence

treatments.

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How Do Erections Occur in a Potent Man?

[Image]Successful erections require the coordinated actions of a healthy

brain, pliable blood vessels, fully functional nerves, and certain

hormones. Erotic stimulation, triggered by the five senses or by memory,

begins the erectile process. The nervous system responds by sending

chemical messages to and from the pelvic area.

These messages cause the smooth muscle tissue inside the penis to relax.

The blood vessels dilate, allowing more blood to flow into the corpora

cavernosa, the two erectile bodies within the penis. Like sponges, they

capture more blood, swelling and lengthening the penis. When all of the

spaces are occupied with blood, the organ becomes rigid. The enlarged

corpora cavernosa take up so much space inside the penis that strong

pressure is exerted against the penile veins, greatly reducing their

outflow of blood.

At this point, the erect penis contains eight times more blood than the

same flaccid or non-erect penis. As long as the sexual stimulation is

continued, an erect stage can be maintained until orgasm and ejaculation.

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What Causes Impotence?

Impotence is not a disease, but a secondary condition brought on by other,

primary causes. It is a side effect, a symptom of something else. Thirty

years ago, when men went to their doctors asking for help for erectile

problems, they were told that there was no treatment because it was caused

by aging, or it was all in their heads (psychological). A generation of

research has been conducted in the intervening years. With more knowledge

now, doctors divide this very common disorder into four general causes:

1. Psychological

2. Physical (Organic impotence)

3. Mixed origin-both psychological and physical

4. Unknown origin

About 85% of this problem is due to a physical (organic) cause. Slightly

more than 10% is totally psychological, or "all in your head." The other 5%

is unknown. The 85% figure includes a mixture of physical impotence with

psychological involvement. Once a man fails to become erect a few times, he

places more stress on himself to have an erection by sheer will power. When

this too fails, he often begins to have a psychological problem.

The main point here is this: 85% of all impotent men are that way because

something within the body, other than the penis, is malfunctioning.

Psychological Impotence describes the problem when physical causes cannot

be found. Pure psychological impotence usually comes on suddenly. It can be

caused by job stress, a troubled marriage, or financial worries. Any

nagging everyday situation which occupies conscious and subconscious

thoughts can cause impotence. Depression or concern over poor sexual

performance can cause it.

It should be noted that every man experiences temporary periods of

impotence at one time or another during his life. That's entirely normal,

and you don't need treatment unless the problem is persistent.

Physical Impotence develops gradually and is characterized by any of these

three basic functional problems:

1. Failure to initiate results from impaired release of the chemical

messages sent by the nervous system. The inability to develop an

erection is common in cases of hormonal insufficiency, spinal cord

injury, radical pelvic surgery, multiple sclerosis and Parkinson's

disease.

3. Failure to fill results from poor blood flow into the penis. The

inability to develop an erection rigid enough for intercourse is

caused by blockage in the arteries, common in cases of pelvic trauma,

hypertension, smoking, diabetes and high cholesterol.

5. Failure to store results from venous leakage when blood escapes too

quickly from the penis, leaking back into the body. This inability to

maintain an erection rigid enough for intercourse is common in cases

of hypertension, smoking, diabetes, high cholesterol and pelvic

trauma.

The consensus of most authorities is that the table below represents an

accurate distribution of the various causes of physical impotence.

* The important thing to remember is that most causes of impotence are

physical and often beyond your control. While it is not good to have these

physical problems (diabetes, high blood pressure, stroke or prostate

disease, etc.), they are conditions you can probably accept and feel

comfortable about trying to correct.

* Diseases of the blood vessels (vascular disease) is the leading cause of

impotence. Vascular disorders include arteriosclerosis (hardening of the

arteries), hypertension, high cholesterol and other conditions which

interfere with blood flow. If poor blood flow occurs in the heart, or

coronary vessels, it causes heart attacks; when it occurs in the brain it

causes strokes; and when it occurs in the penis, it causes impotence.

* Another problem, "venous leakage," occurs when the penile veins are

unable to close off (constrict) properly during an erection. Constriction

of the veins holds the blood in the penis to maintain the erection. When

the veins "leak," blood escapes too quickly back into the body, and the

erection fails.

