Alternative Approaches to ED

By Ginger Manley | Posted: Friday December 14, 2012

December 2012

©2012 Ginger Manley

(This is part 2 of 3 columns--November and December 2012, January 2013--in response to questions about ED and about hysterectomy. Question below was excerpted from original.)

Dear Ginger:

I am worried about the possibility of side effects of Cialis™, like if my husband might develop a hearing loss, and I would prefer that he not have to use erection medicine if he can get the same results and pleasure another way. Do you have much experience or info about the vacuum pump for erection assistance? It seems like a rather mechanical way to initiate sex but it might help him avoid the potential side effects of the drug.


Dear Marianne:

Oral erection medicines work well in many men when paired with physical sexual stimulation, for a combination of both internal and external assisted loving. When a man is using a PDE5 inhibitor, he should limit any alcohol intake to one drink and should also avoid eating a high fat meal (like a juicy rib eye or a slab of ribs) which not only is unhealthy but which also slows absorption of the medicine in his digestive system.

All medications have the possibility of unwanted and /or dangerous side effects. For PDE5 inhibitors (Cialis™, Viagra™, and Levitra™), most of the unwanted side effects involve lowering the blood pressure more than is comfortable or safe. Men who take nitrates for angina cannot take PDE5 inhibitors. Some men who have prostate problems or who take a category of blood pressure medicines called alpha-blockers may not be allowed to take these ED medications. Rarely a man may have sudden vision changes and even more rarely may develop sudden hearing changes, like decrease or loss of hearing, while taking oral ED medicines, but it is almost impossible to know whether the change is a direct result of taking these medicines or from something else.

In your case, Marianne, if your husband is already having some hearing problems, I would suggest that he get a hearing evaluation. As I have written in an earlier column, subtle hearing changes that build up over time are a big source of communication problems in couples your age.

The old saying "use it or lose it," definitely applies to our sexual health and well-being as we age. For men who are experiencing occasional ED and especially for those who are taking oral ED medicine, stimulating the penis by hand (masturbation) or with a vibrator is one part of a sexual well-being program. In addition, pelvic floor muscle exercises (Kegel's), in which the muscles surrounding the base of the penis are tightened and relaxed in cycles of 5-15 repetitions, help the structures stay in shape for when an opportunity presents itself. Men and women who practice stimulation to arousal and climax, either within a partnership or with themselves, on a regular basis are able to function better sexually far better than those who stop engaging in these activities.

All of us are equipped by Nature for externally assisting our partners and ourselves to become aroused and satisfied, including use of our hands, mouths, and any other body parts. In addition, for almost all of recorded history creative people have fashioned equipment to assist in sexual play. Most commonly, these include vibrators (which are useful to both men and women) and equipment designed to lengthen and stiffen the penis, known as vacuum erection devices (VED's) or alternately, vacuum constriction devices (VCD's) or vacuum pumps.

Vacuum pumps or VED's consist of a rigid plastic tube, a hand-held pump, and sometimes a constricting ring that is applied to the base of the penis. VED's work by drawing blood into the penis, causing it to stretch, and then when the vacuum is released, to relax. While use of a VED appears to lengthen slightly the penis in men who have had radical prostate surgery, there is no similar effect on a man who is able to get a natural erection. To see illustrative images and more information on VED's, see and also among many other Internet sites with information.

For some men, a VED may be used as a supplement to or in place of masturbation. Typically the man who most benefits from and is most satisfied with use of a VED is one who has had colon or prostate cancer surgery, advanced diabetes, or other medical issues causing poor blood flow to the penis and who is using the VED in conjunction with other penile rehabilitation techniques. (I have addressed this topic in previous columns, but newer information is available since then, so I will do a column early in 2013 on the complete penile rehab program). Occasionally a VED may be useful as a confidence builder with men who have anxiety or other psychological issues, but my experience as a therapist was that men who had good-enough normal function did not benefit from or enjoy using VED's.

From what you have written, Marianne, I cannot see how a VED will enhance what you and your hubby already are doing. If his health care provider is overseeing his ED medications and you are both comfortable speaking openly to that person about your concerns, you will probably catch any side effects early enough so that long-term problems will not develop. You are already engaging in sexual activity several times a month with good results. Doing more of this should help you continue to meet your sexual well-being goals.

Next month I will address the concerns you voiced about the sexual repercussions of a possible hysterectomy. In the meantime, here are my wishes for you and all my readers to have a very Merry Christmas and a delightful and safe New Year.




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