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Category: Penis Enlargement

Nonsurgical Options for Penile Enlargement A Stretched Fact or a Myth?

Posted on by Dr. Ali Thwaini

Male cosmetic and functional enhancement remains to be an important yet seldom spoken about a topic among men. There have been several proposed treatment options for penile enlargement, most of which are surgical ranging from minimally invasive treatment to open surgery.

However, due to the inherent side effects of these procedures and the time needed to be off work other options have emerged recently was promising results. Below we will discuss one of the conservative options.

Penile Extender Device


This is basically an external device that can be simply applied by the person for a certain amount of time preferably on daily basis. The mechanism of action is stretching on the penis Leading to Mechano-transduction; A process whereby the mechanical stimulus of stretching the penis gets converted into a biochemical stimulation resulting in the progress of cellular proliferation and expansion of the extracellular matrix.

Interestingly, there have been several published small series about the utilization of a penile extender with various encouraging results. Some claim that the use of the penile extender for four hours on daily basis could potentially lead to an increase in the normal penile length of up to 2 cm in a flaccid penis to up to 1.8 cm in stretched penile length.

Others have “extended” the use of penile extender into the treatment of Peyronie’s disease with an encouraging up to 40% improvement of the curvature after a few months of its use.
Of course, any treatment could come with inherent side effects. Penile extender use has the potential of bruising, swelling, and pain ranging between 30 and 40% most of which are simple and self-limiting.

References
Mohammadreza Nikoobakht et al. Effect of the penile-extender device in increasing penile size in men with a shortened penis: preliminary results. J Sex Med. 2011Mohammad Reza Nowroozi et al. Applying extender devices in patients with penile dysmorphophobia: assessment of tolerability, efficacy, and impact on erectile function. J Sex Med. 2015

The Shortest Distance Between two Points in a Straight Line

Posted on by Dr. Ali Thwaini

Peyronie’s disease is a rather common and potentially debilitating condition for sexually Active men.

What is Peyronie’s disease?

It must be quite unnerving in to wake up on a random morning to see one’s erect penis has “taken a turn”.

While the mainly this condition is idiopathic, some are attributed to various other clinical conditions such as Dupuytren’s contracture.

Painful erections with penile deviation to start with, however, with time, the pain settles leaving behind the penile deviation while erect, which sometimes interferes with sexual activity causing dissatisfaction for the patient and the partner

Treatment

There have been several attempts to treat this condition conservatively and most of these conservative treatments were, at best, equal to placebo.

These have ranged from a variety of supplements like vitamin E, Paraamino Benzoic Acid (Potaba) calcium channel blockers, and even local injection of steroids, with no beneficial effects

Surgical interventions on the other hand provide a definite alternative, however, they come with their inherent side effects.

These are generally divided into penile shortening and penile lengthening procedures;

While the former concentrates on shortening the healthy side of the penis to make it as short as this affected side, this inevitably results in losing some of the erect penis’s length, which all men find unsatisfactory..

Penile lengthening procedures, although seemingly appealing, they have the potential side effect of causing erectile dysfunction as it involves cutting the affected segment that’s responsible for the disease, thus causing the potentially venous leak, which will hinder the erectile process

Recently, there has been some treatment which was initially effective. Collagenase clostridium histolyticum (Xiapex) has been tried with initially promising results, however, due to its significantly high price and the potential side effects of corporal rupture, its use has faded, as with other treatments

Other physical treatments such as external shockwave treatment on Penile remodeling have been attempted with modest results

Regenerative medicine has become a viable alternative in a variety of clinical conditions, and Peyronie’s disease is no different.

Several researchers have attempted the injection of platelet-rich plasma cells (PRP) (with or without hyaluronic acid) into the area of the plaque, in addition to exposing the affected area to shockwave treatment and the results are thus far, promising

It takes one or more sessions depending on the severity of the condition and it is carried out as an outpatient procedure with minimal side effects

The immediate results are encouraging, however, we are still waiting for the intermediate long-term results

Watch the space!

References

Li-ESWT with Regenerative Medicine in ED

Posted on by Dr. Ali Thwaini

English


Erectile dysfunction (ED) is a very common health problem that affects a large proportion of men. The word “40 over 40” stands true. Various causes leading to various treatments for ED have been highlighted and adopted respectively. Most, if not all, are situational and not permanent ( apart from modifying lifestyle and care about Men’s health). 