* Diabetes is a very common cause of impotence. This disease can damage

both blood vessels and nerves. When nerves are affected, the brain cannot

properly transmit the sexual stimulus that creates an erection. About 50%

of all diabetic men experience impotence after the age of 55.

* Radical pelvic surgery may also result in impotence. Surgical procedures

involving the prostate gland the bladder or colon may sever the nerves

involved in erectile response. Radiation treatment in this area can also

affect the erectile process.

* Neurologic (nerve) disease is another cause of impotence. Neurologic

disorders affect the nervous system and include multiple sclerosis,

Parkinson's disease and spinal cord injury with paralysis.

* Deficiencies of the endocrine system are another source of erectile

dysfunction. For example, low levels of testosterone or thyroid hormone

often cause poor quality erections. Excessive production of prolactin by

the pituitary gland may contribute to a low testosterone level and lack of

desire. Diabetes is also considered an endocrine disease.

* Prescription drugs often cause Impotence as a side effect, and over 200

medications fall in to this category. Never change a dosage or stop taking

a prescribed drug without the advice of your doctor.

* Substance abuse affects erectile function as well. Illegal drugs and the

excessive use of alcohol or cigarettes can seriously damage the blood

vessels and nerves involved in a normal erection.

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* The Logic to Use in Choosing A Doctor

Where do you go? What type of doctor diagnoses and treats impotence? How do

you get the best answer? Almost all erectile dysfunction in the USA is

treated by the six types of professionals listed below:

1. Family Practitioners

2. Urologists

3. Internists

4. Endocrinologists

5. Psychiatrists

6. Psychologists

Family practitioners, internists, and endocrinologists are primary care

physicians most likely to be your family doctor or principal physician.

This is the doctor you consult first about impotence. He or she knows the

most about your medical history and current condition. If he chooses not to

treat you, he may refer you to another physician who treats impotence

regularly. Many family doctors, however, are now treating this problem

using non-surgical treatments.

As surgical specialists of the genito-urinary system, urologists are

closely identified with impotence. Of about 10,000 urologists in the USA,

some 3,500 of them actively treat impotence.

Psychiatrists and psychologists may be consulted if your doctor cannot find

a physical cause for your problem. In many cases, a psychological aspect

develops after impotence has been present for a while.

Your doctor's job is to help determine, through simple tests, the cause of

your impotence, and to help you choose the simplest, safest and most

effective treatment.

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What Happens at the Doctor's Office?

The purpose of your visit to the doctor is to answer two questions:

1. Why am I impotent?

2. What can I do about it?

The second question assumes that you will be able to select from a number

of treatments. You could also choose abstinence. Though each doctor may

approach diagnosis and treatment differently, your physician will help you

understand the cause of your impotence and your options for dealing with

it. Remember it is your doctor's job to help you determine which treatment

option is best for you.

All physicians will first record your medical history, including

psychological and sexual aspects. They may ask about stress and fatigue and

about the relationship between you and your partner. Some questions may be

very person al, but your doctor needs to know about your present sexual

functioning in order to treat your impotence.

One sure question is, "Do you wake up in the morning with an erection?" If

you always wake up with an erection, your physical system works, and the

impotence may be psycho-logical. If you never wake up with an erection, it

suggests a physical problem with blood vessels or nerves.

Whether you start treatment with your family doctor or a urologist, the

initial approach will probably be conservative. Conservative, non-surgical

treatments for impotence have proven very successful, and most patients

find surgical treatment unnecessary.

In diagnosing your impotence, your doctor will first look for obvious

contributing factors. For instance, diabetes, alcohol abuse or prostate

surgery can cause impotence. "Short cut" diagnosing may be appropriate when

your medical history strongly points the way.

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The Family Doctor

After recording your medical history, a family doctor may do a complete

physical exam, including a rectal exam to check your prostate. He will also

check your genitals for abnormalities that could interfere with effective

treatment. For example, some men have Peyronie's disease, a curvature of

the penis caused by plaque formation. Certain treatments cannot be used if

the curvature is severe.

