The Hubbard Clinic for Bladder Control: Louisville, KY

The Condition
The Treatment
Low Testosterone Quiz

Thanks to Bob Dole and endless advertising, erectile dysfunction (ED) is a household subject. Patients once whispered to Dr. Hubbard in the exam room about getting samples of Viagra. Now they announce it to our receptionist in a room full of people. There are many causes of ED, and it is essential to understand the cause of the problem before a solution can be reached. There are four things that need to happen to have a full erection. They are:

1. Desire (libido) – comes from the male hormone testosterone made by the testicles. This starts the whole sexual process in motion. If desire is lacking, a testosterone blood test should be done. Though testosterone deficiency is not a common cause of ED, when ED does occur due to decreased testorone production, testostene replacement therapy may improve the condition. See Testosterone Screening Test.

2. Arterial blood flow – an erection occurs because of engorgement of blood in two penile blood cylinders. There is one small artery to each blood cylinder. If there is not enough blood flow to the penis, an erection will not occur. Conditions that can cause this include:

• Atherosclerosis, or hardening of the arteries. If you have had a heart attack you have plaque in your coronary arteries and are likely to have it in the small penile arteries.

• Hypertension medication.

• Smoking – nicotine causes constriction of blood vessels.

• Diabetes Mellitus.

• Obesity. For each extra pound over ideal body weight five miles of blood vessels are added for the heart to pump. This means if you are 50 pounds overweight, you have an extra 250 miles of blood vessels, and this robs the penis of blood.

3. Cylinder muscle relaxation – the two blood cylinders are made up of a network of muscle spaces, much like a sponge. If the muscle spaces are contracted, as is usually the case, the blood just runs through the penis with no enlargement. With sexual excitement, the spaces relax and blood fills the spaces and causes the penis to enlarge.

4. Venous leakage – normally when the cylinder spaces are adequately filled with blood the penis enlarges and puts pressure on the cylinder wall. The venous blood leaving the penis runs through this wall. When there is enough blood flowing to the penis and the muscle spaces relax, the blood is retained and the erection is maintained. If there is not enough blood in the cylinders, then there is not enough pressure on the wall and blood leaks off through the veins. This is the case when a man gets an erection but can’t maintain it.

There are numerous treatment options available for erectile dysfunction.These include medication (Viagra, Levitra and Cialis), vacuum pumps, Trimix injection therapy, muse urethral suppositories and penile implants. Each option has its advantages and disadvantages.

In order to gauge which course of treatment will be most effective, it is necessary to perform a personalized evaluation to determine the cause of the erectile dysfunction.

Viagra, Levitra and Cialis are the three most common medications. They are PD5 inhibitors which help relax the muscles of the penile blood cylinder so the penis can engorge with blood. All three are essentially the same drugs, but differ in onset of action, side effects and duration of action. If you have no response to one of the drugs, it is unlikely that the other two would work.

Vacuum pumps work by using negative pressure to engorge the penis with a pump and then using a ring t o hold the blood in the penis. This method works much better in older men because they have less penile sensitivity and are less likely to find the ring painful.

Dr. Hubbard has found the best of all treatments, in terms of maintaining penile rigidity, is Trimix injection therapy. He has prescribed it for over 15 years. The difficult part is convincing men to inject the base of the penis with a small insulin needle. The sensitivity is in the end of the penis, so it actually hurts no worse than getting an injection in the arm or stomach. The injection contains three different medicines, works in about five minutes and stays in your system for 2-3 hours. The penile rigidity obtained is much greater than that obtained through oral medication. The side effects are minimal.

In order to determine which course of treatment will be most effective, it is necessary to perform a personalized evaluation to determine the cause of your erectile dysfunction.


About Us Welcome Male Care Female Care The Women's Life Cycle Center The Women's Care Center Meet Our Providers Directions Helpful Links Privacy Policy Treatments & Conditions Prostate Health Overview BPH/Voiding Problems Erectile Dysfunction Prostate Cancer Media Patient Services New Patient Packet FAQs General Prostate Cancer TUNA/TUMT Therapy ED Contact Us
	The Condition The Treatment Low Testosterone Quiz Thanks to Bob Dole and endless advertising, erectile dysfunction (ED) is a household subject. Patients once whispered to Dr. Hubbard in the exam room about getting samples of Viagra. Now they announce it to our receptionist in a room full of people. There are many causes of ED, and it is essential to understand the cause of the problem before a solution can be reached. There are four things that need to happen to have a full erection. They are: 1. Desire (libido) – comes from the male hormone testosterone made by the testicles. This starts the whole sexual process in motion. If desire is lacking, a testosterone blood test should be done. Though testosterone deficiency is not a common cause of ED, when ED does occur due to decreased testorone production, testostene replacement therapy may improve the condition. See Testosterone Screening Test. 2. Arterial blood flow – an erection occurs because of engorgement of blood in two penile blood cylinders. There is one small artery to each blood cylinder. If there is not enough blood flow to the penis, an erection will not occur. Conditions that can cause this include: • Atherosclerosis, or hardening of the arteries. If you have had a heart attack you have plaque in your coronary arteries and are likely to have it in the small penile arteries. • Hypertension medication. • Smoking – nicotine causes constriction of blood vessels. • Diabetes Mellitus. • Obesity. For each extra pound over ideal body weight five miles of blood vessels are added for the heart to pump. This means if you are 50 pounds overweight, you have an extra 250 miles of blood vessels, and this robs the penis of blood. 3. Cylinder muscle relaxation – the two blood cylinders are made up of a network of muscle spaces, much like a sponge. If the muscle spaces are contracted, as is usually the case, the blood just runs through the penis with no enlargement. With sexual excitement, the spaces relax and blood fills the spaces and causes the penis to enlarge. 4. Venous leakage – normally when the cylinder spaces are adequately filled with blood the penis enlarges and puts pressure on the cylinder wall. The venous blood leaving the penis runs through this wall. When there is enough blood flowing to the penis and the muscle spaces relax, the blood is retained and the erection is maintained. If there is not enough blood in the cylinders, then there is not enough pressure on the wall and blood leaks off through the veins. This is the case when a man gets an erection but can’t maintain it. There are numerous treatment options available for erectile dysfunction.These include medication (Viagra, Levitra and Cialis), vacuum pumps, Trimix injection therapy, muse urethral suppositories and penile implants. Each option has its advantages and disadvantages. In order to gauge which course of treatment will be most effective, it is necessary to perform a personalized evaluation to determine the cause of the erectile dysfunction. Viagra, Levitra and Cialis are the three most common medications. They are PD5 inhibitors which help relax the muscles of the penile blood cylinder so the penis can engorge with blood. All three are essentially the same drugs, but differ in onset of action, side effects and duration of action. If you have no response to one of the drugs, it is unlikely that the other two would work. Vacuum pumps work by using negative pressure to engorge the penis with a pump and then using a ring t o hold the blood in the penis. This method works much better in older men because they have less penile sensitivity and are less likely to find the ring painful. Dr. Hubbard has found the best of all treatments, in terms of maintaining penile rigidity, is Trimix injection therapy. He has prescribed it for over 15 years. The difficult part is convincing men to inject the base of the penis with a small insulin needle. The sensitivity is in the end of the penis, so it actually hurts no worse than getting an injection in the arm or stomach. The injection contains three different medicines, works in about five minutes and stays in your system for 2-3 hours. The penile rigidity obtained is much greater than that obtained through oral medication. The side effects are minimal. In order to determine which course of treatment will be most effective, it is necessary to perform a personalized evaluation to determine the cause of your erectile dysfunction.