Treatments
For Erectile Dysfunction
Most physicians
suggest that Impotence Treatments proceed from least to most
invasive. 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 impotence 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.
Research on drugs for treating ED is expanding rapidly.
Patients should ask their doctor about the latest advances.
Vacuum Device
Mechanical
vacuum devices cause erection by creating a partial vacuum,
which draws blood into the penis, engorging and expanding it.
The devices have three components: a plastic cylinder, into
which the penis is placed; a pump, which draws air out of the
cylinder; and an elastic band, which is placed around the base
of the penis to maintain the erection after the cylinder is
removed and during intercourse by preventing blood from flowing
back into the body.
One variation of
the vacuum device involves a semi-rigid rubber sheath that is
placed on the penis and remains there after erection is
attained and during intercourse.
Surgery
Surgery usually has one of three
goals: -
-
To implant a device that can
cause the penis to become erect
-
To reconstruct arteries to
increase flow of blood to the penis
-
To block off veins that allow
blood to leak from the penile tissues
Implanted devices,
known as prostheses, can restore erection in many men with ED.
Possible problems with implants include mechanical breakdown
and infection, although mechanical problems have diminished in
recent years because of technological advances.
Malleable implants
usually consist of paired rods, which are inserted surgically
into the corpora cavernosa. The user manually adjusts the
position of the penis and, therefore, the rods. Adjustment does
not affect the width or length of the penis.
Inflatable implants
consist of paired cylinders, which are surgically inserted
inside the penis and can be expanded using pressurized fluid.
Tubes connect the cylinders to a fluid reservoir and a pump,
which are also surgically implanted. The patient inflates the
cylinders by pressing on the small pump, located under the skin
in the scrotum. Inflatable implants can expand the length and
width of the penis somewhat. They also leave the penis in a
more natural state when not inflated.
Surgery to repair
arteries can reduce ED caused by obstructions that block the
flow of blood. The best candidates for such surgery are young
men with discrete blockage of an artery because of an injury to
the crotch or fracture of the pelvis. The procedure is almost
never successful in older men with widespread
blockage.
Surgery to veins that
allow blood to leave the penis usually involves an opposite
procedure intentional blockage. Blocking off veins (ligation)
can reduce the leakage of blood that diminishes the rigidity of
the penis during erection. However, experts have raised
questions about the long-term effectiveness of this procedure,
and it is rarely done.
Oral
treatment
Three different
tablets are currently available from the doctor and these work
when there is sexual stimulation. Depending on the treatment,
it will need to be taken 20 minutes to 1 hour before sex and
the period of time over which it works can vary between 3 hours
and up to 36 hours.
Alprostadil
This can be injected
into the penis or inserted using a special applicator - usually
just before sexual intercourse.
Alprostadil has also
become available in some countries as a topical cream and
preliminary studies have shown a clinical efficacy of up to
83%. It has an onset of action of 10-15 minutes and its effects
can last over 4 hours.
Hormone
treatment
It is rare, but
some men receive hormones for their erection problem. This does
depend on the cause of the problem as well as other
factors.
Other treatment methods
Zinc
Zinc is known to help
prevent the conversion of testosterone to estradiol, and
testosterone is essential for proper erectile function and the
synthesis of sperm (testosterone deficiency is a primary
contributor in many cases of erectile dysfunction). Moreover,
zinc levels have been found to be significantly reduced in both
chronic bacterial prostatitis (CBP) and non-bacterial
prostatitis (NBP). Many doctors and nutritionalists recommend
zinc for prostate or erectile problems.
Zinc is best taken in
lozenge form, as in tablet form, zinc is difficult to absorb,
and can irritate the stomach lining.
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