Subspecialty Areas » Impotence

Overcoming Impotence

John is a successful businessman. He is happily married and has two children. He is 50 and in the prime of his life, but he has a problem. John has erectile dysfunction (impotence)—he can't maintain a rigid erection during sexual intercourse. John is frustrated, and worried that something is seriously wrong. He feels inadequate, embarrassed, that he is not a man anymore. He doesn't know where to turn; his worries are starting to interfere with his business and family life.

John is not alone. Roughly 30 million American men are impotent. Many are too embarrassed to ask for help, and others have received advice or treatment that was unsatisfactory. Impotence can occur at any age, and at any time in a man’s life. The myth that impotence is “all in your head” has finally been shattered. Medical research has proven that impotence usually stems from a physical cause. The good news is that impotence can be reversed. Virtually all impotent men can be successfully treated.

Each year hundreds of men visit the Philadelphia Impotence Foundation to find a solution. Our confidential evaluation can determine the cause of their impotence. We explain the medical and surgical treatment options, and choose the best options available. And they return to their partners, ready and capable of enjoying a full and satisfying sexual relationship.

The important thing is to overcome your embarrassment, and get the help that you need. Imagine how much enjoyment you could experience, once your sexual capabilities have been restored. Our patients trust and depend on us because of our experience and reputation. Our medical director is an internationally-known, Board Certified Urologist who specializes in the treatment of impotence. Why wait any longer? The end to impotence and the beginning of a satisfying sex life is as near as your telephone. To schedule a confidential evaluation, or get a second opinion, call us today.

Bruce B. Garber, MD, FACS
The Philadelphia Impotence Foundation

What is impotence?

Impotence (erectile dysfunction or “ED”) is the inability to obtain or maintain a penile erection that is rigid enough for satisfactory sexual relations.

How do normal erections occur?

When an erection is desired, the brain sends a signal through the penile nerves. This signal tells the penile arteries to allow blood to flow into the penile erection chambers. The venous valve system then closes, trapping blood within the penis and allowing it to become rigid.

What are the causes of impotence?

Psychological impotence may be due to a man’s fear that he will not be able to perform sexually (“performance anxiety”). This can be triggered by one incidence of sexual failure caused by fatigue, guilt, or too much alcohol. Other problems such as depression or stress can also play a role.

Physical impotence is by far the most common finding. Abnormalities of the penile arteries, veins, and smooth muscle are the most common causes. Risk factors include advancing age, years of cigarette smoking, high cholesterol, high blood pressure, obesity, “poor circulation,” heart disease, and diabetes. Men with diabetes have a very high chance of becoming impotent, often at a surprisingly young age. Other physical causes include pelvic surgery, radiation therapy, prostate cancer, nervous system diseases, and hormonal imbalances. Many men with physical impotence develop performance anxiety, making a bad situation worse.

How are the causes determined?

To diagnose the causes of impotence, a detailed medical and sexual history and physical examination is required. Blood and urine tests are needed, to measure your hormone levels and to check for diabetes and prostate cancer. Completion of a simple, validated questionnaire such as the International Index of Erectile Function is helpful. Measurement of nighttime erections and/or penile blood flow is indicated in some patients.

How is impotence treated?

The Philadelphia Impotence Foundation offers successful treatment options for virtually all impotent men. We regularly review the medical literature and the Internet for the latest impotence treatments. Recognizing that many of our patients come from a distance, we try to condense the diagnostic procedures and simplify the treatment. Our goal is to restore your sexual capabilities as quickly as possible, minimizing out-of-pocket expenses.

Impotence treatments that are currently available include the following:

1. PDE-5 inhibitors. Viagra®, Levitra®, and Cialis® have revolutionized the treatment of erectile dysfunction. These FDA-approved medications improve penile rigidity in more than 50% of men. However, they are not an effective treatment for all men! Some men develop side effects; others do not get a good erection with these medications. Some men can’t take them because they use nitrates or alpha-blockers; others find these medications are too expensive.
2. Testosterone supplements. For men whose impotence is due to a low testosterone level, testosterone patches and gels are available. This treatment will raise your male hormone level, and has replaced the testosterone shots used previously.
3. Penile injection therapy. Caverject® and Edex® (alprostadil) are FDA-approved medications which can produce an erection when injected into the penile erection chambers. Some men find this to be a satisfactory solution to their erection problems, but penile injection therapy is often somewhat painful. Many men discontinue penile injection therapy after a period of time.
4. Vacuum constriction devices (VCD’s). VCD’s consist of a plastic cylinder, a vacuum pump, and a constricting band. VCD’s have been improved over the years, and are a satisfactory solution for some men. However, many men find these devices cumbersome and messy. They require the use of a constricting ring at the base of the penis, which cuts off penile blood flow and can block ejaculation.
5. Trans-urethral medications. MUSE® (a small alprostadil pellet) is inserted directly into the penile urethra to produce an erection. This method uses no needle, and is a successful treatment for some impotent men. However, this approach is less successful than injection therapy, and may cause urethral burning and bleeding.
6. Penile implants. Penile implants are often selected by men who do not respond to simpler treatments. Inflatable implants give the most natural-appearing erection, and have been available for more than 25 years. Implants are placed into the penile erection chambers and surrounding tissues, and are completely internal. After you have healed, the penis and scrotum look normal. These implants give a stiff, reliable erection when inflated, and a natural-appearing penis when deflated. With a penile implant, you can have sex as often as you like, and for as long as you wish. An implant not only restores erections, it can also restore a man’s sexual confidence, which is a tremendous benefit. Many insurance plans cover a penile implant procedure.
   
