Men’s Sexual Health · University Urology, PC
Erectile Dysfunction Care in Knoxville, TN
ED is common, and it’s treatable. We offer a stepwise, evidence-based approach — from oral medications and injection therapy to penile implant surgery — tailored to your health, goals, and preferences.
About ED
Common, Treatable — and Worth Addressing
Erectile dysfunction affects millions of men and becomes more prevalent with age — but age alone doesn’t cause it. ED almost always has one or more identifiable contributing factors, and identifying the underlying cause is the starting point for choosing the most effective treatment.
At University Urology, we take a practical, stepwise approach: starting with the least invasive options and escalating only when needed. Many men improve significantly with oral medications, lifestyle changes, or injection therapy. For those who don’t, penile implant surgery offers a durable, high-satisfaction solution.
ED can also be an early signal of underlying cardiovascular disease. Because erections depend on healthy blood flow, we evaluate vascular risk factors as part of a complete assessment — and coordinate with your primary care provider when appropriate.
Common Causes of ED
ED Usually Has More Than One Contributing Factor
Identifying the “why” helps us choose the most effective treatment plan.
- Vascular: reduced blood flow due to hypertension, high cholesterol, diabetes, or smoking — the most common underlying cause
- Hormonal: low testosterone or other endocrine disorders; often a contributing factor but rarely the sole cause
- Neurologic: nerve injury or conditions affecting nerve signaling, including multiple sclerosis and spinal cord injury
- Post-prostate treatment: ED after prostatectomy or radiation is common and very treatable
- Medication-related: certain antihypertensives, antidepressants, and other drugs can impair erectile function
- Psychological: stress, anxiety, depression, and relationship factors — often coexist with physical causes
- Peyronie’s disease: scar tissue causing penile curvature can contribute to ED and painful erections
ED as a Signal of Cardiovascular Risk
Because erections depend on healthy arterial blood flow, erectile dysfunction can be an early warning sign of cardiovascular disease — sometimes appearing years before a cardiac event. If you have ED and have not had a recent cardiovascular evaluation, we discuss this as part of your assessment and coordinate with your primary care physician when appropriate.
Evaluation
What to Expect at Your First Visit
Most ED evaluations can be completed in a single focused visit. We review your history, identify contributing factors, and build a treatment plan the same day in most cases.
What We Review
- Onset, consistency, and severity of symptoms
- Presence of morning erections and libido
- Medical history — diabetes, blood pressure, cardiovascular disease
- Medication list — many common drugs contribute to ED
- Prior ED treatments tried and their response
- Post-prostate treatment history if applicable
- Relationship context and patient goals
Testing We May Order
- Testosterone level (total and free) — nearly always checked
- HbA1c and fasting glucose if diabetes is suspected
- Lipid panel if not recently done
- Other hormonal workup as indicated (prolactin, LH, FSH)
- Physical exam when clinically relevant
- Penile duplex ultrasound for vascular assessment in select cases
What to bring: Your medication list, any recent lab results, and — if post-prostate treatment — your operative or radiation summary. If you’ve tried ED treatments before, a brief note on what you tried and how it worked is helpful. We can typically make a plan at the first visit.
Treatment Options
A Stepwise Approach — Starting With the Least Invasive Option
We tailor treatment to your health, preferences, and desired level of spontaneity. Many men benefit from combining approaches. If one option doesn’t work, the next step is a different therapy — not giving up.
Lifestyle & Risk Factor Optimization
Improving vascular health often improves erectile function directly and enhances response to medications. Always recommended as part of any treatment plan.
- Regular aerobic exercise
- Weight management
- Smoking cessation
- Optimizing blood pressure, cholesterol, and blood sugar
- Sleep and stress reduction
Oral PDE5 Inhibitors
The most common first-line therapy for ED. We guide correct use, timing, and dosing strategy — many men who “tried one and it didn’t work” were using it suboptimally.
- Sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra)
- Daily vs. on-demand dosing strategies
- Not compatible with nitrate medications — safety review included
- If pills don’t work: escalate, don’t stop
Vacuum Erection Device (VED)
A non-pharmacologic option useful alone or in combination with other therapies. Particularly valuable for penile rehabilitation after prostatectomy.
- Creates erection using negative pressure
- No medications or injections required
- Often combined with a constriction ring
- Useful for post-prostatectomy penile rehab
Injection Therapy (ICI)
Intracavernosal injection therapy is highly effective for many men, particularly those who have not responded to oral medications. Administered directly into the penis using a very small needle.
- In-office training for safe self-injection technique
- Rapid onset — typically effective within 5–15 minutes
- Strong rigidity for most patients regardless of vascular status
- Alprostadil, trimix, and other compounded formulations available
Intraurethral Therapy (MUSE)
Alprostadil delivered via a small suppository placed into the urethra. An option for men who prefer to avoid injections.
- No needles required
- Generally less effective than ICI but appropriate for select patients
- Can be combined with a constriction ring or VED
Penile Implant (IPP)
The most durable, definitive treatment for ED when other therapies are ineffective or not tolerated. High patient and partner satisfaction rates.
- Inflatable (3-piece) or malleable device options
- On-demand function with no medications required
- Performed by Dr. Lacy (primary) and Dr. Kim
- Outpatient or short-stay procedure at UTMC
Related Condition
Peyronie’s Disease
Peyronie’s disease is a condition involving scar tissue (plaque) in the penis that causes curvature, pain, and in many cases contributes to erectile dysfunction. It is more common than most men realize and is very treatable.
What Is Peyronie’s Disease?
Peyronie’s disease occurs when fibrous scar tissue develops inside the penis, typically following minor trauma or injury. The scar tissue creates an inelastic area that causes the penis to curve, shorten, or develop an hourglass deformity during erection. This can make intercourse difficult or painful and frequently causes ED.
Peyronie’s disease has two phases: an acute phase (active inflammation, changing curvature, often painful) and a stable phase (curvature stable for at least 3 months, pain usually resolved). Treatment approach depends on which phase you are in.
Common Symptoms
- Penile curvature during erection (upward, downward, or lateral)
- Penile shortening or narrowing
- Pain with erections, especially during the acute phase
- Palpable plaque or hard area along the shaft
- Difficulty with penetration due to curvature
- Associated erectile dysfunction
Xiaflex (Collagenase Clostridium Histolyticum) — FDA-Approved Treatment
Xiaflex is the only FDA-approved injectable treatment for Peyronie’s disease. It is an enzyme that breaks down the collagen in the Peyronie’s plaque, reducing curvature over a series of injection cycles. Xiaflex is most effective in the stable phase for men with curvature greater than 30 degrees.
Treatment involves: A series of in-office injection pairs, each followed by a modeling procedure performed by your physician. Multiple treatment cycles are typically needed.
Other treatment options include oral medications, traction therapy, surgical plication, and grafting for severe cases. For men with both Peyronie’s and severe ED, penile implant with intraoperative straightening may be the most effective single procedure.
Xiaflex Provided By
Frequently Asked Questions
Common Questions About ED
Ready to Take the Next Step?
ED is treatable at every level of severity. We build a plan that fits your health, your goals, and your life. Same-week appointments often available.