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FOR COMMON MALE PROBLEM, HOPE BEYOND A PILL

If you watch enough television, you'd think that treating erectile dysfunction was as effortless as popping a pill and then whirling your partner around the living room in a romantic dance. Correcting erectile dysfunction, alas, is not so simple - and it can be rather costly. One Viagra pill, for example, the most common way to treat erection problems, costs about $15.

Insurers can be chary of reimbursements. And despite the fact that ED, as the dysfunction is known, becomes increasingly common after men reach 65, Medicare Part D does not cover drugs for it.

An estimated 30 million men in this country experience erectile dysfunction. Nearly a third of men in their 50s experience ED, whereas more than half of those in their 60s have the problem.

If you're hoping to have Viagra-aided sex twice a week, your bill for the entire year could run about $1,500. If you're fortunate enough to have insurance that covers the medications, your copay will be on the high side, about $40 for a one-month supply of six to eight pills - bringing your annual bill to a more manageable $500 or so. There are no generic ED drugs yet.

Even among the name-brand drugs, which also include Cialis and Levitra, the medications do not work for about half of the men with ED, said Dr. Ajay Nehra, professor of urology at the Mayo Clinic in Rochester, Minn. He is also president of the Sexual Medicine Society, an association of health care professionals.

And yet, as it turns out, there are other treatments for ED. Some of them are more cost-effective than the brand-name pills advertised on television.

"There is not a man out there that cannot be helped in some way with his ED - even if money is an issue," says Dr. Andrew McCullough, an associate professor of urology and director of Male Sexual Health and Fertility at the Langone Medical Center at New York University.

the diagnosis

The first step is to see a doctor who specializes in ED (usually a urologist) and have your overall health checked.

ED can be the sign of an underlying disorder like diabetes or hypertension.

lifestyle changes

By adopting healthier habits, you may be able to improve your well-being and restore your erectile function.

In a study of men with ED, or at risk for developing it, researchers in Italy found that the men could improve their erections by losing weight, improving their diet and exercising more frequently. After two years of significant lifestyle changes, 58 percent of the men had normal function, according to the studyin The Journal of Sexual Medicine.

drugs and more

Lifestyle changes can be difficult to make and may take months to take effect. In the meantime, your doctor will probably prescribe a phosphodiesterase type 5 inhibitor, also called a PDE-5 inhibitor, like Viagra, Cialis or Levitra. These drugs enhance the effects of nitric oxide, a chemical that helps to increase blood flow in the penis.

If the pills don't work for you, you might want to try self-administered injections of alprostadil, a drug that helps blood vessels expand and facilitates erections. The shot, sold under the brand names Edex and Caverject, is done with a fine needle and produces an erection that can last up to four hours, doctors say.

The shots cost about $35 per injection and are covered by most insurers, but not by Medicare.

Another option is a vacuum erection device or penis pump, which pulls blood into the penis. When the penis is erect, a snug ring is placed around the base to maintain the erection.

The cost for a prescription device can be $300 to $600, but most insurers and Medicare will cover part of that.

implants

If all other treatments fail, you could consider getting penile implants. The most common type of implant works through inflation: Two cylinders are placed inside the penis and a fluid-filled reservoir is implanted under the abdominal wall or groin muscles; a pump and a deflation valve are placed inside the scrotum. To create an erection, you pump fluid from the reservoir into the cylinders. To deflate the penis, you press the release valve.

Most insurers and Medicare cover the surgery, so your out-of-pocket costs will be minimal. Implants can last as long as 10 years.

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