Andrew Kramer, M.D.
Help For Erectile Dysfunction

Understanding ED and How Penile Implants Can Help Men Find a Better Quality of Living


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Men Have Options for ED Treatment

Men do have options for the treatment of erectile dysfunction. I tell my patients, “There is a menu with 6 things on it and you are free to order whatever you want.”

These “Menu” Items Include:

PDE-5 (phosphodiesterase E-5) inhibitors
  • These are pills such as Sildenafil (Viagra) or Tadalafil (Cialis). These can be prescribed by primary care doctors, by Dr. Kramer, or any urologist. They work best at full strength and typically are most effective on an empty stomach, without alcohol in the system. They ususally have an onset of action within 30 minutes. Side effects include facial flushing, heartburn, and headache. They are CONTRAINDICATED in men who take oral nitrates such as Nitroglycerine for heart disease.



Penile Injections – Trimix
  • Trimix is a liquid injected directly into the corpus cavernosum (erectile body). Benefits include the rapid onset of action no systemic effects such as a headache or stuffy nose. The three substances typically used are prostaglandin E1, phentolamine, and papaverine. They work by stimulating increased blood flow to the penis.
    • The treatment can cause priapism, a prolonged, painful, undesired erection. If an erection lasts longer than 4 hours after an injection, then the patient must contact the treating physician or go to the emergency room to receive treatment.
    • These injections can be very effective but have a high dropout rate because they are considered by some to be cumbersome, painful, and may cause scar tissue on the penis.


MUSE – Medicated Urethral Suppository for Erection
  •  A suppository is inserted into the penis via a small, plastic catheter. Then the penis is manipulated to stimulate blood flow until an erection ensues. It usually works within 5-10 minutes. Some men experience pain in the area of insertion from this treatment.



Vacuum erection device for erectile dysfunctionVacuum Erection Devices
  • These devices are plastic cylinders that are placed around the penis, increasing blood flow. A pump creates vacuum suction within the cylinder. Pumping the air out of the cylinder draws blood into the penis to create an erection. Then, a constrictive band is placed at the base of the penis to maintain the erection. While effective, some men complain that the erection feels artificial and the quality of the erection is less than desired.


Energy Wave Therapy
  • Energy Wave Therapy is a newer, non-invasive treatment for ED that uses the application of low-frequency sound waves to increase blood flow to the penis. A special treatment wand used on the penis triggers revascularization, a process in which new blood vessels form. By improving blood flow to the penis, men may achieve a natural erection. Treatment is once a week for about 6 weeks. Not every man is a candidate and results are variable.



Penile Prosthesis Placement
  • Penile prostheses, or implants, have the highest satisfaction rates of any ED treatment option with around a 98% satisfaction rate. These require a minimally invasive surgical procedure which can be performed on an outpatient basis in one of Chesapeake Urology’s ambulatory surgery centers.

Learn more about implants and Dr. Kramer’s expertise. 

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