Erectile Dysfunction | Dr. Andrew Y. Sun

Erectile Dysfunction

Help restore your confidence and improve your performance through various treatment options.

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What is Erectile Dysfunction?

Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection. Though most people think that ED only affects older men, the incidence of ED is actually much higher than you might think – roughly the same percentage as a man’s age. That means approximately 30% of men at age thirty have some degree of ED, rising up to approximately 70% of men by age 70.

How Erections Normally Happen

To understand erectile dysfunction, let’s briefly review how erections normally happen. In response to stimulation (visual, mechanical, psychological, etc), neurotransmitters in the brain send a message to the penis to make more of a molecule called Nitric Oxide. This Nitric Oxide causes the blood vessels in the corpora cavernosa (the two “erection” chambers on the top of the penis) and erectile tissue in the penile head to open up, bringing in more blood flow, which generates the erection. This erection is then usually sustained until ejaculation, at which time the pressure in the penis decreases, allowing the blood to leave the penis and relaxing the penis back to its normal, flaccid size and shape.

There are many components that must function properly in order to make this complex chemical cascade work. All four of these must function properly in order to achieve good erectile function:

Blood Vessels
Nerves
Hormones
Psychology

Not surprisingly, many things can affect these components, such as:

Nerve damage
Vascular disease / reduced blood flow to the penis
Diabetes (which causes blood vessel damage and nerve damage)
Venous leak (vein leakage)
Pelvic trauma
Damage from surgery or radiation therapy
Peyronie’s disease (scarring of erectile tissue)
Certain prescription drugs
Psychological conditions and stress

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30%

of men at age thirty have some degree of ED, increasing to 70% by age 70.

96%

Satisfaction in using penile implants as treatment for erectile dysfunction. (highest of all ED treatments)

Signs and Symptoms of Erectile Dysfunction

Unfortunately, psychological stress and ED operate in a vicious cycle with each other. Every man knows that psychological factors can have an impact on their erections. Additionally, men suffering from ED often experience negative psychological side effects as a result of their ED. They may have low self-esteem or feel inadequate as a sexual partner. Partners of men suffering from erectile dysfunction may also feel the emotional strain of the diagnosis.

Inability to achieve or maintain an erection

Low self-esteem or feeling of sexual inadequacy

Treatment Options for Erectile Dysfunction

If a patient suffers from erectile dysfunction because of psychological issues, they often have success through visits with specially trained sex therapists. Although we urologists cannot claim to be experts in the psychological causes of ED, we certainly have a variety of treatments that can help to improve the biology of erectile function. In counseling my patients on how to treat the penis – we divide therapy into a bunch of “P’s”:

Prevention (diet, exercise)
Pills (eg. Viagra, Cialis, Levitra etc…)
Pulses (shockwave)
Pokes (injections)
Pumps (vacuum devices)
Procedures (penile implant)

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Let’s examine each of these in a bit more detail, shall we?

Oftentimes, erectile dysfunction can be a sign of underlying disease conditions, such as diabetes and high blood pressure. Anything that impacts the function of the blood vessels (high blood pressure, high cholesterol), nerves (diabetes), or hormones (low testosterone) can have a negative impact on erectile function. Sometimes, ED is the first outward sign of these chronic conditions! To properly treat ED, understanding the underlying cause can be helpful.

Specific laboratory tests may be performed to determine the cause of erectile dysfunction including:

Blood Tests – These tests may involve checking hormone levels like testosterone, cholesterol, blood sugar, liver and kidney function, and thyroid function.
Urinalysis – Used to analyze protein and sugar levels that can indicate diabetes or kidney problems.

Ben Franklin said “an ounce of prevention is worth a pound of cure” – he was talking about fighting fires in Philadelphia, but the same is most certainly true for the penis. The first step in ED treatment is optimizing your lifestyle factors, controlled diabetes and high blood pressure, and aerobic exercise! A healthy body equals a healthy penis. If your body is unhealthy, how can you expect your penis to be happy?

For most patients, oral medication is usually the first step, and can include pills (such as Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil), or Stendra (avanafil)). Some medications work better than others for specific patients, and each have their plusses and minuses. To complement medical therapy, we will sometimes advocate for the use of certain vitamin supplements which have been shown to help improve erectile function. While there are a lot of advertisements out there for products of dubious scientific value, there are several supplements that have legitimate scientific data supporting their use in ED, and we will sometimes advise our patients to add these to their regimen.

