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Treatments for Erectile Dysfunction

Almost everyone experiences decreased sexual response from time to time due to such common problems as illness, fatigue, stress or just a lack of knowledge. For some individuals, however, erectile dysfunction becomes a chronic problem. Although the causes of impotence are often psychological, at least half, if not as many as three-quarters, of all cases of erectile dysfunction have a physiological basis as well. In case of chronic impotence, always speak to your doctor first to rule out causes such as illness, medications, injury or habits (e.g. heavy drinking or smoking). Diseases like multiple sclerosis and diabetes, for example, as well as prostate surgery and spinal cord injury may weaken the nerve impulses needed to activate the penis (more information on conditions that cause erectile dysfunction).

When a medication or habit is the cause, change it. If the problem is due to some underlying condition restricting blood flow to the penis, you will need to address this condition first. For example, you can prevent clogging of the arteries by taking better control of diabetes or lowering elevated cholesterol levels. However, most cases of erectile dysfunction also have a psychological component, including depression, stress, anxiety, relationship problems, etc., but most of these problems can be overcome with the help of a professional. If you continue to experience chronic problems with erections despite addressing the underlying physiological and psychological factors, your doctor will consider the treatment options discussed below.

Oral Pills

Sildenafil Citrate. The approval of sildenafil (sold as Viagra) in 1998 revolutionized the treatment of erectile dysfunction. Sildenafil was the first of a new class of drugs called PDE5 inhibitors that enhance the action of nitric oxide. Nitric oxide relaxes the smooth muscles in the walls of the blood vessels, allowing them to expand. As a result of the muscle relaxing effects of sildenafil, blood vessels in the penis dilate as soon as sexual stimulation occurs, enabling an increased inflow of blood to the penis and a normal, sustained erection.

Because sildenafil can also widen other blood vessels in the body, it can cause a sudden drop in blood pressure. However, when combined with drugs known as nitrates (medications commonly used to treat and prevent chest pain due to heart disease), this effect can be severe. Therefore, it is dangerous to combine sildenafil, or any other PDE5 inhibitor, with a nitrate drug in any form, at any time.

Sildenafil should also be used with caution by patients who have had a stroke, heart attack, or life-threatening irregular heartbeat within the past six months; patients with a history of cardiac failure or coronary heart disease with unstable angina; those with significant low or high blood pressure; and patients suffering the eye disorder called retinitis pigmentosa. Sildenafil was found ineffective in the treatment of female sexual dysfunction and, therefore, it should not be used by female patients.

Common side effects associated with sildenafil include headaches, flushing, heart burn, stuffy or runny nose and upset stomach. Some patients have also reported more serious problems such as blurred vision, ringing in the ears and sudden hearing loss, irregular heartbeat and prolonged erections that can cause damage to the penis. If you experience any of these serious side effects, stop using sildenafil and contact your doctor.

Vardenafil. In August 2003, the FDA approved vardenafil (sold as Levitra) as the second prescription drug for the treatment of male erectile dysfunction. Vardenafil belongs to the same group of drugs as sildenafil, called PDE5 inhibitors and it is structurally very similar to sildenafil. Therefore, it shares the same working mechanism with sildenafil and its side effects and drug interactions are also similar but considered to be milder. Because of these milder adverse effects, vardenafil is marketed as the most suitable ED (erectile dysfunction) treatment for older gentlemen who regularly take medications for various other conditions.

Tadalafil. In November 2003, tadalafil received approval from the FDA (trade name Cialis) for the treatment of erectile dysfunction or impotence in male patients. Like sildenafil and vardenafil, tadalafil is also a PDE5 inhibitor, but it is structurally slightly different from the two. Although the working mechanism of tadalafil is the same as that of sildenafil and vardenafil, its pharmacologic distinction is its longer half-life, which results in longer duration of effects. The effects of tadalafil can last for up to 36 hours, compared with relatively short duration of action of sildenafil (4-6 hours) and vardenafil (6-8 hours). Furthermore, tadalafil has the earliest onset of action among these three PDE5 inhibitors. While other ED drugs are only used when needed (but no more than once a day), tadalafil was also approved as a once-daily pill for long-term therapy of ED to improve sexual function. Its side effects and drug interactions are similar to those of the aforementioned two ED drugs.

Avanafil (marketed as Stendra) is the latest PDE5 inhibitor that was approved by the FDA in April 2012 to treat erectile problems in men. Though its mechanism of action is not principally different from those of other three ED drugs, the marketers of avanafil claim that adverse effects are milder, which is due to avanafil’s high selectivity for PDE5. This should, among other things, make the new ED drug less likely to cause a sudden drop in blood pressure. Furthermore, avanafil has the fastest onset of action from all four PDE inhibitors approved for ED, of only 15 minutes.

Yohimbine. This alkaloid is a natural aphrodisiac and the oldest oral treatment used to cure impotence. Yohimbine is only effective in improving erectile function in men whose erectile problems have a psychological cause. Side effects of yohimbine include nausea, nervousness, dizziness and insomnia.

L-Arginine. When it comes to treating male impotence, the natural amino acid L-arginine has been shown to have effects similar to those of PDE5 inhibitor drugs like sildenafil, but these effects are achieved differently. L-arginine promotes the synthesis of nitric oxide (whereas PDE5 inhibitors slow the breakdown of nitric oxide), which has a positive impact on the duration of the erection. Recent scientific studies suggest that the consumption of foods rich in L-arginine, not only helps improve symptoms of erectile dysfunction, but it also reinforces the treatment with sildenafil. Therefore, L-arginine can also enable the patient treated with oral sildenafil to minimize the necessary doses of this drug.

Injectable Medications

In the past, many patients with erectile dysfunction have been using injectable medications, which were injected directly into the penis before sex in order to relax the muscles and thus to increase blood flow to the penis. Drugs in these injections included alprostadil, papaverine and phentolamine, used either separately or in combination. This therapy is hardly ever used today, as it was largely replaced with oral treatments.

Cock Rings

A cock ring is placed tightly around the penis in order to maintain erection for a longer period of time by slowing the blood flow away from the erect penile tissue.

Vacuum Devices

For male patients with ED who cannot or do not want to use oral drugs, vacuum devices offer an effective and safe alternative. These devices create a vacuum around the penis, prompting blood to flow into the sponge-like regions of erectile tissue. Once an erection is achieved, a cock ring or a band is tightly secured around the base of the penis and the cylinder of the vacuum device is removed. Possible side effects include some discomfort from the vacuum, blocked ejaculation and pain from use of the band or the ring.

Hormone Replacement Therapy

Hormone replacement therapy in the form of injections, patches or gel is prescribed to male ED patients with chronic testosterone deficiency.

Surgical Treatment

Surgery is used when erectile dysfunction cannot be corrected by any of the aforementioned therapies. There are two types of surgeries performed: a surgery to repair blood vessels in patients who suffered injuries that left them with restricted blood flow to the penis; and a permanent penile implant surgery. A penile implant (prosthesis) is a substitute only for the erection mechanism of the penis, not a replacement for the penis itself. The implant is surgically inserted into the corpora cavernosa of the penis. There are several types of implants, such as the semi-rigid implant, the multi-part inflatable implant or the self-contained inflatable implant, with each of them offering unique advantages and difficulties. Most patients choose a hydraulic, inflatable implant, because it allows the patient to have an erection whenever desired and is easy to conceal. See also “Dealing with Female Sexual Dysfunction“.

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