For most men, erectile dysfunction is just an inconvenience. But for men with severe erectile dysfunction, and it can life-changing.
Drugs like Viagra and Cialis – and their generic equivalents – allow men to achieve normal erections. These oral medicines belong to a class of drugs called phosphodiesterase type 5 (PDE-5) inhibitors. They were invented about 20 years ago, and they are still the most common treatment for ED.
Even mild ED still has an impact. Men and their partners may suffer a loss of self-esteem, or even depression. There is less spontaneity when a man needs to take a drug prior to sex. But for most men, the overall impact of erectile dysfunction is manageable.
Unfortunately, about a third of men do not respond to PDE-5 inhibitors. This is often an indication of severe erectile dysfunction.
Another way to assess the severity of ED is by using the Sexual Health Inventory for Men, or SHIM test. This is a simple 5-question assessment instrument that is often used by doctors. You can take the SHIM test online; a score of 7 or less is classified as severe ED.
Laying the Groundwork to Overcome Severe Erectile Dysfunction
Whether you have mild, moderate, or severe erectile dysfunction, you should take some basic steps:
(1) Talk with your spouse or partner
ED has a big impact on relationships. Both partners often experience a loss of self-esteem, less sense of intimacy, and even depression. Erectile dysfunction can even destroy relationships.
You and your partner need to get comfortable talking about the issue. Both of you will need to learn about ED, and work together to overcome its consequences.
(2) Improve your lifestyle
RD is often caused by circulatory problems. It can be a good indicator of overall health. To combat ED, you should eat a heart-healthy Mediterranean diet, get regular aerobic exercise, avoid tobacco and drugs, and minimize alcohol.
Lifestyle changes will not cure severe erectile dysfunction, but studies have shown that lifestyle can lessen the effects. Moreover, if you get fit you will feel better about yourself. This can reduce the psychological impact of ED.
(3) Get educated
Learn about the causes and treatments for erectile dysfunction. Look for authoritative, reliable websites such as the Harvard Medical School, the Cleveland Clinic, the Mayo Clinic, or the American Urological Association. There are other good websites as well, but make sure their information is based on real science. Look for websites that link to actual clinical research.
(4) Talk to your doctor or urologist
Your doctor can advise you on the best treatment options for your specific situation and condition.
Treatment Options for Severe ED
For men who don’t respond to PDE-5 inhibitors, or who cannot take them for some reason, there are some other treatment options:
If you can’t get an erection with a PDE-5 inhibitor such as Viagra, it’s worth asking your doctor to switch your prescription to a different medication. Some men respond better to one drug than another.
Intracavernous Penile Injections
In order to achieve an erection, the user injects a vasodilator into the corpora cavernosa on the side of the penis shortly before sexual activity. There is one drug, alprostadil (a form of prostaglandin) which is approved by the FDA as an injectable medicine for erectile dysfunction. It is sold under the brand names Caverject® and Edex®.
Many doctors prescribe mixtures of drugs that may be more effective than alprostadil alone. These mixtures are called Bimix or Trimix.
Intracavernous penile injections are effective for about 80% of men who try them, including many men with severe erectile dysfunction.
Low-Intensity Extracorporeal Shockwave Therapy (LI-ESWT), commonly called shockwave therapy, can treat ED caused by vascular problems. Low-intensity sound waves encourage the development of new blood vessels (angiogenesis), and improve the function of smooth muscle and endothelial cells. They also break up plaque that blocks arteries in the penis.
Shockwave therapy is usually administered as a series of 6-12 treatments in a men’s clinic. There are also home therapy devices available.
Clinical studies  show that shockwave therapy is a safe and effective treatment for men with ED.
Shockwave therapy works best for men with mild or moderate ED. For men with severe ED, shockwave therapy will probably not provide a complete cure. On the plus side, you may see enough improvement to get an erection using oral medicine (PDE-5 inhibitors).
Vacuum Erection Devices (VEDs), or penis pumps, can give you an erection by drawing blood into the penis. To maintain the erection, you can use a constriction band or ring.
You can use a penis pumps can be used to get an erection shortly before sex. But for men with severe ED, the erection will probably not be firm enough, or will not last long enough, for sex.
The main use of a vacuum pump is really therapeutic. In other words, it is used to treat your ED instead of just giving you an erection.
Men with severe ED don’t have enough blood flow to the penis. They usually don’t get erections while they are sleeping at night.
Over the long term this can cause the erectile tissues to atrophy and shrink. Regular use of a vacuum pump can improve blood flow, which can restore erectile function and even help regain lost length .
Just like shockwave therapy, pumps will not cure severe ED. They will help to restore the health of your penis, so that oral medicines will work.
You can use a vacuum pumps in conjunction with shockwave therapy for better results.
A penile implant is made up of an inflatable chamber that is placed in the shaft of the penis, and a pump that is hidden in the scrotum.
Inflatable penile implants allow men to have erections as often and as long as they wish. They allow men to have sex, to have orgasms, to ejaculate, and even father children, just as they did prior to the implant.
The implant procedure is performed by a surgeon. You may be able to go home the same day, or you may need a couple of night’s stay in the hospital. Recovery usually takes about six weeks before you can inflate the implant.
Penile implants have the highest rate of patient and partner satisfaction of any form of ED treatment – 97% and 90% respectively .
What to Avoid
There are a couple of treatment options that are heavily promoted, but are actually just a waste of money. These include:
Over-The-Counter Herbal Products
There are also many studies of various herbal remedies for ED. The studies show that these products do little if anything to help with ED.
More importantly, these over-the-counter products are very poorly regulated, and can actually be dangerous. Investigators have found that 50-80% of the products being sold don’t even contain the ingredients listed on the label. And hundreds have been found to contain “hidden, deceptively labeled, or dangerous ingredients” – including insecticides!
It’s not worth wasting your money and risking your health for products that don’t even work.
Platelet-Rich Plasma (PRP) Injections
PRP injections are administered in a clinic. A technician or nurse will draw some of your blood, put it in a centrifuge to concentrate it, and then re-inject it. This is supposed to promote the development and growth of blood vessels and nerves.
But there have been hundreds of clinical studies for PRP injections, and most show little improvement.
Doctors reviewed the various studies in 2019. They concluded that “Despite a global presence of PRP clinics and ongoing active marketing and public interest in regenerative medicine, no scientific evidence has been published to establish an evidence-based risk-benefit profile for PRP use for ED in humans.”
On the WebMD website, Dr. Sheldon Marks says, “there is no evidence to show it is scientifically proven to work as claimed and it has not been thoroughly tested for safety. Additionally, at a cost of several thousand dollars per shot, it’s an expensive gamble. Unless new research comes to light, I won’t be recommending this treatment to my patients.”
A Satisfying Sex Life with Severe Erectile Dysfunction
One of the most devastating effects of ED is its impact on intimacy and relationships. While there are treatment options that can improve ED, it’s important to understand that you can have a full and satisfying sexual relationship, even if you are not able to achieve an erection suitable for sex.
Your partner may not understand that you can be aroused and enjoy sex play, even if you do not get an erection. You can even have an orgasm if your penis is not erect. That’s why it’s important for couple to talk about ED and how it affects their sex life.
Many couples are not comfortable talking about sex, or trying new things. If that’s the case, you may want to get help from an intimacy or relationship coach. A counselor or coach can help you and your partner get more comfortable talking about your needs and preferences when having sex.
For more thoughts on talking with your partner about ED, see our article “Your Partner Has Erectile Dysfunction – Is It Your Fault?”
References for Details and Clinical Study Citations