The newest and most exciting option for men with ED is Low-intensity shock wave therapy (LiSWT). This technology comes out of Europe and may be able to truly restore blood flow to the penis, making it a very attractive option indeed. Unfortunately, too many unscrupulous actors have capitalized on the legitimate science behind LiSWT to market and sell “acoustic wave,” “gainswave,” and “radial wave” therapies at exorbitant prices – promising men the world while using devices that have absolutely zero scientific evidence to support them. Long story short – the positive data for LiSWT uses a very specific and specialized technology called “focused linear shockwaves” that must be delivered from a specific FDA Class III machine. Here at UPNT we offer this treatment using the best-in-class Storz Duolith SD-1 device, the technology that has been most studied and validated in extensive clinical trials. This has been a powerful addition to our arsenal in the treatment of ED and we have seen outstanding results in our patients. Do not be fooled by advertisements offering other similar-sounding technologies as these are often delivered from FDA Class I generators. For reference, this is the same classification as an electric toothbrush, and about as useful!

For patients who don’t respond to oral medication, the next step is to deliver a stronger dose of a medication directly to the target – in this case the penis. Unfortunately, the best way to get a dose of medication into the penis is by sticking it with a needle – something that no man is particularly excited to do. In all fairness, injections work quite well: 3-4x more effectively than pills, and they really don’t hurt…much. But there are some notable downsides such as bruising, scaring, and a general lack of spontaneity. To be honest, the biggest criticism of injections is not the needle poke – it’s all the logistics surrounding the event. The inevitable “hey baby, hold on a sec” while the man goes to the fridge, gets the medication, draws it up, injects, masturbates furiously for a few minutes (injections take about 3-5 min to work) while hoping that the mood is still there….you can easily see how this is suboptimal. Still, this has been a mainstay of ED therapy for 40+ years, is highly effective, and even though it is not covered by insurance, it is quite affordable – maybe $5-10 a shot. Medication can also be delivered using a jelly shot up the urethra (where you pee from) but this proves to be a unpopular option due to the pain associated with it.

In the treatment of ED, an old standby is the vacuum erection device (VED). Invented by a Ford auto worker in the 1960s, this is essentially a tube that is placed over the penis, and a pump which generates negative pressure inside the tube, drawing blood into the penis, and creating an erection. Often these are paired with a constriction ring placed at the base of the penis to trap the blood flow. While I am a big proponent of VED therapy as applied to penile exercise and rehabilitation after pelvic surgery, admittedly it is not the most popular option for patients to achieve an erection suitable for penetrative intercourse. Still, some men find this to be a helpful adjunct to their ED strategy and fortunately they are relatively inexpensive and very safe.

Congratulations for making it this far – we saved the best for last! As you have seen, all ED treatments involve some tradeoff between invasiveness and efficacy. Pills are the least invasive, but also the least effective. On the other end of the spectrum is the penile implant – the only true “cure” for ED that offers 100% effectiveness and excellent spontaneity, but it does take a surgical procedure to get there.

There are a lot of great things about a penile implant – it is carried with you inside the body so it can be quite spontaneous, it achieves 100% rigidity and is 100% reliable, never going away (even after orgasm) until you want it to go away, and has the highest overall satisfaction among all ED treatments – 96%. This procedure is also fully covered by Medicare and many other insurances as well, and is performed through a 1-inch incision, in a 1-hour, outpatient (same-day) surgery, and takes about 1-month to heal.

Inflatable penile prosthesis involve the surgical implantation of two soft silicone tubes into the penis, a small reservoir in the abdomen, and a small pump in the scrotum. A patient produces an erection with this prosthesis by squeezing the pump in the scrotum to move sterile saline from the reservoir into the tubes, simulating the movement of blood in a normal erection. A button on the pump deflates the device when the patient is done using it – that could be after 20 minutes or after 2 hours, however long your stamina lasts for!

Of course, like all surgical procedures there are risks, but fortunately in experienced hands they are rare. Here at the UPNT Center for Men’s Health, we are the highest-volume penile implant center in the DFW Metroplex and second-highest in the state of Texas, doing about 150 implants a year- saving the world, one penis at a time. While certainly not the right solution for everyone – for the right patient, either a patient who has tried and failed all the other options, or the patient who wants the surest way of regaining their sexual function, a penile implant can be a great choice.

I appreciate you taking the time to read all of this information. A well informed patient is a patient empowered to make the best choice for their own specific situation. Every patient, and every penis, is different – what works for one may not work for another. Rest assured that at the UPNT Center for Men’s Health, your treatment team will work together with you to find the best solution possible, and restore your confidence and masculinity.