Of particular interest when diagnosing the cause of impotence are various

blood pressure readings, the results of blood tests, and an update on the

medicines you take.

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The Urologist

If your family doctor is not comfortable with treating impotence, he or she

may refer you to a urologist, who may prescribe any of the known treatments

for impotence. He or she may also do all the examining and testing already

mentioned, if not done by your family doctor. The urologist will conduct

additional, more sophisticated tests if you are thinking about a surgical

correction for your impotence.

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The Current Treatments for Impotence

A panel of experts met in Washington, D.C. in December 1992 to define the

state of the art in the diagnosis and treatment of impotence. In treatment,

they recommended that "as a general rule, the least invasive procedures

should be tried first." Their statement then listed current treatments in

this order:

1. Psychotherapy or counseling, if appropriate

2. External vacuum devices (such as ErecAid® System)

3. Penile injection therapy

4. Penile implant surgery

5. Vascular surgery

A few men may be helped by taking an oral drug like yohimbine, but

undesirable side effects may occur, and results are usually weeks away. A

few may also benefit from taking hormone medications, but unless the

hormone deficiency is severe, this treatment may not help.

Vacuum therapy with ErecAid® System, the original external vacuum device,

is probably the most widely recognized first-step treatment since it works

for all types of impotence and has minimal side effects. Even if other

non-invasive treatments, like yohimbine or counseling, are tried first,

vacuum treatment can be applied concurrently to get immediate results.

Penile injections have been used for over a decade with about a 70% success

rate, but many men express disdain for this treatment when they learn that

it involves a needle stuck into the penis. However, there are many

impotence clinics which specialize in this therapy.

Implanted devices, of course, involve surgery. Experts now believe that

this treatment, once considered as the "gold standard" therapy, should only

be done as a last resort, when the lesser invasive treatments have failed.

The placement of an implant permanently alters the interior of the penis.

If a pill is finally invented which cures impotence, it will surely require

healthy corpora cavernosa in order to work. An implant prevents this part

of the penis from being useful again.

The bar graph below shows the estimated percentages of men on various

impotence treatments at this time.

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Yohimbine Tablets

This natural aphrodisiac from the bark of the yohimbehe tree is sometimes

prescribed by doctors for men with intermittent erectile dysfunction. In

most of these cases, the physician suspects a psychological problem, but

cannot prove it. The drug is used to stimulate desire and improve the

quality of the erection. Dispensed in tablet form, yohimbine is taken three

times a day for 4-6 weeks to test its effect. Costs are about $40 a month.

Even if the tablets work, which they do in 15-20% of patients, stopping the

tablets may return the patient to his former state of impotence. Side

effects may include headaches, sweaty palms, dizziness, and nausea. Men

with ulcers or hypertension probably should not take this drug.

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Hormone Medication

A severe deficiency of the male hormone, testosterone, can cause impotence.

The nature of the treatment is to give the man either oral testosterone or

an injection in the arm or buttocks to raise the hormone to acceptable

levels. In these cases, the treatment can be an effective one. Only about

4% of the male population, however, have the problem and can benefit from

the treatment. Side effects of testosterone replacement therapy can be

serious, and patients with a medical history that includes liver disease,

heart disease, kidney problems, or prostate cancer should probably avoid

supplemental testosterone. This chemical can lead to the retention of

fluids, enlargement of the prostate, and damage to the liver.

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External Vacuum Therapy

This treatment is a simple, non-surgical method of producing a quality

erection. The external vacuum device was created by Geddings Osbon, in the

early 1960s, to solve his own impotence problem. He created the ErecAid®

System, based on negative pressure and tension rings, to produce and

maintain a naturally engorged erection every time one was needed.

The vacuum System (two versions are depicted) consists of a clear plastic

cylinder, a hand pump or battery pump, and a special tension ring. The user

stretches the tension ring around the open end of the cylinder, then

inserts his penis into that end. Holding the device firmly against his body

to form an air seal, he uses the pump to remove air from inside the

cylinder. This creates a partial vacuum around the penis, causing the

body's blood to enter the corpora cavernosa. This engorges the penis in a

way similar to a natural erection.

