My Doctor Online The Permanente Medical Group

Oral Medicines

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Oral medicines for ED are helpful for about 50 percent of men with ED. The pills, called phosphodiesterase inhibitors, all work the same way by making it easier for you to get and keep an erection after stimulation. These medicines are equally effective, with slightly different side effects. Take the medicine 30 to 60 minutes before sex.

Never use these medicines if you take nitrate-containing heart medicines because life-threatening reactions like a sudden drop in your blood pressure may occur. If you are unsure about whether your medications contain nitrate, ask us.

There are 3 common oral medicines for treating ED. They are all available, but the cost may differ, depending on your benefits.

• Vardenafil (Levitra). First oral medication option with Kaiser. It works quickly and lasts about 6 hours. It is less effective if taken shortly after a fatty meal.
• Sildenafil (Viagra). This is the oldest drug for ED. It works in about 30 minutes and lasts about 6 hours, and it is also less effective after a fatty meal.
• Tadalafil (Cialis). Takes about an hour to work and lasts about 24 hours. It is not affected by the stomach's contents.

Common side effects for all of these drugs include headaches, flushing or a feeling of warmth, nasal congestion, and upset stomach. Less common side effects include:

• Bluish vision and sensitivity to light. Although this may seem unusual, it is not considered a serious side effect because it usually goes away a few hours after you take the medicine.
• Heart problems are very rare.
• Blindness or hearing loss is very rare. If you experience either of these, seek immediate medical care.
• Backaches may occur with Cialis and may last for 1 to 3 days.

Self-Injections

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Medicines injected directly into the penis stimulate blood flow in the penis, which leads to an erection. An erection will occur within 15 minutes. Sometimes you may need stimulation for the erection to occur. With our approval and instruction, you can titrate (adjust) the dose to achieve a satisfactory erection. Your erection should not last for more than 4 hours. If it does, seek immediate help or go to the Emergency Room. Having an erection for a long period of time may cause permanent damage to your penis. We will teach you how to properly inject this medicine so you can use it safely at home.

Self-injection medicines

Edex (alprostadil) is often the first injectable medication offered, but a combination of medications (alprostadil, papaverine, and phentolamine) may be prescribed if alprostadil alone is not effective.

Common side effects include bruising, penile pain, and prolonged erection.

Rare side effects include penile scarring, infection, low blood pressure, and fainting.

Urethral Suppository

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This method of treatment uses a medicine called alprostadil in the form of a small pellet. This treatment works about 30 percent of the time. With the help of a small applicator, you insert the medicine into the urethra. The urethra is the connecting tube in the center of the penis that carries urine and sperm. An erection takes about 15 minutes to occur and will last about an hour. We will teach you how to properly insert this medicine so you can use it safely at home.

Side effects of urethral suppository can include pain in the penis, pain in the urethra, and prolonged erection.

Vacuum Erection Device (VED)

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A vacuum device brings blood into the penis, which creates an erection. The device has 3 parts: a plastic cylinder, a pump, and a ringlike band. The plastic cylinder is placed over the penis and held against the skin. The pump draws air out of the cylinder, while the ringlike band placed around the base of the penis keeps the blood in the penis to maintain the erection. Once you get an erection, you may remove the cylinder and pump. The ring stays at the base of the penis during intercourse to maintain the erection. Pumps may be manual or battery powered, depending on your needs and whether you have problems with your hand strength. Some considerations when using a VED:

• Some men may notice that their penis is cold and turns a bluish or purple color.
• The ring or pump may be uncomfortable.
• At times, the device does not make the penis rigid enough for sexual activity.
• Ejaculation mays not occur externally because the ring squeezes the urethra. This is not dangerous, nor does it cause pain. Semen usually ejects once the ring is removed. A VED is not a contraceptive.
• Effectiveness may improve when combined with ED medications.

Penile Implants

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Penile implants would be considered only if all other options have failed. It is important to have a detailed discussion with us about whether or not to have a penile implant. The surgical procedure is not reversible. Semirigid or inflatable implants are placed into the penis that allow you to have an erection on demand. This is a highly successful treatment.

Side effects include infection, poor fit, pain, implant mechanical failure, and migration of the implant out of the penis and into the urethra.

Other Treatments

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Other treatments, like testosterone replacement therapy, may be recommended only if you have low testosterone levels. This therapy typically helps about 30 percent of men with low testosterone. You may still need another treatment for ED.

You may come across other treatments such as herbs and vitamin mixtures. Please talk with us about any type of alternative treatment you may be considering, as this can affect other aspects of your treatment plan. These treatments may not be approved by the Food and Drug Administration (FDA), and therefore we cannot tell you how effective or safe they are. The most important message we want to convey is to please feel free to talk with us about any treatments you might have heard of. We will try to help you sort through the information so that you can make well-informed decisions.

Your Care with Me

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If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and sexual history and I may perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

We will teach you how to properly use the treatment option you select, so that you can use it safely at home.

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If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

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Coordinating Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the "After Visit Summary" that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

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Convenient Resources for You

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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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