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What Patients Are Saying

Anthony

Dr. Sun is one of the few doctors who really listens to you and will always take the time to address your concerns and answer questions and is highly knowledgeable. Very highly recommended.
Jesus M

Dr. Sun was recommended by a friend of mine, and I’m glad he was. He is not only obviously knowledgeable, he’s personable and as dedicated to providing the best experience as any man can hope. Himself and his Assistant, Deja, made me feel comfortable throughout the entire process. I recently contacted him about a specimen count as I was overseas and wasn’t available after the short healing time. An entire year since the procedure Dr. Sun is still as attentive to my needs as the day I met him. Thank you so much, Doc!
Guoliang Wang

Dr. Sun was referred to me by my daughter who is a MD. I consulted Dr. Sun for my health remotely and was very impressed by his eagerness to treat patients and by his intelligence and deep domain knowledge in the field. He was very polite and asked detailed questions to really understand my situation. Then he explained to me patiently in full detail about the different medications, procedures/surgical options, and each of their advantages and side effects. I was so happy consulting with Dr. Sun as he helped me understand my health situation in a deeper and broader aspect. I highly recommend Dr. Sun.
Ty Turkett

Never heard of Peyronie’s disease at 55 before speaking to Dr Sun but after him giving me an explanation and best direction for correction I felt much more comfortable moving forward with surgery. I am happy to say he did a fantastic job of correcting curvature and explaining after care stretching. I highly recommend Dr Andrew Sun as your urologist as he will continue to be mine moving forward.
James B. Bobo

I was referred to Dr. Sun by a friend of mine, after reading his Bio I chose to have a consult with him. Dr. Sun is extremely intelligent and knowledgeable on many things when it comes down to male health. I chose Dr. Sun to do my NSV & was amazed by how little pain there was. I felt no pain during or after the procedure. Dr. Sun was gentle and accurate with every motion. He also possesses a very outgoing and comedic personality! Which made the entire procedure a breeze. Highly Recommend Dr. Sun!
Ross

Dr. Andrew Yang Sun MD.., is a great surgeon, he explained the procedure very well, it helped me with my erectile dysfunction. It resolved my problem and provide self confidence as man. I highly recommend talking to Dr. Sun. His rate: AAA+++ January 2024
Lorraine Ellis

My husband sees Dr. Sun. We both find him to be very knowledgeable and he has helped improve my husband’s health a lot! He is honest, caring and friendly. His front and back office staff are amazing! Smiles can be seen on every face working there. We highly recommend Dr. Sun and his practice!
Gehrig Saldana

I gladly submit my personal referral for my excellent urologist, Andrew Y. Sun, MD. Dr. Sun has been my urologist for almost a year to date. I’m 71 years young, & noticed over the past few years I had to wake up too many times to use the restroom disrupting my sleep along with having ED creep up on me as I aged to my present age. My primary physician referred me to Dr. Sun & I’m glad he did! Dr. Sun’s care for my prostrate (multiple trips to restroom at night) issue & my ED issue are now resolved to a point where I sleep much better at night. Top that off with my ED issue now pretty much in my rear view mirror. In short, I feel like I’m living the life of a 50 year old dude! Thank you Dr. Sun! Gehrig Saldana
Michael Mcclenon, Sr.

Dr. Sun is a great doctor, he explains things to you so you can understand it. He is a very cool professional, thank you Dr. Sun for taking care of me, GOD BLESS YOU AND YOUR FAMILY.
Alex Hernandez

Awesome experience. Doctor Sun is very knowledgeable & explains things simply to ensure I understand exactly what’s going on & what he plans to do to help. I recommend him highly.
Orlando Villegas

Doc was very informative and very direct and explained in real people language, not Doctor lingo. LOL The options are there and he is willing to explain all of them and I asked many what if scenarios, he was very understanding.
Julie Johnson

I have never encountered a more kind and patient doctor. He takes the time to answer all the questions I have had in detail, and until I’m comfortable. I would recommend Dr. Yang to anyone!
Jerry Carbajal

I felt comfortable speaking with Dr. Sun about my ED problem. He answered all of my questions and explained all of my options. I feel real good about my journey together!
Steve M. Walker

I didn't have any issues and Dr. Sun and Dr. White kept a check on me through the whole process.
Ken Abrams

Excellent service and answered questions
Shane Derby

Have been with Dr Sun for five years. Extremely knowledgeable and friendly.
Neil Landers

Excellent listener and makes you feel like a partner in your care decisions. Highly recommend!
Joe Bouch

He is very knowledgeable, communicates well, and is efficient.
Earl Pigg

Talked to me and my wife so we can understand what's going on with problems
Chris Stratton

The Best.
Jeffrey Hawthorne

Outstanding Physician and Surgeon
Tasha Taylor

Very professional