Regenerative therapies for ED


Therefore, additional treatments are being investigated, including regenerative therapies. Regenerative therapies aim to restore function via replacement or regeneration of human cells, tissues, or organs. Regenerative therapies for the treatment of ED include low-intensity extracorporeal shockwave therapy (Li-ESWT).

Benefits of Li-ESWT


Li-ESWT began to be explored as an alternative means of treating ED,33 with the first randomized controlled trial (RCT) published in 2012. The benefits of Li-ESWT stems from its ability to induce microtrauma. A shockwave is a type of longitudinal acoustic wave that is composed of three sequential parts: a short pulse, a rapid increase to max positive acoustic pressure (the “shock”), and a prolonged period of negative pressure.

Stem Cell Therapies (SCT)


On the other hand, stem cell therapies (SCT) seek to harness the regenerative potential of stem cells for the repair of injured or damaged tissues. The utilization of adult stem cells has allowed for easier access to stem cells, leading to a higher likelihood of utility in regenerative medicine.


Since the causes of ED are numerous and include damage to the neurovascular bundle or neuropraxia during radical prostatectomy nerve damage, endothelial dysfunction, and oxidative stress in the setting of diabetes mellitus, SCT has gained a lot of interest in this field.


As opposed to PRP, several studies have evaluated the efficacy of SCT for the treatment of ED in humans, with promising results.


The combination of Li-ESWT and SCT in ED is an emerging concept. For stem cells to reach the affected tissues, and to accept their actions via paracellular and intercellular signals, they have to be “led” to the affected tissues. One method is to induce an acute micro-trauma to the targeted tissues allowing them to release their attractive signals for the relating cells, of more importantly here, the stem cells, to accumulate in that particular area and exceed their restorative tasks. Animal studies have already proven this concept. Human trials are awaited. Food for thought..

Reference : journals.sagepub


Arabic

Li-ESWT مع الطب التجديدي في الضعف الجنسي

ضعف الانتصاب (ED) هو مشكلة صحية شائعة جدًا تؤثر على نسبة كبيرة من الرجال. كلمة “40 فوق 40” صحيحة. تم تسليط الضوء على الأسباب المختلفة التي أدت إلى علاجات مختلفة للضعف الجنسي واعتمادها على الاسباب. معظمها ، إن لم يكن كلها ، ظرفية وليست دائمة (بصرف النظر عن تعديل نمط الحياة والاهتمام بصحة الرجل).

لذلك ، يتم التحقيق في علاجات إضافية ومستديمة ، بما في ذلك العلاجات التجديدية. تهدف العلاجات التجديدية إلى استعادة الوظيفة عن طريق استبدال أو تجديد الخلايا أو الأنسجة أو الأعضاء البشرية. تشمل العلاجات التجديدية لعلاج الضعف الجنسي علاجًا منخفض الكثافة بالموجات الصدمية خارج الجسم (Li-ESWT).

بدأ استكشاف Li-ESWT كوسيلة بديلة لعلاج الضعف الجنسي ، مع أول تجربة ذات ادله (RCT) نُشرت في عام 2012. تنبع فوائد Li-ESWT من قدرته على إحداث الصدمات الدقيقة. موجة الصدمة هي نوع من الموجات الصوتية الطولية التي تتكون من ثلاثة أجزاء متتالية: نبضة قصيرة ، وزيادة سريعة إلى أقصى ضغط صوتي إيجابي (“الصدمة”) ، وفترة طويلة من الضغط السلبي.

من ناحية أخرى ، تسعى علاجات الخلايا الجذعية (SCT) إلى تسخير الإمكانات المتجددة للخلايا الجذعية لإصلاح الأنسجة المصابة أو التالفة. توجيه استخدام الخلايا الجذعية البالغة بالوصول السهل إلى الخلايا الجذعية ، يؤدي إلى زيادة احتمالية الاستفادة منها في الطب التجديدي.

نظرًا لأن أسباب الضعف الجنسي عديدة وتشمل تلف الحزمة الوعائية العصبية أو الأعصاب أثناء تلف الأعصاب الجذري للبروستاتا ، والخلل البطاني ، والإجهاد التأكسدي في حالة مرض السكري ، اكتسبت SCT الكثير من الاهتمام في هذا المجال.

على عكس PRP ، قيمت العديد من الدراسات لفعالية SCT في علاج الضعف الجنسي لدى البشر ، مع نتائج واعدة.

