DAVID FOLK THOMAS: Welcome to our webcast. I'm David Folk Thomas. You're looking right now at some common treatments for erectile dysfunction. There are a lot of treatments for it out there. That's our topic today: erectile dysfunction or male impotence, or in more layman's terms, "getting it up" or having trouble "getting it up." Fifteen million men in the United States alone suffer from erectile dysfunction. Of those 15 million, only one in 20 seek treatment. This makes erectile dysfunction one of the most common medical problems that goes untreated in the world. We're going to get to the bottom of how to treat it and show you about that.
Right now, joining me are two experts. On my left is Dr. Michael Perelman. He is a Cornell psychologist, specializing in sex and marital therapy in Manhattan. Next to Dr. Perelman is Dr. François Eid. He is the Director of the Center for Male Sexual Function at New York Hospital in Manhattan. Also joining us are a couple of Dr. Eid's patients. They're off-camera -- Jim and John. They have both received the internal penile pump. We're going to get into that and show you exactly how that works and find out what their experiences have been. Gentlemen, thanks for joining me today.
GUESTS: Thank you.
DAVID FOLK THOMAS: Let's start with you, Dr. Eid. All of the treatments out there, what different types of treatments are there for erectile dysfunction?
J. FRANÇOIS EID, MD: We have a lot of different treatments. Really what I'd like to start with is by saying that we can treat every single man that has a problem with erection. That is something that I'm very proud to be able to say that.
Now, of course, the initial treatment that everybody tries is Viagra. Viagra is an incredible medication.
DAVID FOLK THOMAS: It got a lot of publicity. A lot of jokes on lately.
J. FRANÇOIS EID, MD: A lot of publicity, a lot of jokes, but it's extremely effective. The number of patients that receive Viagra prescriptions is tremendous. Approximately one million men a month receive a prescription of Viagra. Now of that million men, approximately 350,000 are new prescriptions.
DAVID FOLK THOMAS: What does Viagra do exactly?
J. FRANÇOIS EID, MD: Viagra works by blocking the enzyme that takes away an erection. If a patient is unable to start an erection, initiate an erection, Viagra will not work. Viagra will improve an erection.
MICHAEL PERELMAN, PhD: It's particularly important for people to realize that, as we've discussed before, you need direct stimulation to the penis in order to be able to obtain and maintain your erection. So one of the beauties of Viagra is taking the pill will not give you an erection, but when you get the same kind of stimulation that used to result in good experiences sexually for you, this will allow it to happen again.
J. FRANÇOIS EID, MD: Of the 350,000 new prescriptions for Viagra, we know that approximately one-third of these men will not respond to the medication unfortunately. So that's approximately 100,000 new patients each month join the treatment pool are not going to be treated by Viagra.
So we need other options and that's why we're here tonight to talk about a lot of the other options that are available including the internal penile pump, penile injections, urethral suppositories, and vacuum devices.
DAVID FOLK THOMAS: Right before we get to those, Dr. Perelman, what about psychological treatments for erectile dysfunction? And do they tie into Viagra and other medical --?
MICHAEL PERELMAN, PhD: They tie in perfectly. Patients are a lot smarter than I think some of the doctors give them credit for. People seek out the kind of help they need. Quite frequently they're able to discern it in advance. I'm able to see people who are suffering from fatigue, suffering from difficulties with their partners, in part because they're expecting their penis to work like it used to, and they're just essentially experiencing normal age-related changes. So therapy can be a process of education. Therapy can be an assistance in working out relationship difficulties. The kinds of situations and treatments that Dr. Eid is talking about are best applied to the large number of men who can be suffering from different physical problems that are diagnosed through a variety of diagnostic devices that Dr. Eid can describe, as well as consequences of severe illness. Like these gentlemen who are here who had radical prostatectomies where sometimes you do experience erectile dysfunction afterwards. So we can work together to help restore their sexual health, in this case, by using implant procedure that Dr. Eid was able to do for them.
DAVID FOLK THOMAS: Dr. Eid, before we get to the internal penile pump, what about some other treatments such as injections. I think you may have some props over there.
