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How to Treat Erectile Dysfunction with Dr. Rolando Rivera?


  • Erectile dysfunction (ED) is a common problem affecting up to 52% of men between the ages of 40 and 70 years, but it is not a normal part of aging.
  • Treatment for ED depends on the underlying cause, with options including medication, vacuum devices, surgery, and emerging therapies like stem cell therapy and platelet-rich plasma.
  • At Advanced Urology Institute, personalized and compassionate treatment is provided to help patients find the best, safest, and most effective option for their ED.

Are you having problems getting and keeping an erection for enjoyable and satisfying sexual intercourse?

If so, you are not alone. And you shouldn’t be worried if it happened once or occurs rarely.

Any man can have an occasional failure to get an erection. The risk increases when you drink too much alcohol, have relationship issues, go through stress, or feel fatigued.

“One in every ten men fails to get an erection at some point during their lifetime,” says Dr. Rolando Rivera, a board-certified urologist at Advanced Urology Institute. “So you should not worry too much if it happens,” he adds.

But when the failure to get an erection that’s firm enough for sexual intercourse becomes regular and bothersome, then you may need to get checked for erectile dysfunction (ED).

“You have erectile dysfunction when you fail to have an erection more than 50-percent of the time,” says Dr. Rivera. “The condition is marked by an acute inability to respond to sexual stimulation, trouble getting an erection, and weak, unsatisfactory erections whenever you have them.”

Common problem

Erectile dysfunction is one of the most common conditions in middle-aged and older males. In fact, up to 52-percent of men between the ages of 40 and 70 years have experienced some form of erectile dysfunction.

However, the condition is not a normal part of getting older—men of advanced age may need more stimulation but should still be able to achieve an erection and fully enjoy sexual intercourse.

Erectile dysfunction is a very common problem in men,” says Dr. Rivera. “But since it is a very sensitive subject for many of us, few men with the condition are ready to speak out about it. Fortunately, there are a variety of effective treatments that can help men achieve normal erections and enjoy satisfactory intercourse,” he adds.

Treating the underlying condition

The treatment depends on the cause of the dysfunction, which is why your treatment will begin with finding out if there is an underlying condition.

Conditions such as high blood pressure, type-2 diabetes, multiple sclerosis, kidney disease, obesity, and hypogonadism (low testosterone) can all cause erectile dysfunction. Once the underlying issue is established, it is treated or managed appropriately, resulting in improved erectile function.

“Quite a number of erectile dysfunction cases are due to underlying medical conditions,” says Dr. Rivera. “That is why we are usually keen on finding out if there is an underlying problem before we treat patients with ED,” he adds.


Your doctor may prescribe a phosphodiesterase-5 (PDE-5) inhibitor, such as sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis), or avanafil (Stendra) to help you with ED. You will need to take the recommended pills 30-60 minutes before sex to boost your blood circulation and help you achieve an erection.

“Pills are an easy and convenient option for the majority of men with the problem,” says Dr. Rivera. “So whenever possible, we put ED patients on these drugs,” he adds.

If you cannot use pills, due to a heart condition for example, your doctor may opt for second-line options administered alone or in combination. The second-line options include prostaglandin E1, vasoactive intestinal peptide, phentolamine, papaverine, and atropine.

Alternatively, your doctor may recommend an Alprostadil urethral suppository that is inserted in the urethra with a special applicator or applied topically as a cream. Plus, you may receive testosterone replacement therapy if you have low testosterone.

Vacuum devices

Suppose you don’t want to use drugs, can’t use them, or they aren’t working. In that case, your urologist may recommend a mechanical way of producing an erection. Typically, your penis is made rigid through a hollow tube (vacuum pump) sealed around it.

“A penis pump is an effective, low-cost, and non-invasive treatment,” says Dr. Rivera. “With practice and correct use, most men can use it to get an erection sufficient enough for satisfactory sex.”

The hand or battery-powered pump helps to create a vacuum that enables blood flow to the penis. A tension ring is placed around the base of the penis to keep the erection after the device is removed.


If you’ve not had success with pills and other non-invasive options, your urologist may recommend surgery. For instance, your surgeon may advise you to undergo penile implant surgery. An inflatable implant is placed in your penis and then inflated with a pump, making the penis longer and wider.

“If medication does not successfully treat your condition, your urologist may recommend surgery,” says Dr. Rivera.

“Surgery may also be the only treatment option if you have severe erectile dysfunction, prior surgery in the pelvis, or a medical condition such as cancer,” he adds.

There is also the option of inserting malleable implants that you can alter manually to adjust the rigidity and position of your penis as you desire.

However, in extreme cases and as a last resort, your surgeon may recommend vascular surgery to correct any blood vessel disorder causing ED.

New groundbreaking options

Urology is a continuously evolving field where developments change quickly. And recently, there have been scientific breakthroughs in treating the condition, some sparking a lot of hope.

For example, stem cell therapy is promising to be a safe, effective treatment. Although still only experimental and not yet approved, the injection of your stem cells into the penis already appears like a potent option for ED patients.

Platelet-rich plasma is another option. It has already been approved and is currently available, though still approached with caution. The plasma repairs and heals penile tissue and allows the growth of new blood vessels that help restore normal functioning.

The other novel options are a vascular stent, penile transplant, and penile shockwave therapy.

Personalized, compassionate treatment

At Advanced Urology Institute, we believe in open communication as the cornerstone of erectile dysfunction treatment. You will have a candid consultation session with a compassionate urologist, share how long you’ve had the symptoms and how the symptoms affect your life, and freely discuss your treatment options. The physician will then help you find the best, safest and most effective option for you.

We continue to improve our treatments, integrating current therapies and seeking out better and safer alternatives.

We will share the latest treatment options with you and allow you to be part of the decision-making process that leads to a tailored treatment plan that meets your needs.

The goal is to improve your penile function in a way that allows you to enjoy satisfying sexual encounters and a better quality of life.


I’m Rolando Rivera and I’m board certified in urology and female pelvic medicine and reconstructive surgery with Advanced Urology Institute.

Right, so we’re in an evolving market or surgical field of urology where there’s a lot of things that are changing very quickly. But even so, we always seem to be coming back to full circle. Air torsion is very popular, a very sensitive subject for many of us. But once again, we do have options to take care of the problem, some of them minimally invasive medications, some of them more invasive.

There are some novel therapies in the future that are still experimental but being considered. There’s Samui therapy, there’s injection therapies of different kinds to help improve erectile dysfunction. But again, the end goal is the same. We’re trying to improve the men’s function so they can have good quality of life and satisfactory sexual encounter with their partners.


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Advanced Urology Institute

Advanced Urology Institute is the largest urology practice in Florida. We are dedicated to improving the lives of our patients by providing excellent Patient-Centered Care. Set an appointment or visit our closest office near you.

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