يعتبر الجمع بين Li-ESWT و SCT في ED مفهومًا ناشئًا. لكي تصل الخلايا الجذعية إلى الأنسجة المصابة ، وباستثناء أفعالها عبر الإشارات بين الخلايا والداخلية ، يجب “توجيهها” إلى الأنسجة المصابة. تتمثل إحدى الطرق في إحداث صدمة صغيرة حادة للأنسجة المستهدفة مما يسمح لها بإطلاق إشاراتها الجذابة للخلايا ذات الصلة ، والأهم من ذلك ، الخلايا الجذعية ، لتتراكم في تلك المنطقة بالذات وتتجاوز مهامها التصالحية. لقد أثبتت الدراسات التي أجريت على الحيوانات بالفعل هذا المفهوم.

Stem Cell Therapy in Male Sexual Dysfunction:

Posted on by Dr. Ali Thwaini

Erectile dysfunction is becoming a common urological problem affecting men worldwide, with almost 40% of men at and above the age of 40 years being affected by the disease, at various levels.

Whilst there are several conservative and interventional treatments for erectile dysfunction, they would treat but not cure the disease.

What is Stem cells

Stem cells exist as undifferentiated cells. They are present in the embryonic and adult stages of life and are considered as a source for differentiated cells that make up the building blocks of tissue and organs.

Due to their abundant source and high differentiation potential, stem cells are considered as potential new therapeutic agents for various medical conditions.

Recently, there has been a vested interest to investigate their use in male sexual dysfunction.

Stem Cell Therapy for Erectile Dysfunction

According to the European Association of Urology’s latest press release, new clinical trial results demonstrated the ability of stem cells to restore sufficient erectile function to allow previously impotent men to have spontaneous intercourse. This is the first time stem cell therapy has produced patients who have recovered sufficient erectile function to enable intercourse.

In recent years several groups have worked to develop stem cell therapy as a cure for erectile dysfunction. None of the male participants reported significant side effects over the trial period, or in the following year. Within 6 months of the treatment, 8 out of the 21 patients reported that they had recovered sufficient erectile function to achieve penetrative) sexual activity. This improvement has been maintained for a year, indicating that this treatment may confer long-term benefits.

Stem Cell Therapy Results

Results presented at the European Association of Urology conference in London show that 8 out of 21 have successfully regained sexual function.

We use stem cells taken from abdominal fat cells via liposuction (under local anesthetic as an office-based procedure). After isolating the stem cells, they were injected into the corpus cavernosum area of the penis. The patients are able to be discharged the same day.

Is stem cell therapy for ED Safe

This treatment is suitable for men seeking to improve their sexual performance without taking medication and/or any other external treatment, also the patient with Diabetes, Hypertension, and other diseases can benefit from this safe treatment.

Some patients might feel the benefit immediately after the treatment, but the majority will feel gradual improvement over the next 2 to 3 months, with the maximum effects achieved at 6 months.

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Non-surgical methods for Penile Enhancement

Posted on by Dr. Ali Thwaini

Non surgical methods for penile enhancement There are several conservative measures that if used properly, might help in gaining some length and possibly strength during erection.

Penis stretching?

Penis stretching refers to using own hands or a device to increase the length or girth of the penis.
Although there’s evidence to suggest that stretching can increase penile size, the results are usually minimal. In some cases, they may even be temporary.

It’s important to remember that much of the evidence around penis stretching is anecdotal, as there are no randomized trials with its effects to draw a valuable conclusion.

Manual stretching exercises involve using own hand to massage the tissues along the length of the penis. This is intended to stretch the skin and create “micro-tears” in the tissue.
The tissues may appear engorged as they heal, making the penis look longer.
Some exercises also claim to increase girth. Girth exercises, such as jelqing, are also centered around tissue massage.
Consistency is key to maintaining either of these purported effects. However, excessive use of such exercises might lead to more tissue damage leading to harmful outcomes.


Penile Enhancement Exercises

Penile Enhancement Exercises


1. Stretching


This is carried out by grasping the penis just behind its head. Don’t hold it too firmly or too loose. The penis is then gently stretched initially downwards for 20-30 seconds followed by upwards stretch for another 20-30 seconds


2. Rotational stretch


This is achieved by grasping the penis just below its head and pulling it outwards firmly. It is normal to feel a stretch in the shaft but not any pain. Then the penis is moved in circular motion maintaining the stretch and grip. Each rotation should take around 30 seconds. For each direction, at least three rotations are to be performed.