J. FRANÇOIS EID, MD: Yes. I brought with me some props. The penile injections are very effective. Eighty percent of the men who try these respond very well. It gives one a predictable, reliable erection in about five minutes after the injection.
DAVID FOLK THOMAS: So can I just say from my perspective, I'm sure there are people out there, that doesn't sound like something people are rushing out to do. It sounds very difficult.
J. FRANÇOIS EID, MD: Exactly. I have a lot of compassion for men who really try injections. It takes a lot of courage and also it doesn't feel natural. Each time that one wants to make love to have to excuse yourself, take an injection and then --
DAVID FOLK THOMAS: Let's take a look at it. If you hold it up...
J. FRANÇOIS EID, MD: The needle is very small and it's really painless. However, I have to tell you that approximately 80% of patients will drop out of injection therapy the first year that we put them on injections. Over 50% of the patients that we start injections stop injections the first two months of therapy. So yes, it is effective. It is a good treatment. But it takes a lot of motivation to do it.
MICHAEL PERELMAN, PhD: One thing to point out is by working with the man and his partner, we can actually improve that 80% dropout rate by helping the couple introduce their intimacy again in a way that takes into consideration the female partner's needs as well as just providing an erection.
DAVID FOLK THOMAS: Good point. Now let's move on quickly to the vacuum pump.
J. FRANÇOIS EID, MD: The vacuum pump is a device that is placed over the penis and then an electric battery will activate the vacuum.
DAVID FOLK THOMAS: Can you turn it on?
J. FRANÇOIS EID, MD: I don't have a battery in it.
DAVID FOLK THOMAS: I think you do. I'm being told by the people in the control room -- Oh, there it is. [NOISE OF MACHINE].
J. FRANÇOIS EID, MD: So it makes a little bit of a noise.
DAVID FOLK THOMAS: It sounds like a cattle run. I didn't mean to interrupt.
J. FRANÇOIS EID, MD: So it is placed over the penis and then it draws blood into the penis, very much like a breast pump. Patients don't like this. It's gimmicky. It's painful. Many times patients will report that the erection is not natural. They have to use a lot of lubrication over the penis. They have to shave the base of the penis and then the rubber band is snapped over the base of the penis, after the vacuum has given the patient an erection. So this device is simple to buy. It's a one-time purchase, but unfortunately most of the patients that actually buy this end up tossing it away.
I have in my office an incredible collection of these devices. Patients bring them to my office thinking that maybe it could help someone else. Then I just open my closet and show about 45 different devices.
MICHAEL PERELMAN, PhD: For the right couple you can see where these things may have been helpful. But all these things were developed prior to Viagra. Obviously just listening to this story, you can get an idea as to why Viagra was such a huge hit, given the fact of its ease of use.
DAVID FOLK THOMAS: People have been popping pills in aspirin form or whatever --
MICHAEL PERELMAN, PhD: That's right.
DAVID FOLK THOMAS: What about the urethral inserts?
J. FRANÇOIS EID, MD: The urethral insert had a lot of promise in that it avoided the injection. It's the same medication that's in the injectable, except that an applicator is applied approximately 1-1/2" inside the penis. A plunger is pressed which pushes a little pellet of medication into the urethra. The problem with this option is that it doesn't give patients a very firm erection. It's not as firm as with the injection. It has more side effects than the injection. It is more painful.
So although psychologically perhaps more pleasing than an injection, as far as the effectiveness and side effects, it's not as good.
DAVID FOLK THOMAS: When do you use that? Right before--
J. FRANÇOIS EID, MD: Right before and one needs to urinate and then shake the penis and put this in the penis. Again, many patients try it. Many patients drop out. So these are options that can help a limited group of patients. Unfortunately, most patients who try these will eventually move on to something else.
DAVID FOLK THOMAS: Now let me ask John who is one of Dr. Eid's patients off-camera briefly -- did you try any of these other procedures before you selected the internal penile pump?
JOHN: No, I visited the surgeon who did the prostatectomy and I was given a medication prescription for Viagra. My problem with the erection wasn't as much dysfunction as a byproduct, I guess, of the operation which is a recurrence of a Peyronie's disease which I had when I was in my early 30s. Not being a medical person, it's basically a blockage of sorts in the penis cavities and not allowing the erection to erect straight. So I was having erections, but I was having erections that were going off into angles.