To maintain the erection, it is necessary to reduce the outflow of blood

from the penis. Therefore, while the penis is still under vacuum pressure,

the tension ring is pushed from the cylinder on to the base of the penis.

This breaks the seal of the vacuum, allowing the cylinder and pump to be

removed and laid aside. The user can maintain an erection for up to 30

minutes, wearing only the tension ring. This procedure, which takes about

two minutes, is used whenever an erection is needed.

The ErecAid® System has been effective for over 90% of men who have used

it. Men who have had their prostates removed are successful with it. Men

who have had penile implants installed and later removed can often use this

system successfully, as can men with blood vessel blockages. Psychological

patients are successful with it, as well as diabetics.

The manufacturer of the System polls new owners to determine the

effectiveness of the product. Over 200,000 men have been surveyed. When

questioned about the 6-month period just prior to acquiring the vacuum

System, 76% of the men reported that they had had no sexual intercourse or

very irregular sexual activity. After using the System for 90 days, 80%

said they were having sexual intercourse at least twice a month. Initially,

it takes practice to use the System. 42% of patients learn to use it in one

day, and 90% master it in two weeks. 69% can create a usable erection

within two minutes.

An unexpected statistic which emerged from the survey pertained to the

occasional restoration of natural erections. About one in four (26%)

reported that after using the System for a number of months, they were

sometimes able to have intercourse without using the device. This means

that the use of a vacuum device to force blood into the penis may have the

effect of bringing back some sexual power, some of the time. This was also

noted in a Case Western Reserve University Medical School study (Cleveland,

Ohio) in 1989-1990.

The most significant advantage of the ErecAid® System is that it works

without requiring surgery or a healing period. As such, it is non-invasive.

It is used on the body (not in the body), and can stay in a dresser drawer

or on a shelf when not in use.

Another advantage is cost. The hand-pump ErecAid® costs the patient $395,

and the battery model, $455. Most other impotence treatments are far more

expensive. The major components of both Systems have lifetime guarantees,

and medical insurance coverage is available in many cases.

A significant advantage is that the erections are of high quality, lasting

longer than natural ones, and they do not usually disappear after an

orgasm. Also, once the erection technique has been learned, the patient can

achieve reliable, consistent erections each time. The erection stops when

the tension ring is removed, recommended to be no longer than 30 minutes.

With some men, minor side effects can occur, such as petechiae and

ecchymosis. Petechiae are caused by placing the penis under negative

pressure too rapidly. Reddish pinpoint-size dots appear on the surface of

the penis. The penis may need to be reconditioned slowly after a prolonged

period of inactivity.

Ecchymosis is a bruise caused by the penis being held under vacuum pressure

too long. Neither condition is painful nor serious and does not need

treatment. They stop happening after a few uses. A final side effect is a

temperature drop of 1-2(deg)in the penis, caused by the tension ring. No

major injuries have ever been reported concerning the ErecAid® System.

This device may not be an appropriate treatment for men who have sickle

cell anemia, leukemia, or blood clotting problems. Proper use of it

requires some manual dexterity and average hand strength. All criticism of

these devices centers around the use of tension rings, and the loss of

spontaneity in lovemaking. Many men believe, however, that they are far

better sexual partners with the device.

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Penile Injection Therapy

[Image]Physicians learned in the early 1980s that some medications injected

directly into the corpora cavernosa would produce an erection within a few

minutes. Urologists now routinely use this method to treat men by teaching

them self-injection techniques to use at home.

Currently, three medications are used for this purpose. Papaverine was the

first one used. Phentolamine, an alpha blocker, was used second, initially

as an additive to papaverine, and later to prostaglandin El, the third

drug.

Papaverine and prostaglandin both act on smooth muscle tissue in the

corpora cavernosa, while phentolamine is more effective in the tiny penile

arteries to prolong the erection. Most doctors mix all three drugs

together.

Diabetic needles (27 or 28 gauge, a half-inch long) are used for these

injections. The patient must learn to inject the base of the penis using

less than 1 cc. Either corpus cavernosum may be injected but not the

urethra. Hand pressure is applied afterward for 2-3 minutes to prevent

bleeding. Ideally, erections will last 30-60 minutes and will become more

rigid if stimulation occurs.