3. Jelqing

Jelqing-penile enhancement


With the penis being partially erect and using a lubricant, the penis is held at the base with the thumb and index finger. Slow movement of the hand up the penis maintaining the pressure.This is one jelq and it should take you 2 to 3 seconds to do 1 jelq. This help in pushing the blood towards tip of the penis and will not cause any pain. Repeat this process.


4. Kegel


The key is to identify the Pubococcygeus muscle by stopping the flow of urine. Once recognized, the muscle is held in contraction for about five seconds and then released. This method is then repeated as many times as desired, ideally for about 30 minutes every day to see an improvement in erection.

5. Opposite stretch

After folding the tip and base of the Leno’s with each hand respectively, both hands are then pulled in opposite direction, without causing any pain. This position is held for about 30 seconds and then relax. This method is repeated as required and after enough number of stretches let your penis relax.


Research on penis stretching techniques is limited. None of the studies that have been done point to any one technique as an effective way to permanently lengthen the penis. However, a temporary increase in size may be possible.One 2010 review reported that men who used the Andropenis stretching device saw an increase in size with extended daily use. Participants used the device for six hours per day over the course of four months. They gained anywhere from 1.8 to 3.1 centimeters (cm) in length.
Stretching with a device

To use a penis pump:

  • Place your penis inside the air-filled chamber.
  • Use the pump mechanism to suck the air out of the chamber. This pulls blood into your penis, causing it to become erect.
  • Attach the included ring or clamp to your penis to keep it erect for up to 30 minutes. It’s safe to have sex or masturbate during this time.
  • Remove the ring.

To use a traction device:

  • Insert your penis into the base end of the device.
  • Secure the head of your penis within the two notches at the opposite end.
  • Fasten the silicone tube around the shaft of the penis.
  • Grip the ends of the silicone tube on the bottom of the device and slowly pull your penis outward. Stop pulling if it starts to feel painful or uncomfortable.
  • Leave the penis in the stretched position for 4 to 6 hours a day.

Potential risks and complications

Being too rough with your penis can cause large tears in the tissues or damage to the ligaments that connect your penis to your body. These injuries can potentially hinder your ability to get or maintain an erection. When wearing a traction device, follow your doctor’s instructions for how long to wear it. Wearing it any longer can cause injuries that affect the penis function. After using a pump, don’t let the blood stay in your penis for more than 30 minutes. Having an erection for more than a few hours can permanently damage your penis. Stretching exercises or devices may cause:

  • itching
  • minor bruising or discoloration
  • red spots along the penile shaft
  • numbness
  • vein rupture

See your doctor if your symptoms last for more than a couple of days or are severe. Your doctor can assess your symptoms and advise you on any next steps.

Your results will depend on the approach you take and how consistent you are with use. Traction devices, for example, must be used daily — often for months at a time — in order to achieve any noticeable effects. Anecdotal reports suggest that using a penis pump can produce much faster results, but there isn’t any research to support this.It’s also unclear how much time will pass before you see results from manual stretching exercises.

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The bottom line

If you have questions or concerns about your penis size, talk to your doctor. They can discuss your options for lengthening and explain how to do so safely.Learning how your penis responds to stretching and other forms of stimulation may help you feel more comfortable with your body. You may also notice changes in appearance or performance over time.Be sure to follow any product directions or guidelines provided by your doctor. If performed incorrectly, stretching can result in injury or erectile dysfunction.Seek immediate medical attention if you experience pain or discomfort while stretching, or if you notice any change in your erectile function.

Penis Enlargement

Posted on by Dr. Ali Thwaini

Penoplasty (male enhancement)

The penile enlargement procedure is seldom discussed. Men in general are private about their privates at the best of times, and when it comes to such an intimate matter, they are even more introvert.

However, the amount of men going for penis enlargement procedures is up. 

A recent UK based study, a general questionnaire was sent to community men of various ages, They found that almost 50% would like a larger penis.

For the last five years, members of the International Society of Aesthetic Plastic Surgery carried out almost 50 000 enhancements worldwide.

There are several procedures that would increase the apparent length and the actual girth of the penis. These, however, are to be tailored to the anatomy of the patient, and also to patient expectations.

It is important to realise that there is no procedure that actually increases the real length of the penis. Penoplasty makes the penis appear longer by repositioning it in relation to the tissues around it.

Penoplasty (Penis Enlargement)

Although there are medical indications for penoplasty. However, these are rare indications, and surprisingly, the majority of men seeking penile enlargement have normal sized genital organs. The reasons for wanting a larger penis are often nothing to do with sexual performance. Most men seek this procedure mainly to enhance the appearances of their flaccid penis size, especially when going to the gym and using communal showers because.

