Sexual Dysfunction

Problems with sexual interactions can impact a patient’s psychological state negatively and strain a relationship or marriage. Dysfunction can occur at any age and can be persistent, recurrent or situational.

Dysfunction is divided into categories: low desire, as in sexual desire disorder (where libido or desire is low or lacking); sexual aversion disorder (distress incurred on the patient upon sexual contact); sexual arousal disorder (the ability to get excited or aroused sexually with appropriate lubrication is affected); female orgasmic disorder (the ability to experience orgasms is reduced or absent); sexual pain disorder (encountering pain either during intercourse or upon anticipating intercourse) and erectile disorder.

Sexual dysfunction in women

Women often live into the 8th or 9th decade, but many become less interested or less satisfied with sexual interactions. We specialize in anatomic correction, hormone management for vaginal lubrication, arousal disorders, orgasm disorders and compatibility issues with partners.

Our team can assess your pelvic health and ensure that no structural abnormalities are present that could explain the distress encountered. Accordingly, your physicians can help coordinate your care with highly trained sexual therapists. Our physicians are known for their empathy, caring and respect for patients who are enduring such psychological and physical ordeals.

Sexual dysfunction in men

Sexual dysfunction is a common problem affecting more than 50% of men between the ages of 40 and 70. With newer treatments available, public awareness of the problem has greatly increased.

Impotence, or erectile dysfunction, commonly called ED, as with many disease processes, has a spectrum of severity. The most frequent symptom that we see is the inability to achieve any penile erection at all. Commonly, however, one may experience partial erection with either incomplete rigidity or loss of rigidity before ejaculation.

In the past, physicians often attributed ED to psychological causes. However, we now know that psychogenic impotence is responsible for less than 10% of cases of serious ED. Common causes of ED include medications for other conditions, arterial blockage due to atherosclerosis, peripheral nerve damage due to diabetes, pelvic fracture and spinal cord injury. Fortunately, determining the specific cause of ED is usually not necessary as treatment is fairly standard.

Often, ED can be treated easily with prescription oral medications. Physicians at The University of Kansas Health System will evaluate your erectile dysfunction and select the best medication for you. If one of these medications is not effective, our physicians are equipped with a wide range of options to treat erectile dysfunction, including intracavernosal injections, vacuum erection devices, intraurethral therapy and surgical placement of a penile prosthesis.

If surgery is needed for your erectile dysfunction, Ajay Nangia, MD, and Joshua Broghammer, MD, are among the few physicians in the Kansas City area who implant penile protheses and perform complex prothesis surgery to treat erectile dysfunction. The procedure uses an artificial device to provide erections and is reported to result in satisfaction rates greater than 90%. With extensive experience in these techniques, our physicians offer the latest approaches for this surgical correction of impotence.

Effective treatments for ED

Our urologists specialize in the latest treatment options for ED, the persistent inability to maintain an erection that is firm enough or lasts long enough to have sexual intercourse. This common problem is often caused by physical conditions, including prostate cancer, diabetes and cardiovascular disease. ED can limit your intimacy, affect your self-esteem and impact your most important relationships. But the good news is that today nearly every case is treatable. You don’t have to live with it.

Treatment options

  • Oral medications (Viagra®, Levitra®, Cialis®)
  • Vacuum erection devices
  • Injections
  • Intraurethral suppositories
  • Penile prosthesis

The satisfying solution

Our urologists have extensive experience with penile prosthetic surgery. Penile prostheses have been in use for more than 30 years, and offer a satisfying long-term solution for ED. In a study comparing ED treatment options, patients reported a 93% satisfaction rate with penile prostheses, which far surpasses satisfaction with other treatment options.