With injection treatment, high quality erections are available on demand,

and they last longer than natural ones. The erection does not always

disappear at orgasm or ejaculation. Injections work in about 70% of all

cases. The 30% failure is often due to poor blood flow or venous leakage.

There are concerns with injections. The key ones are priapism, pain,

dropout rate, and cost. Priapism is the word to describe an unwanted,

prolonged erection. Injecting too much of the drug may cause an erection

which lasts much longer than intended. After four hours, men should seek

medical help for reversal of the erection. This is done by injecting an

adrenaline-like drug into the penis.

The pain from injecting is primarily from the needle puncture. Many men are

frightened to think of injecting the penis with a needle. This apprehension

may account for the high dropout rate for men on injections. A 1990 study

(University of Chicago) showed that 51% of the group dropped out after

receiving only a test injection. The average patient stayed in the study

group for seven months before leaving it. Other men, however, inject

successfully for years.

Depending on the exact mix of the drugs, an injection costs $5 to $15. If a

man is sexually active twice a week, the annual cost will range from $520

to $1560. Third-party insurers, especially Medicare, do not usually pay for

these treatments because the FDA has not approved the drugs for impotence

treatment, and is still considering using them for impotence treatment to

be experimental.

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Introduction to Implants

In 1972-73, physicians began doing penile implants to help with lost

potency. Over the years since then, three distinct types of implants have

been used. Today, surgeons implant about 20,000 of these devices per year

into American men who choose this treatment. Semi-rigid rods account for

about 35%; multi-component inflatable implants are thought to be 45% of the

total; and self-contained devices make up the last 20%. In all cases, two

synthetic cylinders are surgically placed inside the corpora cavernosa of

the penis. After 4-6 weeks, a man is ready to engage in sexual intercourse.

These devices are either mechanical, inflatable, or hydraulic. Their

implementation permanently alters the corpora cavernosa, ending all hope of

the return of natural erections, so this treatment should be considered a

final step, not an early one. There is also the usual risk of infection

with surgical procedures, and eventual malfunction or deterioration of the

device may require other surgeries.

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Semi-Rigid Rods

[Image]Two bendable rods have an outer coating of silicone and inner,

parallel, silver or stainless steel wires or interlocking plastic joints

held together by a cable. With this rod, the penis is always erect, but can

be bent down. To prepare for intercourse, the man simply bends the penis to

a "ready" angle.

The rate of complication is low and many of these rods are inserted as an

outpatient procedure with a local anesthetic. The surgeon's skill is

important since he has to properly "size" the implant to your penis. Cost

is approximately $6,000-$10,000, including the surgery.

Disadvantages are these: Because the penis is always erect, it is difficult

to hide under a swimsuit or tight-fitting clothes; the erection is due to

metal and silicone, not the flow of blood into the penis; and, finally, the

surgery is not reversible.

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Multi-Component Inflatable Implants

[Image]This implant has two or three components. Inflatable cylinders are

placed in the corpora, a fluid reservoir goes into the abdomen (or scrotum)

and the pump is placed in the scrotum. A squeeze of the pump moves fluid

from the reservoir to the cylinders, causing rigidity. Another pump squeeze

reverses this process.

A skilled urologist, using general anesthesia, implants this device for a

total cost of $12,000-$15,000. After 4-6 weeks of healing, the patient may

begin to use it. Mechanical failure or patient infection are the two most

common complications. Both can cause a need for more surgery. Key factors

are (1) the surgical procedure is not reversible, and (2) the erection

stems from saline solution, not the bloodstream.

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Self-Contained (Inflatable) Implants

[Image]Two cylinders are placed inside the penis. Each one contains a pump,

fluid, and release valve. A squeeze of the head of the penis forces a fluid

transfer to the forward chamber, causing rigidity. A certain bend of the

penis causes fluid to flow back into the storage area, ending the erection.

Using general anesthesia, a urologist implants the device for a total cost

of $10,000 - $12,000. After 4-6 weeks, sexual activity starts.