There is a range of procedures. They can be generally split between those increase the length of flaccid penises, or more girth.

One thing you can do is use liposuction on the fat around the base of the penis — if you’ve got four inches of fat there, your penis will look four inches bigger when the fat is surgically sucked out.

The lengthening procedure, however, mainly involves making an incision at the base of the penis in an area that can be easily covered by the hairline, and dividing a ligament which is called the ‘suspensory ligament’ which connects the penis to the pubic bone.”

Once the ligament is cut, the penis will permanently come further out of the body.

Penis Enlargement Surgery

Cutting the ligament means the angle of erection will change so it’s not as upright, and there is a thing balance between cutting too much and too little of this ligament, and a skilled surgeon can keep this change to a minimum so you don’t end up with a downward-pointing erection.

Increasing the penile girth usually involves injecting material into the soft tissue underneath the skin on the penis. The most commonly used material is the patient’s own fat, usually from the abdominal area. There surgeons use a synthetic filler like hyaluronic acid, which is what women use to enhance the lips or fill gaps in cosmetic surgery. Each has its own pros and cons.

Post operatively, me are advised to refrain from having sex for at least about four weeks.

Although these procedures do not actually increase the surest penis length, as they significantly enhance the girth of the flaccid and erect penis, there will be an improvement in overall outcome, with more pleasurable for both partners.

Non-surgical methods for Penile Enhancement

penile enhancement

Non surgical methods for penile enhancement There are several conservative measures that if used properly, might help in gaining some length and possibly strength during erection.

Visit Dr. Ali Thwaini for Penis Enlargement Dubai, Complicated surgery often calls for expert surgeons

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Erectile Dysfunction

Posted on by Dr. Ali Thwaini

Erectile dysfunction (ED in men) impotence is defined as an inability to obtain or maintain an erection sufficient for penetration and for the satisfaction of both sexual partners.

ED in men can be caused by many factors and may have a gradual or sudden onset. It can be very upsetting and result in a lot of stress and worry. It can feel embarassing to discuss this with your doctor but it is important that you do, so that you can receive the appropriate help. Erectile dysfunction can also be a sign of other illnesses such as heart disease or diabetes, so it is important that you seek medical advice. 

  • ED in men becomes commoner with increasing age and is seen in 50 – 55% of men between 40 and 70 years old;
  • It is often associated with obesity, high blood pressure, high cholesterol & diabetes which are all significant risks to health;
  • Investigation is only indicated if both partners wish to pursue treatment;
  • Most treatable causes can be identified by a clinical history, physical examination and routine blood tests;
  • If there is no treatable cause, treatment with tablets is the first option for most men;
  • Other methods of treatment are only indicated if medication proves ineffective, causes side-effects or cannot be used because of specific medical conditions.

A psychological component, often called “performance anxiety”, is common in men with impotence. However, a purely psychological problem is seen in only 10%.

Of the 90% of men who have an underlying physical cause, the main abnormalities found are:

  • Cardiovascular disease in 40%;
  • Diabetes in 33%;
  • Hormone problems (e.g. high prolactin or low testosterone levels) & drugs (e.g. antihypertensives, antipsychotics, antidepressants, antihistamines, heroin, cocaine, methadone) in 11%;
  • Neurological disorders in 10%;
  • Pelvic surgery or trauma in 3-5%; and
  • Anatomical abnormalities in 1-3% (e.g. tight foreskin, short penile frenulum, Peyronie’s disease, inflammation, penile curvature).

TREATMENT:

Improvements in your lifestyle, such as a eating healthy diet, reducing alcohol intake, losing weight and increasing your exercise can dramatically improve erectile dysfunction. More specific treatment usually involves:

  • weight loss and increased exercise (this may reduced the risk of erectile dysfunction by up to 70%)
  • treatment of any hormone abnormality (testosterone treatment is only indicated if your testosterone levels are low and may be harmful if your the levels are normal);
  • lifestyle modification (e.g. reduce stress, stop smoking, reduce alcohol consumption & stop illicit drugs);
  • treatment of any anatomical abnormality if present (e.g. circumcision, frenuloplasty, penile straightening);
  • psychological support if necessary.

