• Treatment to modify reversible causes
• Change in current medication e.g. blood pressure medication
• Hormone replacement with male hormone testosterone
• Corrective surgery in case of penile curvature (Peyronie’s disease) and trauma

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First-line treatment

• Oral treatment
• Vacuum constriction devices
• Psychosexual therapy

Second-line treatment

• Intra-cavernosal injection therapy

Third-line therapy

• Surgery (prosthesis)

The least invasive treatment should be considered first. Non-surgical treatments work for 60 to 70% of men and may make surgery unnecessary. Although treatments like injections are effective more than 80% of the time, up to 60% of men may eventually drop out of treatment. Sometimes, once men can get an erection again, they realise they have overestimated its importance in their relationships. They may decide that the nuisance or cost of the treatment is not worth the effort.

Reviewed by Dr Werner Botha Specialist Urologist, Cape Town Medi-clinic.

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