How is ED treated?
Most physicians suggest that treatments proceed from least to most
invasive to treat erectile dysfunction. For some men, making a few healthy lifestyle changes may
solve the problem. Quitting smoking, losing excess weight, and
increasing physical activity may help some men regain sexual
function.
Cutting back on any drugs with harmful side effects is considered
next. For example, drugs for high blood pressure work in different
ways. If you think a particular drug is causing problems with
erection, tell your doctor and ask whether you can try a different
class of blood pressure medicine.
Psychotherapy and behavior modifications in selected patients are
considered next if indicated, followed by oral or locally injected
drugs, vacuum devices, and surgically implanted devices. In rare
cases, surgery involving veins or arteries may be considered.
Psychotherapy
Experts often treat psychologically based ED using techniques that
decrease the anxiety associated with intercourse. The patient's
partner can help with the techniques, which include gradual
development of intimacy and stimulation. Such techniques also can
help relieve anxiety when ED from physical causes is being treated.
Drug Therapy
Drugs for treating ED can be taken orally, injected directly into
the penis, or inserted into the urethra at the tip of the penis. In
March 1998, the Food and Drug Administration (FDA) approved Viagra,
the first pill to treat ED. Since that time, vardenafil
hydrochloride (Levitra) and tadalafil (Cialis) have also been
approved. Additional oral medicines are being tested for safety and
effectiveness.
Viagra, Levitra, and Cialis all belong to a class of drugs called
phosphodiesterase (PDE) inhibitors. Taken an hour before sexual
activity, these drugs work by enhancing the effects of nitric oxide,
a chemical that relaxes smooth muscles in the penis during sexual
stimulation and allows increased blood flow.
While oral medicines improve the response to sexual stimulation,
they do not trigger an automatic erection as injections do. The
recommended dose for Viagra is 50 mg, and the physician may adjust
this dose to 100 mg or 25 mg, depending on the patient. The
recommended dose for either Levitra or Cialis is 10 mg, and the
physician may adjust this dose to 20 mg if 10 mg is insufficient. A
lower dose of 5 mg is available for patients who take other
medicines or have conditions that may decrease the body's ability to
use the drug. Levitra is also available in a 2.5 mg dose.
None of these PDE inhibitors should be used more than once a day.
Men who take nitrate-based drugs such as nitroglycerin for heart
problems should not use either drug because the combination can
cause a sudden drop in blood pressure. Also, tell your doctor if you
take any drugs called alpha-blockers, which are used to treat
prostate enlargement or high blood pressure. Your doctor may need to
adjust your ED prescription. Taking a PDE inhibitor and an
alpha-blocker at the same time (within 4 hours) can cause a sudden
drop in blood pressure.
Oral testosterone can reduce ED in some men with low levels of
natural testosterone, but it is often ineffective and may cause
liver damage. Patients also have claimed that other oral
drugs?including yohimbine hydrochloride, dopamine and serotonin
agonists, and trazodone?are effective, but the results of scientific
studies to substantiate these claims have been inconsistent.
Improvements observed following use of these drugs may be examples
of the placebo effect, that is, a change that results simply from
the patient's believing that an improvement will occur.
Many men achieve stronger erections by injecting drugs into the
penis, causing it to become engorged with blood. Drugs such as
papaverine hydrochloride, phentolamine, and alprostadil (marketed as
Caverject) widen blood vessels. These drugs may create unwanted side
effects, however, including persistent erection (known as priapism)
and scarring. Nitroglycerin, a muscle relaxant, can sometimes
enhance erection when rubbed on the penis.
A system for inserting a pellet of alprostadil into the urethra is
marketed as Muse. The system uses a prefilled applicator to deliver
the pellet about an inch deep into the urethra. An erection will
begin within 8 to 10 minutes and may last 30 to 60 minutes. The most
common side effects are aching in the penis, testicles, and area
between the penis and rectum; warmth or burning sensation in the
urethra; redness from increased blood flow to the penis; and minor
urethral bleeding or spotting.Natural Male Enhancement as a cure
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