Now this was another -- I think a disease that most men never heard of except it was mentioned on the news of Bill Clinton when Paula Jones said, she could identify his penis, which I found --
DAVID FOLK THOMAS: This is only a 10 minute show here, John. Let's not get into Bill Clinton.
J. FRANÇOIS EID, MD: What I would like to add is that after prostate cancer surgery, the penis sometimes if there is impotence, then the penis will shrink and will become sometimes deformed. We refer to that as Peyronie's disease. That is something that is known in the medical community.
Now because of that the best treatment option for that problem is really the internal penile pump. It restores a patient's anatomy and at the same time restores the ability to have a spontaneous erection. Other treatment options don't work for this condition, including Viagra. Penile injections may cause more scarring and are only temporary. Since the penis is already shrinking, it's already telling you that it's going to become more and more damaged.
DAVID FOLK THOMAS: I should mention that Jim and John, the reason for their erectile dysfunction was a result of prostate cancer and subsequent surgery.
J. FRANÇOIS EID, MD: Exactly.
DAVID FOLK THOMAS: Now we have a computer animation of the internal penile pump, so let's --
J. FRANÇOIS EID, MD: Let's show that.
DAVID FOLK THOMAS: Let's show that right now and you can tell us -- there you see it -- what's going on here?
J. FRANÇOIS EID, MD: You can see that this is in the flaccid state. There are two cylinders that are placed in the penis. The penis feels totally normal and actually the patient who has one of these doesn't know that it's something inside. By squeezing the pump, the fluid is transferred from the reservoir into the cylinders and an erection occurs.
Now the feeling, the texture of the erection is entirely normal. There is normal sensation and will be ejaculation and orgasm. So everything feels normal with this device in place. These devices are very reliable. I took one out today that was placed 13 years ago. They last a very long time. When they fail, we take them out and put a new one back in. It's a very easy treatment.
DAVID FOLK THOMAS: It obviously looks -- when you say computer animation -- you think you should be dealing with some sort of space shuttle launch. But from what I hear and what you're saying, it's a very natural thing. Let's ask Jim. You had this procedure. Is it as natural as they say? Can you testify to that?
JIM: Yes, I can. It feels exactly the same and what's better, it lasts longer. It can last as long as I want it to.
J. FRANÇOIS EID, MD: Once the erection is there, the person controls the duration of the erection.
MICHAEL PERELMAN, PhD: If you think about it, you've totally removed any concept of performance anxiety inhibiting erection. In fact, the only thing we --
DAVID FOLK THOMAS: Technical difficulties I guess would be the only problem.
MICHAEL PERELMAN, PhD: Technical difficulties and one other thing -- it's so effective that sometimes men forget and need to be reminded that they still need to make it romantic. They still need to make it sexual. They still need to make it erotic for themselves and their spouses so that they're able to both enjoy themselves and be able to have orgasm and ejaculate.
DAVID FOLK THOMAS: Dr. Eid, once you have had this procedure, is there any way really for anybody else to tell they've had it?
J. FRANÇOIS EID, MD: In most cases, no. But most patients will discuss this with their partners eventually and the partner, of course, knows about it. But the important thing is to know that they feel normal. It feels very natural. I think this is something that hasn't been emphasized in the past.
The other important point is that the procedure is very minor. John who is here today had the procedure less than three weeks ago. So it's a very minor procedure. We do it through a small opening in the scrotum, even though the computer animation shows a lot of pieces of devices there, it's a very minor procedure. Because it's fluid filled, we can put everything in empty and then fill it once it's inside the patient.
MICHAEL PERELMAN, PhD: You mentioned before about this being a little bit of a joke, and the point that Dr. Eid just made about the impact on the man's psychology by restoring sexual health really can't be underestimated. I mean it's profoundly positive thing for someone.
DAVID FOLK THOMAS: Dr. Perelman, we're going to lose this actual footage of somebody demonstrating the penile pump. Dr. Eid, if you can explain.
J. FRANÇOIS EID, MD: This is a patient that is demonstrating the penile pump. This patient had the procedure a year ago. He is pumping the device and he is going --
DAVID FOLK THOMAS: You use two hands usually?