   (Click here to view photos of a penile implant surgical procedure, Figures 1-13)
   (Click here to view photos of men who have an inflatable penile implant, Examples 1-5)
   (Click here to view an implant animation video)

Internationally-known surgeon

Dr. Garber has developed special expertise in the medical and surgical treatment of male impotence. Dr. Garber’s professional and personal dedication to the treatment of impotence led him in 1987 to start The Philadelphia Impotence Foundation. He is internationally recognized for his work with penile implants, and has over 20 years of experience. His reputation as an expert surgeon has brought Urologists from throughout the United States to Philadelphia for training in penile implant techniques, and prompted Mentor Corporation to film Dr. Garber’s techniques for worldwide distribution. Most recently, the distinguished journal Expert Review of Medical Devices asked Dr. Garber to write a review of inflatable penile implants, which was published in 2005, and updated in May of 2008. If you read these articles, you will become very knowledgable about penile implants.

(Click here to view the 2005 article as a PDF download)
(Click here to view the 2008 article as a PDF download)

In addition, after successfully completing more than 2000 inflatable penile implant procedures, Dr. Garber received an award from COLOPLAST Corporation. There are very few Urologists anywhere in the world that can offer this degree of experience to their patients.

A brief list of Dr. Garber’s impotence-related publications is as follows:

1. Garber, B.B. 1989. Mentor GFS penile prosthesis-initial experience. Abstracts, Mid-Atlantic section, AUA, p. 96.
2. Garber, B.B. 1993. Penoscrotal or infrapubic approach: which is better? Mentor Urology Issues and Answers, volume I, issue 1.
3. Garber, B.B. 1994. Mentor Alpha I inflatable penile prosthesis: patient satisfaction and device reliability. Urology 43: 214-217.
4. Garber, B.B. 1994. Mentor Alpha I inflatable penile prosthesis: patient satisfaction and device reliability. Journal of Urology 152: 1662.
5. Garber, B.B. 1995. Mentor Alpha I inflatable penile prosthesis cylinder aneurysm: an unusual complication. International Journal of Impotence Research 7: 13-16.
6. Garber, B.B. 1995. Retraction method for implantation of penile prosthesis. British Journal of Urology 76: 411.
7. Garber, B.B. 1996. Inflatable penile prosthesis: results of 150 cases. British Journal of Urology 78: 933-935.
8. Garber, B.B. 1996. Intracorporal lengths of organically impotent men. International Journal of Impotence Research 8: 259-260.
9. Garber, B.B. 1996. Guide to outpatient penile implant surgery: a review of evolving trends. American Medical Systems publication #23600018.
10. Garber, B.B. 1997. Outpatient penile prosthesis insertion. Urology 49: 600-603.
11. Garber, B.B. and Marcus, S.M. 1998. Does surgical approach affect the incidence of inflatable penile prosthesis infection? Urology 52: 291-293.
12. Garber, B.B. and Marcus, S.M. 1999. Does surgical approach affect the incidence of inflatable penile prosthesis infection? Journal of Urology 161: 1727.
13. Garber, B.B. 2003. Inflatable penile prosthesis: site-specific malfunction analysis. International Journal of Impotence Research 15: 22-25.
14. Garber, B.B. 2003. Inflatable penile prosthesis: site-specific malfunction analysis. Journal of Urology 170: 680-681.
15. Garber, B.B. 2005. Inflatable penile prostheses for the treatment of erectile dysfunction. Expert Review of Medical Devices 2(3): 341-350.
16. Garber, B.B. 2008. Inflatable penile prostheses for the treatment of erectile dysfunction: an update. Expert Review of Medical Devices 5(2): 133-144.

TEACHING VIDEOS:

• Mentor Alpha I inflatable penile implant: infrapubic technique, by Bruce B. Garber, MD. Distributed by Mentor Urology, Santa Barbara, California, 1998.

It is estimated that less than 5% of impotent men get help for their problem. Isn’t it time to let impotence end, and a full life begin? Don’t wait any longer—help is only a phone call away.

Bruce B. Garber, MD, FACS
The Philadelphia Impotence Foundation
Box 686
Bryn Mawr, PA 19010
Phone: 610-613-9251