Erectile dysfunction medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Medical Therapy
Treatment depends on the cause. Testosterone supplements may be used for cases due to hormonal deficiency. However, the cause is more usually lack of adequate penile blood supply as a result of damage to inner walls of blood vessels. This damage is more frequent in older men, and often associated with disease, in particular diabetes.
Treatments (with the exception of testosterone supplementation, where effective) work on a temporary basis: they enable an erection to be attained and maintained long enough for intercourse, but do not permanently improve the underlying condition. There are different treatments available:[1]
- Oral treatment
3 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.
- BEFAR
Currently, only commercially available in the Far East, Befar® has shown a clinical efficacy of up to 83% in patients with varying degrees of ED. The cream itself has a onset action of 10-15 minutes and can continue on past 4-hours, and is favorably comparable to the efficacy of the injectable alprostadil.
Due to Befar’s direct application method (i.e. unlike Viagra®, Befar’s actions are limited to the area of its application), the side effects induced by the application have to date been limited to transient warm and burning sensations.
So instead of using an injectable or intra-urethral pellet, Befar® cream rapidly and effectively promotes the permeation of alprostadil into the active site of the penis. Can be purchased at: [2]
- Vacuum pumps
These work by drawing blood into the penis and are also used just before sexual intercourse.
- 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.
- Counselling
Counselling is often a consideration, both where a psychological cause is suspected or must be ruled out, or to assist in management of any distress.
ED can in many cases be treated by drugs taken orally, injected, or as penile suppositories. These drugs increase the efficacy of NO, which dilates the blood vessels of corpora cavernosa. When oral drugs or suppositories fail, injections into the erectile tissue of the penile shaft are extremely effective but occasionally cause priapism. When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the penis to maintain it. These pumps should be distinguished from other "penis pumps" (supplied without compression rings) which, rather than being used for temporary treatment of impotence, are claimed to increase penis length if used frequently, or vibrate as an aid to masturbation.
More drastically, inflatable or rigid penile implants may be fitted surgically. Implants are irreversible and costly.
All these mechanical methods are based on simple principles of hydraulics and mechanics and are quite reliable, but have their disadvantages.
In a few cases there is a vascular problem which can be treated surgically.
Uncontroversial Treatments
- PDE5 Inhibitors
- The cyclic nucleotide phosphodiesterases constitute a group of enzymes that catalyse the hydrolysis of the cyclic nucleotides cyclic AMP and cyclic GMP. They exist in different molecular forms and are unevenly distributed throughout the body. These multiple forms or subtypes of phosphodiesterase were initially isolated from rat brain by Uzunov and Weiss in 1972[3] and were soon afterwards shown to be selectively inhibited by a variety of drugs in brain and other tissues.[4][5] The potential for selective phosphodisterase inhibitors to be used as therapeutic agents was predicted as early as 1977 by Weiss and Hait.[6] This prediction has now come to pass in a variety of fields, one of which is in the pharmacological treatment of erectile dysfunction.
One of the forms of phophodiesterase is termed PDE5. The prescription PDE5 inhibitors sildenafil (Viagra®), vardenafil (Levitra®) and tadalafil (Cialis®) are prescription drugs which are taken orally. They work by blocking the action of PDE5, which causes cGMP to degrade. CGMP specific phosphodiesterase type 5 causes the smooth muscle of the arteries in the penis to relax, allowing the corpus cavernosum to fill with blood.
(Specific devices are mentioned for information only; mention should not be taken as endorsement).
- Dopamine Receptor Agonist
- Inflatable implant
- Rigid implant
- Surgical treatment of certain cases
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).[7][8][9][10][11] 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.[12][13][14]
Zinc is best taken in lozenge form, as in tablet form the zinc is difficult to absorb, and can irritate the stomach lining.[15]
References
- ↑ http://www.lovelifematters.co.uk
- ↑ http://www.unitedpharmacies.com
- ↑ Uzunov, P. and Weiss, B.: Separation of multiple molecular forms of cyclic adenosine 3',5'-monophosphate phosphodiesterase in rat cerebellum by polyacrylamide gel electrophoresis. Biochim. Biophys. Acta 284:220-226, 1972.
- ↑ Weiss, B.: Differential activation and inhibition of the multiple forms of cyclic nucleotide phosphodiesterase. Adv. Cycl. Nucl. Res. 5:195-211, 1975.
- ↑ Fertel, R. and Weiss, B.: Properties and drug responsiveness of cyclic nucleotide phosphodiesterases of rat lung. Mol. Pharmacol. 12:678-687, 1976.
- ↑ Weiss, B. and Hait, W.N.: Selective cyclic nucleotide phosphodiesterase inhibitors as potential therapeutic agents. Ann. Rev. Pharmacol. Toxicol. 17:441-477, 1977.
- ↑ Om, and Chung KW, AS (1996 Apr). "Dietary zinc deficiency alters 5 alpha-reduction and aromatization of testosterone and androgen and estrogen receptors in rat liver". J Nutr. 126 (4): 842–8. Check date values in:
|year=(help) - ↑ Schmidt, M; et al. (1998 Sep). "Progesterone inhibits glucocorticoid-dependent aromatase induction in human adipose fibroblasts". J Endocrinol. 158 (3): 401–7. Check date values in:
|year=(help) - ↑ Mahajan, SK; et al. (1982 Sep). "Effect of oral zinc therapy on gonadal function in hemodialysis patients. A double-blind study". Ann Intern Med. 97 (3): 357–61. Check date values in:
|year=(help) - ↑ Pfeiffer, Carl C. Ph.D. MD. (1976). Mental & Elemental Nutrients: a physicians guide to nutrition & health care (Hardcover ed.). Keats Pub. ISBN 978-0879831141.
- ↑ Pfeiffer, Carl C. Ph.D. MD. (1978). Zinc & Other Micro-Nutrients (Trade Paperback ed.). Keats Publishing, Incorporated. ISBN 0879831693.
- ↑ Int J Androl. 5: 487–96. 1982. Missing or empty
|title=(help) - ↑ Fertil Steril. 26: 1057–63. 1975. Missing or empty
|title=(help) - ↑ Balch, Phyllis A., CNC (2000). Prescription for Nutritional Healing. Avery Press. pp. p. 597. ISBN 1-58333-077-1. Unknown parameter
|coauthors=ignored (help) - ↑ "Milwaukee Journal Sentinel, Feb 10, 2002, "Think zinc as way to boost your immune system"".