First line treatment will be medication with a phosphodiesterase inhibitor such as sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra) or avanafil (Spedra). These drugs only work when used together with sexual stimulation and will have no effect on your sex drive. There is no evidence that these drugs are dangerous if you have underlying heart disease. However, they should not be used if you are taking nitrates (e.g. GTN, isosorbide) for angina

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ED in men


Phosphodiesterase inhibitors

  • The commonly used PDE-5 inhibitors are sildenafil (generic or ViagraTM), tadalafil (CialisTM), vardenafil (LevitraTM) and avanafil (SpedraTM)
  • They increase blood flow into the penis by blocking the naturally- occurring enzyme (PDE-5) which turns off an erection
  • You should only obtain PDE-5 inhibitors by prescription
  • Side-effects occur in approximately 1 in 9 patients (11%) but only3% stop treatment because of them
  • You should not use PDE-5 inhibitors of you are taking nitratemedications for angina or heart disease

These drugs boost the body’s natural mechanism for getting an erection. This allows erections to be achieved and maintained more easily but they do require sexual stimulation to be effective.

They may not work in severe ED in men or where the natural erectile mechanism has been irreversibly damaged. The drugs work by dilating (opening) the blood vessels supplying the penis; this causes a greater blood flow into the penis and improves your erection.

How should they be taken?

Depending on the medication you are prescribed, a tablet should be taken between 30 minutes and 1 hour before anticipated sexual intercourse. Some of the drugs are affected by eating a heavy or fatty meal before taking the drug. We normally advise you to take them on an empty stomach, or two to three hours after a meal.

You should read the manufacturer’s instruction leaflet carefully because this gives you full instructions. You are advised not to take more than one dose per day. Treatment is usually long-term.

Because of its long half-life, Tadafil (CialisTM) may be taken at a lower, daily dose so that the drug is always in your system to provide a background boost to erections. This can help with night-time and morning erections.

We normally advise you to try treatment for four to six weeks to see whether it works. Your urologist, GP or specialist will suggest a starting dose for you and you will be followed up to see if an increased dosage is needed.

When should they not be taken?

You must not use PDE-5 inhibitors if you take nitrate medications (GTN spray, isosorbide or amyl nitrate) for angina, heart disease or other reasons. If you are not sure whether you are taking these medications, please check with your doctor. PDE-5 inhibitors interact with nitrates and can cause a dangerous drop in blood pressure. This may result in cardiac arrest, or even death.

You should probably avoid taking these drugs with alcohol. If you are unsure as to whether PDE-5 inhibitors are safe for you, consult your GP, specialist or cardiologist who will be able to advise you.

PDE-5 inhibitors are not appropriate if you have been told that sexual activity is inadvisable (e.g. if you suffer from unstable angina or severe heart failure). They should not be used at the same time as other treatments for ED in men, unless you have been advised to do so by a specialist.

What are the side-effects?

The most common side-effects include headache (12%), flushing (10%) and indigestion (7%). Some patients develop altered (blue-tinged) vision and dizziness (3%). If dizziness does occur, you should not to drive or operate heavy machinery. It is important that you report any severe side-effect to your doctor, and consider stopping the drug until you discuss it with your doctor.
PENILE INJECTION THERAPY
Self-administered injections of prostaglandin E1 (Caverject® or Invicorp®) provide a simple means of obtaining a natural erection. You will be taught how to administer the injections (pictured) and told what to do in the event of problems such as an erection which will not go down.

Medicated Urethral System for Erection (MUSE):MUSE offers an alternative route for administration of prostaglandin using a small pellet inserted using an applicator into the tip of the urethra (water pipe opening). Once massaged the prostaglandin is released and helps the blood to flow into the penis to gain an erection. Some men experience a mild burning sensation afterwards in the water pipe but this is a good alternative option for men who do not like the idea of using injection therapy.

Vacuum Erection Assistent Devices (WEDs)
VEDs provide a simple way of obtaining an erection for 30-45 minutes by sucking blood into the penis and holding it in place with a constriction (pictured). Ejaculation may be restricted by the ring but this technique is simple, safe and has no known side-effects. Unfortunately, most patients have to purchase VEDs themselves.

PENILE PROSTHESIS
Insertion of a penile prosthesis (implant) (pictured) is an end stage solution when all other treatment options have failed. It involves a surgical procedure through a small incision in the junction between the penis and scrotum. Patients go home the following day if the procedure is uncomplicated, and the prosthesis can be used for sexual intercourse at 6 weeks following the operation. Complication rates are low in centres that conduct the surgery in large numbers. The risk of infection is <2% and over 85% of the devices are still functioning at 10 years. 

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