Complications: Device failure and infection. Important factors are (1) this

is not reversible, and (2) the erection is from saline solution and plastic

parts.

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Vascular Re constructive Surgery

Penile surgery of this type is like heart bypass surgery, which reroutes

the blood supply around blockages. Fewer than 1% of impotent men are

candidates for this procedure, and the failure rate is very high.

Venous ligation is a penile surgical procedure in which the surgeon

attempts to repair the veins causing venous leak. This procedure was

popular until physicians began to realize that it offered only a temporary

solution. Many patients required another operation within a few years.

These procedures cost about $15,000 and should only be done by surgeons

experienced with the procedures, preferably in an investigational setting.

Complications may include: permanent numbness near the incision and scar

tissue which may shorten or "torque" the penis. Also, the surgery may need

to be repeated.

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Sex Counseling and Sex Therapy

Sex counseling refers to consultations with a qualified counselor who helps

the couple to identify, understand, and cope with their sexual concerns.

Sex therapy is more structured in that it uses counseling, but also

includes a time element and specific exercises for the couple. Exercises

are meant to remove stress from areas of the relationship that influence

sexual function. They may include sexual touching and other sexual

exploration.

When the cause of impotence has a strong psychological involvement, sex

counseling or therapy can be very effective. Couples should seek this

therapy only from a trained professional with a good reputation.

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Which Treatment Should I Choose?

Several factors must be considered in selecting a treatment. A few of them

have been outlined below.

Partner's opinion. Ask her to go through this booklet with you. Ask her to

visit the doctor with you. Does she lean toward one treatment more than the

others? If you are young with no partner, you may be happier with implants

and injections.

Frequency of sexual activity. Will sex be performed twice a week, twice a

month, or twice a year? Select a therapy which is consistent with the

estimated amount of use.

Must you change the way you live? A permanently erect penis (semi-rigid

rods) may keep you out of a swimming pool forever. Ask your doctor about

any compromises you may have to make.

Treatment sequence. The best way to look at impotence therapy is that the

simple, inexpensive, reversible treatments should be tried first, while the

more complex, expensive, non-reversible treatments should be attempted

later. The ErecAid® System, yohimbine tablets, and sex therapy might be

tried earliest since all are relatively inexpensive and reversible. Last on

the list are injections, vascular surgery, and implants. All of these are

invasive therapies which cause internal changes in the penis. If some new

treatment appears in the future which requires the corpora cavernosa to be

healthy, you probably will miss out on it if you have permanently altered

the erectile bodies.

What are the odds of re-operation? Ask your physician about the odds of

having repeat surgeries. Ask about the failure rate of the implant he is

recommending. Ask about the failure rate of the various vascular surgeries.

Injections may only be temporary. The majority of men choosing injections

have switched to another treatment within one year. Ask your doctor why.

Ask about "fibrosis" caused by the frequent needle punctures. Make sure you

know about "priapism" and how it is reversed. Learn about how the body can

develop a tolerance to the drugs, making you use larger and larger doses.

ErecAid® System in a backup role? A large number of patients select the

ErecAid® System as their primary treatment. But it should be noted that

some men use the System along with injections. Why? By using a tension

ring, it is possible to inject less drug to get a good result; also, the

two treatments can be alternated so that the weekly limit of two sexual

encounters can be exceeded. An ErecAid® System is also sometimes used to

enhance the rigidity of an implant. This is a safe practice for rod

implants, but becomes riskier with the inflatable models.

Financial considerations. What is the out-of-pocket cost of the treatment

selected? How much will health insurance pay for? What are the guarantees

or warranties of the treatment chosen?

Maintenance costs. Ongoing costs for treatment must be identified. For

example, yohimbine tablets have an ongoing cost, as do penile injections.

Safe and effective treatment? Has the chosen therapy received FDA marketing

approval? Have clinical studies been performed for this treatment? Is the

treatment backed up by a reputable provider, with liability insurance?

Physician, heal thyself? A medical publication asked urologists, in 1990,

how they would treat themselves if they became impotent. The question was:

If you or a close family member suffered from erectile dysfunction, which

treatment would you choose/recommend as the first step?