Benefits and risks of a penile prosthesis

Benefits
  • Long-term solution
  • Have an erection anytime you choose
  • Allows for spontaneity – have sex when the mood strikes
  • Maintain erection as long as you desire
  • No ongoing costs for pills or shots
  • Feels natural during intercourse
  • Doesn't interfere with ejaculation or orgasm

 

Risks

  • Will make latent natural or spontaneous erections, as well as other interventional treatment options, impossible
  • If an infection occurs, the prosthesis may have to be removed
  • May cause the penis to become shorter, curved or scarred
  • May cause lasting pain
  • There may be mechanical failure of the prosthesis
A penile implant is entirely concealed within the body and is designed to be simple and discrete to operate. It may offer a permanent, long-term solution to ED, and can help you return to an active, satisfying sex life.

 

How AMS penile prostheses work

Choosing the penile prosthesis that is best for you is a personal decision. Because each type of prosthesis offers unique features, you will want to discuss the choices with your doctor to choose the option that is right for you.

One-piece positionable prosthesis (malleable)

One-piece positionable prostheses are the simplest types of penile prostheses. The prosthesis consists of a pair of cylinders that are surgically inserted into the penis. The prosthesis is positioned up for intercourse or down for everyday activities.

Advantages

  • Totally concealed in the body
  • Easy for you and your partner to use
  • Good option for men with limited dexterity
  • Generally the simplest surgical procedure
  • Simply bend prosthesis to conceal
  • 91% patient satisfaction rate

     

Disadvantages

  • Remains firm when not being used
  • Less appropriate for patients requiring repeated cystoscopy

     

Two-piece inflatable prosthesis

The 2-piece inflatable prosthesis consists of a fluid-filled pair of cylinders implanted in the penis and a small pump implanted in the scrotum. To get an erection, you simply squeeze and release the pump several times. When the fluid is pumped into the cylinders, it creates an erection that provides rigidity.

Advantages
  • Totally concealed in the body
  • Simple to use
  • 1-step deflation
  • Device is inflated to provide rigidity and deflated for concealment
  • 90% of partners would recommend it to other couples
Disadvantages
  • Requires some manual dexterity
  • Cylinders remain partially filled with fluid when deflated

Three-piece inflatable prosthesis

The 3-piece, fluid-filled inflatable prosthesis features a pair of cylinders implanted in the penis, a pump implanted in the scrotum and a reservoir implanted in the lower abdomen. When the fluid is pumped into the cylinders, it creates an erection that provides rigidity and girth expansion.

Advantages

  • Totally concealed in the body
  • Like a natural erection
  • Device is inflated to provide rigidity and deflated for concealment
  • Expands in girth (all AMS 700® cylinders) and length (AMS 700 LGX® and Ultrex® cylinders)
  • When deflated, the cylinders are soft and flaccid
  • AMS 700 with InhibiZone® is the only inflatable penile prosthesis with clinical evidence showing a significant reduction in the rate of revision due to infection
  • Parylene coating increases durability
  • 92% patient satisfaction rate

     

Disadvantages

  • Requires some manual dexterity
The AMS 700 LGX may not be appropriate for all patients. Please consult with your physician to determine if it is right for you.

Finding the right treatment for you

Of course, a surgical solution is generally not the first course of action. Many men with ED benefit from other therapies like oral medications, injections or vacuum devices. But for those men who are not satisfied with those treatments – or not getting the results they desire – a penile prosthesis may provide a permanent, satisfying option.

Make an appointment to learn more

If you suffer from ED and are interested in reclaiming your sex life, make an appointment to discuss your options and learn more about today’s satisfying solutions. As with any medical procedure, there are risks involved and not all patients are candidates for a penile implant. Discuss the risks and benefits of this procedure in more detail with your doctor.

Summary of warnings, precautions and contraindications for penile prostheses

  • Implantation of the device will make latent natural or spontaneous erections, as well as other interventional treatment options, impossible and may result in penile shortening, curvature or scarring.
  • The device contains solid silicone elastomer. The risks and benefits of implanting this device in patients with documented sensitivity to silicone should be carefully considered.
  • The implantation of this device is contraindicated in patients who have active urogenital infections or active skin infections in the region of surgery.
  • The implantation of the InhibiZone® version of this device is contraindicated in patients with known allergy or sensitivity to rifampin (rifampicin) or to minocycline or other tetracyclines.
For a complete list of indications, contraindications and precautions, please contact us today.

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