Frequently Asked Questions It may surprise you that over 30 million men have trouble with erections. 30 million!! That's no laughing matter . . . and when you think that today there are more choices and treatment options than ever before it's a wonder more people still don't seek help. In the following pages we will try to share some of these options with you and answer the questions you so frequently ask. The Florida Center for Impotence (FCI) was established with you in mind. Our facility has the most up to date diagnostic technology to determine the cause of a patient's individual problem. Our staff is highly trained. We not only seek to make sure our patients receive the finest care but we realize, above all, the discreet nature of the problem! The professional atmosphere, the excellence in our doctors training and our experience has maintained our leadership in this field for over 14 years. WHAT IS ERECTILE DYSFUNCTION . . . IMPOTENCE? Whatever you call it, the problem deals with the inability to achieve an erection strong enough and long lasting enough to fulfill the sex act. An erection that never gets rigid enough for penetration, or one which is lost before it should be . . . these are typical complaints we hear from men who have, or are starting to have, erectile dysfunction. Terms like premature ejaculation or delayed ejaculation are erectile dysfunctions but are different than impotency in that "control over the ejaculation" is the main problem, as opposed to the inability to get an erection. WHAT CAUSES IT? The usual culprit is a lack of blood flow. Peripheral vascular disease, hardening of the arteries, high blood pressure, diabetes. These are all very common diseases and tend to occur with advancing age. A brief understanding of how an erection occurs may help to explain what may cause the problem. An erection occurs when the penis fills with blood. Actually there are two cavities within the penis that have a tough outer capsule and these fill with blood under pressure. (This outer capsule is similar to the covering of an inflatable raft used to go down a river . . . you can fold it for storage yet it gets hard enough, when properly filled, to go down the grand canyon!) When a man becomes sexually aroused, the small blood vessels that are supplying these cavities become aroused as well and allow filling to occur. If there is trouble with hardening of the arteries or other disease that can affect the blood vessel (high blood pressure or diabetes are examples) you can be sure these tiny blood vessels will be affected. People with a history of heart attacks, bypass surgery or diabetes have up to a 50% chance of impotency. IS IT IN MY HEAD? Not too long ago most men were thought to have a psychological basis for their impotence. Depression, anxiety, nerves, stress . . . all these seem to affect everyone at one time or another. So, what is actually causing the problem? After much study, we know that most of the time the issue is physical, and not mental! Most often there is a blockage of the blood supply to the penis or a similar mechanical problem, instead of an emotional basis for the impotency. Your specialist at FCI is well trained to pick out the salient points from his discussion with you to decide the cause of your problem and to advise when further testing is needed. HOW STRESS AFFECTS POTENCY? How many people do you know who can still maintain an erection when the telephone rings, the doorbell rings or when a child walks in. Not many! These events are all examples of a stress. Now lets say you have a report due in the morning, you're having trouble at your job or your having problems with your marriage . . . more stress but in a more drawn out way. Anything that gets your nerves going can directly block the erectile process. This is natural and appropriate behavior (and probably helped the cave man when he needed to run from danger!) Another problem can arise which will complicate matters even more . . . lets say you have a problem with potency one evening. You try again the next night and the same problem happens again. Well . . . you'd better do it right on the third try or don't bother coming home!. This is performance anxiety and it is the Catch-22 of stress and sex. The more you try, the more futile is your ability to get an erection . . . the stress of having sex makes you impotent. With subsequent attempts you are reminded of the past failures and down it goes. The more you try, the worse it seems. Your doctor can help you unravel the problem. Sometimes a medication can help. Just remember, you're not alone and your doctor is well trained to see that you get back on course. WHAT ABOUT THE PILLS I'M TAKING? Definitely, medications can cause impotence. Its not a simple matter however. Since you were put on the medication for a reason, stopping the medication may create another problem. Typically, blood pressure pills, stomach ulcer medication and antidepressants are the typical culprits. However, there are many more. Often, we can recommend an alternate drug to help matters and make suggestions to your other physicians. CAN SURGERY CAUSE IMPOTENCE? Yes, although its not very common. Remember that a sequence of events must occur in order to have an erection. Lets go through it: 1 Sexual stimulation (visual, thoughts etc.) 2 Brain triggers nerves down in pelvic area 3 Nerves cause blood vessels in the penis to dilate and channel blood flow. 4 Penis becomes rigid . . . etc., etc., etc. Now if surgery or other conditions injure the nerves to the penis or blocks the supply of blood to the penis . . . well, you get the idea. HOW DO YOU TREAT IMPOTENCE? There is no simple answer. Obviously it starts with finding the cause. The cause of impotence is found during your meeting with the doctor. STEP ONE. This is always the hardest part. Oh, The doctor visit is a breeze. Its realizing that you have a problem and making a call.... that's the hard part. A potency problem can usually be treated safely and easily! Generally speaking, there are 5 common options in treating impotence: medication psychological counseling vacuum devices injection therapy penile implants MEDICATION: There are no pills that will create an erection, sorry. No vitamins, powders, or potions for that matter. Certain medications can prolong an erection or delay ejaculation but these are of no benefit if your problem, like most, is of a physical