J. FRANÇOIS EID, MD: You can use two hands, or one hand. This gentleman is 70 years old. He is showing how natural it looks. You can see that the penis looks a little bit fuller. I like to joke with my patients. I tell them that this is a very youthful looking penis that you have even though he is a 70-year-old gentleman. It actually feels exactly like the penis of a 16 or an 18-year-old man. It really feels very natural. That's why I like this option for a lot of these patients.
DAVID FOLK THOMAS: He pumps it up and how long does that last?
J. FRANÇOIS EID, MD: It will last -- and you can see me here. I asked this gentleman -- I'm trying to show where the pump went in. You can see it's totally healed. There is no way for somebody to actually see anything. You can see that this looks like a very natural erection.
Now the erection, he controls the erection. He hasn't pumped it completely and I'm demonstrating that you can still pump it and make it much harder.
The erection is controlled by the patient. That's the beauty of this. If somebody has a little premature ejaculation, then the erection will maintain itself until the partner reaches orgasm. So this is something that is tremendous for a lot of the patients and the couples that use it.
MICHAEL PERELMAN, PhD: Actually one important point to make since it is like the penis of a 16 or 17-year-old is that the degree of erection the patient had prior to it being fully pumped up, would be enough to have successful intercourse. Dr. Eid is correct that doing more increases confidence and increases pressure, but I don't want people to get the impression, that unless it's as rock hard as we just saw, they can't function. Of course, you can.
DAVID FOLK THOMAS: Let's also -- we've got just handed to me, fresh off the Internet, off our website, some e-mail questions. I will read these to both of you. The first one says, "I have never been circumcised and have no problem with pulling foreskin back. Will this remain the same and the looks of the penis still be the same after being implanted with the pump?
J. FRANÇOIS EID, MD: Yes, it will. The flaccid penis will look fuller than the flaccid penis without the pump.
DAVID FOLK THOMAS: Let me go to the second one. I am considering having a penile pump installed, but I have a question. I have a condition called Peyronie's disease (which we just mentioned) whereby I can achieve a fair semi-erection, but with a great deal of curvature to the right. My question is how will the pump interact with my natural semi-erection and the curvature?
J. FRANÇOIS EID, MD: I think the pump is a great alternative for this patient. It will correct the curvature without a lot of surgery and will enable him to maintain an erection of sufficient rigidity for intercourse. It's a great option for that.
DAVID FOLK THOMAS: Let me get one more out here. Does the penis when pumped up feel like a normal erection to the touch? In other words, is the outer wall of the penis also firm?
J. FRANÇOIS EID, MD: Yes. I think that I emphasize that really it is a very normal erection. We have a couple where the patient had the pump before he was married. Subsequently, he married and he never got the courage to discuss it with his wife. He came back six years later and I said, "Well, how are things going? How is your sexuality?" He said to me, "You know, doc, it's going great. But I still haven't told my wife that I have one." She still did not know. Now I don't recommend that, but this is to tell you how natural it feels.
DAVID FOLK THOMAS: And doctor, very briefly, how much do these cost? Is it covered by insurance? How long does the whole thing from --?
J. FRANÇOIS EID, MD: They're covered by insurance. They cost anywhere from $12,000-20,000 depending on the hospital. The procedure itself takes about 40 minutes in experienced hands. Typically patients stay in the hospital about 24 hours or -- we call it the 23-hour short stay where they'll come in the morning of the procedure and then are discharged the following day.
DAVID FOLK THOMAS: Very quickly, John and Jim, in two words, three words, would you recommend the penile pump to our viewers on the webcast?
JIM: Absolutely, and the only thing I wish I knew more about it prior to going into the prostatectomy. I just hope that this webcast gives people the opportunity to know that anything can be rectified in that area, and it's so important.
JOHN: I second that and I want to thank Dr. Eid for doing such a professional job.
DAVID FOLK THOMAS: And I want to thank Dr. Eid and Dr. Perelman for stopping by and to Jim and John, joining us on our webcast here tonight about erectile dysfunction and treating erectile dysfunction. Hope you've learned a lot. My name is David Folk Thomas. We'll see you next time.