Understanding Erectile Function and Dysfunction

Erectile function is not always understood by many men. You may not realize it, but men get erections every day. The penis is erect, typically, for about 2  hours out of every 24 hour period. This mostly occurs during deep sleep. That is why sleep is essential for proper erectile function. While a man is sleeping his penis is literally working out because the penis is primarily made up of blood vessels surrounding by smooth muscles. The smooth muscle relaxes and the blood vessels engorge (fill) and then the smooth constricts  and the increased blood flow returns to the body.Tthis happens about 4-6 times per night in perfectly healthy men. This penis muscle “work out” keeps the structure of the penis functioning properly for erectile function. When the night-time and morning erections stop, the muscles can atrophy (shrink) leading to worse erectile dysfunction.

Erections require blood flow and nervous conduction (communication between the brain and penis). Once a man is excited the brain sends a message down to the penis causing certain chemicals to be activated and leading to smooth muscle relaxation and vasodilatation in the penis. The penis begins engorged with blood and that swelling within the corpora cavernosa pushes against superficial veins locking the blood in the penis. Any disease that impacts blood (high blood pressure, high cholesterol, being overweight, cardiovascular disease, diabetes, etc…) flow or nervous conduction (diabetes, chronic spinal disc issues, stroke, etc…), could potentially affect the ability to get a full erection. The most common medical conditions can lead to erectile dysfunction (if not well controlled) and that is why about 1 out of every 5 men will have erectile dysfunction in their life time.

To learn more go to videos I made for men & women with sexual dysfunction at:



Jeffrey Albaugh, PhD,  APRN, CUCNS




Erectile Dysfunction Prescription Drug Costs are Sky Rocketing! Beware: Many Conterfeit Websites and Companies Exist

There is no such thing as generic sildenafil, vardenafil, tadalafil or avanafil. These are generic names for the oral popular erectile dysfunction medications, but none of them are off patent, so anyone who is claiming to give you generic medications is breaking the law! You can only be absolutely sure you are getting the correct medication made under the correct circumstances from a legitimate United States (U.S.) pharmacy. To find out if a pharmacy is a legitimate you can go to: LegitScript.com 

Today in clinic I was very unhappy to learn that many pharmacies increased prices for tadalafil by almost $7 per pill at some pharmacies. In helping my patients, I discovered that there is not much out there to help patients find the best cost for legitimate United States Pharmacies for erectile dysfunction medications. With all the counterfeit medications coming from around the world through pharmacies outside the U.S. and the many counterfeit websites and companies in the U.S., it is incredibly frustrating. The truth is that when you order from anything but a legitimate U.S. pharmacy, you are taking a risk. You don’t know where the medication is coming from or if it is real or safe. Some of the medications made by the very smart counterfeit companies use the same logo and packaging, but it is possible they made the medication in unclean conditions outside the pharmaceutical company that has the patent on the medication. Please only use legitimate U.S. pharmacies. I am going to try to check pricing on some of these medications and post comparisons here. Maybe we can create a ED prescription buddy on this site to try to keep up with changing costs…With men doing penile rehabilitation after prostate removal for prostate cancer, this cost is huge. If your provider wants you to try to use the medications regularly to promote blood flow with regular stimulation for penile rehabilitation you could pay hundreds of dollars a month for the taking the medication several times a week.  

Here is what I found out today with the increased cost of Tadalafil calling different pharmacies or looking at online prices from some of the completely legitimate pharmacies:

As of 10/8/2013 for a prescription of Cialis 20 mg, 10 pills the cost per pill is (prices are only as accurate as information I was given or on the websites, so they may vary and you should check for yourself):

Target  $35.20/per pill

Costco $30.57per pill  (one of the few with prices actually posted on their website at http://www2.costco.com/Pharmacy/DrugInformation.aspx?p=1 )

Walgreen’s $41.22/per pill

CVS $36.40 per pill

Walmart $34.72 per pill

The prices are really up in the past month and my only goal is that we can all help each other know the most reasonable legitimate U.S. Pharmacy to purchase them.  I will try to continue to add pricing information here.

Most importantly, only use legitimate U.S. Pharmacies if you want to be sure you are getting the right medications.

I hope this information is helpful.


Jeffrey Albaugh, PhD, APRN, CUCNS



Reclaiming Sex & Intimacy After Prostate Cancer

Everyday I see patients who are struggling with the issues of sexual dysfunction and/or incontinence after prostate cancer. Every time I speak to a group of men, many of them come up afterwards to tell me how important this information is to them and their partners.

In terms of sexual dysfunction, several issues occur after prostate cancer treatment. First, men typically do not ejaculate fluid after prostate removal (surgery) and/or radiation.  The prostate plays a vital role in contributing some of the volume to ejaculate as well as mixing everything together before it is expelled and that is why a man will typically not ejaculate after prostate removal or radiation.

Second, the penis may atrophy (shrink) up into the body after prostate removal or radiation. This is related to unchallenged sympathetic tone (nerve influence which becomes out of balance after surgery or radiation). This may resolve within a few months, but the lack of regular night time and morning erections can lead to further atrophic (muscle shrinkage) changes causing a more lasting effect.

Third, the nerves for erections lay on the back of prostate and so they are traumatized by either surgery or radiation leaving many men with an inability to get and keep an erection sufficient for penetrative sex. Sometimes this situation resolves as nerves may recover from the trauma and sometimes it does not. If the surgeon is concerned about getting all the cancer during surgery, he may need to remove the nerves leading to permanent erectile dysfunction. Even when nerves are sparred, they often take an average of 1-2 years to recover from the trauma.

The good news is that there are several different treatments for erectile dysfunction. Each treatment has pros and cons and what is right for one man, may not be right for another.

If you are interested in learning more about the topic, you may want to go to the website for my book “Reclaiming Sex & Intimacy after Prostate Cancer Treatment”.  The book was written out of a request from so many men for the information. It is available at www.drjeffalbaugh.com

I hope this information has been helpful!


Quality-Of-Life After Prostate Cancer Concerns

The concern for many men is that prostate cancer treatment is not without side effects, the most common being sexual dysfunction and urinary problems. All medical treatments have positive and negative effects, and prostate cancer treatments are no different. For many men, quality-of-life after prostate cancer treatment is their greatest concern.

DrJeffAlbaugh.com-1Hi I am Jeffrey Albaugh, PhD, APRN, CUCNS, a board-certified Advanced Practice Urology Clinical Nurse Specialist and Director of the NorthShore University Sexual Health Clinic, Evanston, IL. I have cared for thousands of patients with sexual dysfunction and prostate cancer for more than 18 years in urology and over 26 years of patient care. I specialize in treating men, women, and couples  with sexual dysfunction. I also see men undergoing  treatment for prostate cancer.

This blog is dedicated to helping prostate cancer patients and their partners understand prostate cancer treatments and how to address issues related to treatment such as sexual dysfunction and incontinence.