nature. Hormone replacement by an injection in the buttocks is useful if the problem is a very low hormone level. Men with this problem typically will have lost their LIBIDO . . . sex drive. PSYCHOLOGICAL COUNSELING: This doesn't mean you're crazy. On the contrary, Many cases of impotence, where stress is involved, occur in men with recent deaths in the family, or in situations of stress such as when one loses a job. When it's obvious your life isn't what it once was, a good counselor can make a tremendous difference. VACUUM DEVICE: (Pumps) This is a means of mechanically drawing blood into the penis by means of a specially designed device that fits like a tube over the penis. Shaped like a tennis ball canister, the penis is placed inside and a hand or small battery operated pump is used to create a suction. The suction literally draws the penis out, filling it with blood and ultimately causing it to become erect. At this point a special rubber ring is slipped onto the penis, trapping the blood inside. It works! You then have intercourse with the ring on for up to half an hour. Ejaculation is not usually impaired; although a slight restriction is usually felt. It takes a few minutes to get started, so spontaneous sex is a little delayed. Again, it works and its simple, non invasive, and involves no surgery. Usually anyone except those on blood thinners can use the pump. INJECTION: Sounds a little scary at first but it's remarkably safe and easy. Just as a diabetic uses an insulin needle several times a day, this same type of needle can be used to inject a small amount of medicine for a painless and predictable erection! The needle is placed at the base of the penis, close to the body, on the side of the shaft. There isn't anything to really hurt yourself with at this point of the penis and believe it or not, it is not a very sensitive area. Your doctor will teach you how to do it . . . sometimes a spouse can be taught, as well. The dose and type of medication may vary with each patient. A small test dose is given during the first visit, followed by varying subsequent doses for the following visits depending on your response. Never give more than one injection per day and a maximal use of every other day is recommended. Three medications are in common use nowadays . . . Prostaglandin E1 (Caverject) is used most often. These drugs can be used in combination or individually, depending on the doctor, as each drug has its own side effects. Generally, beyond the routine risks of any injections (hematoma, infection, allergic response...all are rare) there are basically two concerns. A firm area may eventually form along the shaft after multiple injections (this occurs very infrequently, perhaps in one man in a hundred). It may develop from injury or bleeding at the injection site, or it may be a response to the drug. The other concern is a prolonged erection. You might say " terrific!! " but actually its a problem that requires a return trip to the office for an antidote injection. This problem is also very rare, and occurs in far less than one in ten patients, and it is usually going to occur during the first visit. Once the dose is adjusted ,the risk of the prolonged erection is very rare and by the second or third office visit the patient should feel confident that if he wants to go on a cruise or travel he can safely go and enjoy..... with the injections of course! The injection technique works. It is predictable, and most of all ..... it feels like a good erection. The injection technique using prostaglandin has F.D.A. approval. Safety and efficacy has been established, as long as the technique is properly taught and observed. Medications, such as blood thinners, heart medications or blood pressure pills are generally not affected by the injections, and these medicines can be used in conjunction with injection therapy. PROSTHESIS: (Implants)Yes, its a surgical procedure, but the techniques are usually outpatient and as far as the results are concerned... spontaneity is not a problem! Two types are used: inflatable implants and those that are semi-rigid. The inflatable ones have the advantage of deflation, i.e. you look more natural when not erect. The semirigid rods will fold down when not erect so as not to cause an embarrassment. They also have fewer mechanical parts to cause potential problems down the road. The inflatable type has a small grape-sized pump that fits in the scrotal sac ,under the skin.When ready, you feel around for the pump and then squeeze a few times to fill the two inflatable cylinders in the penis. The parts are all below the skin, of course, and once the cylinders are filled an erection is, well, inflated, so to speak. You feel the same, have the same orgasm and urinate the same as before. Obviously this is more invasive than any other treatment and has inherent risks of infection, mechanical problems etc. These prosthesis have been around since the 1970's and have gone through many improvements over the years. Problems common years ago seldom occur nowadays and there is a patient satisfaction rate of up to 90%. WHICH THERAPY IS THE BEST? The choice of therapy will depend on a variety of factors. If a psychological factor is not the problem and hormone levels are in the normal range, its usually narrowed down to vacuum pump, injection or prosthesis. The most "natural erection" is by use of the injection technique. The prosthesis offers the most spontaneous result in that you don't need to leave for the bathroom. The pump is least spontaneous but avoids the needle factor and any implant procedure. Your doctor is able to listen to your needs and wishes and decide with you what will be best for you! At the Florida Center for Impotence we have treated hundreds of satisfied patients who have turned around their lives by taking care of their potency problem. Its easy and safe and only takes a phone call. Just think what it can do to rekindle the romance in a relationship. ITS NEVER TOO LATE TO START. We have treated men in their 80's, as well as men with cardiac bypass surgery cancer, diabetes, high blood pressure and other conditions. ALL IN ALL, THERE ARE MORE OPTIONS TO TREAT IMPOTENCE TODAY THAN EVER BEFORE. SAFELY, SIMPLY AND EFFECTIVELY!!! BUT YOU NEED TO TAKE THE FIRST STEP...... JUST CALL FOR AN APPOINTMENT TO SEE IF YOU MAY BE ABLE TO RESTORE YOUR POTENCY. WHAT DO YOU HAVE TO GAIN??? MORE JOY OUT OF LIFE...