The answers came back as follows:

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Health Insurance and Impotence

Insurance companies will generally pay for impotence treatment when the

cause is physical. Your physician must specify on the claim form the

physical cause of your impotence and that your treatment is "medically

necessary."

If your physician diagnoses a psychological cause, many insurance companies

will deny the claim, unless state law mandates limited coverage. Some group

policies exclude coverage for impotence of any type.

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Health Maintenance Organizations (HMOs)

Most HMOs consider sexual health to be an integral part of an individual's

total health, so they will generally provide treatment unless there is an

exclusionary clause in the patient's contract.

HMO physicians generally try to guide patients to the most effective

treatment at the lowest cost. For this reason, external vacuum devices are

usually favored because of the high success and relatively low cost.

Penile injections and implants are used less often. The initial costs for

penile injections are relatively low, but costs accumulate as long as the

patient is sexually active. Penile implants, with higher initial cost and

higher risk of complications may be considered for payment by the HMO only

after the patient has tried more conservative treatments.

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Medicare and Impotence

Medicare coverage is divided into Medicare "A," which covers surgeries,

hospital stays and the more costly medical services; and Medicare "B,"

which covers doctors' office visits, medical devices and the less costly

items and services.

If you have FICA taxes deducted from your paycheck, you will be covered by

Medicare A at no charge when you reach 65. Medicare B costs about $30 a

month and may be deducted from your Social Security check.

Surgical treatments for impotence are usually covered by Medicare A in most

states, as long as your doctor verifies a physical cause of the impotence

and states that the treatment is "medically necessary." Vacuum devices are

covered under Medicare B. Penile injection therapy is not covered since the

drugs used for injection have not yet been approved by the FDA as a

treatment for erectile dysfunction.

As of late 1993/early 1994, Medicare is reimbursing for external vacuum

devices under Medicare B. With a valid prescription, you may obtain a

vacuum device from Medic Drug, a medical

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Knowing your interest in the latest medical advances, we wanted to

share with you information about The Upjohn Company's new product,

CAVERJECT Sterile Powder (alprostadil for injection), which is now

available. As the first pharmacological agent indicated for the

treatment of impotence, CAVERJECT provides an effective option for men

suffering from impotence.

Impotence is the inability to achieve or to sustain an erection

adequate for sexual intercourse. It's a common, treatable condition,

yet over 90% of affected men never receive treatment. This is because

often they're reluctant to discuss the subject with their doctor.

Until recently, many health care professionals believed impotence was

psychological. Patients were often told, "It's all in your head."

Today, experts have learned that up to 75% of impotence cases aren't

psychological in nature. Impotence is often a symptom of an underlying

physical condition and can be medically treated.

Most men experience occasional impotence at some time, usually as a

result of fatigue, temporary stress, or excessive alcohol consumption.

Temporary impotence is not something to worry about. However, if the

condition persists or interferes with your normal sexual activity, you

should consider seeing a doctor who specializes in treating impotence,

typically a urologist.

Impotence can now be managed effectively with CAVERJECT which is

indicated both for the treatment of impotence due to neurogenic,

vasculogenic, psychogenic, or mixed origin and as an adjunct in the

diagnosis of impotence. CAVERJECT contains alprostadil, the naturally

occurring form of prostaglandin E (PGE), and normally induces an

erection within 5 to 20 minutes, once the optimum dose has been

established. The dose must be individualized for each patient by

careful titration under physician supervision. (See DOSAGE AND

ADMINISTRATION section of the prescribing information.)

The activity of CAVERJECT is localized to the penis. Mild to moderate

penile pain, generally well tolerated, is the most frequently reported

side effect of injection, occurring in approximately one third of

patients. *CAVERJECT is contraindicated in men with a known

hypersensitivity to the drug or conditions that might predispose them

to priapism, and in men with penile implants or anatomical deformities

of the penis.

I hope this information has been helpful to you. Please feel free to

*Among patients reporting pain, not every injection was associated

with it. Of 21,490 injections studied, 11% were pain related.

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