Erectile Dysfunction - Treatment

There are many treatment options for erectile dysfunction, so most patients undergoing treatment who fail to regain a satisfactory level of erectile function. For this cause or causes of dysfunction, and risk factors should be identified. Deoseori Treatment involves lifestyle changes, medications, surgery for implantation of a penile prosthesis or sexual counseling.Psychogenic erectile dysfunction is relatively rare and is characterized by the presence of nocturnal and morning erections and the negative results from other tests. Most men who suffer from depression are facing erectile dysfunction. Generally, we recommend a full psychological evaluation in these patients to identify their causes and proper treatment.There are many drugs to treat erectile dysfunction. Most works by increasing blood flow to the penis and are administered orally, but some are applied locally - by injection or placed in the penis.
PDE5 Inhibitors
Treatment of choice is oral erectile dysfunction oral phosphodiesterase type 5 inhibitors (PDE5) inhibitors - sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) - a class of drugs that maintain blood vessel dilation at the penis, preventingdegradation of chemicals needed expansion vessels.Take one tablet one hour before sexual intercourse, its effect lasts on average four hours (an erection does not last four hours, but the drug offers a range of 4:00 in which the person may have one or more sexual contacts).PDE5 inhibitors are not aphrodisiacs, so sexual stimulation is needed for the drug to act. These drugs are effective in 80% of cases, the efficiency is lower when chronic diseases like diabetes.These drugs shows interactions with other medicines and cause a drop in blood pressure, especially in people undergoing treatment for heart disease.Contraindications:- Treatment with nitroglycerin or nitrates (because they can lead a potentially fatal drop in blood pressure)- Heart failure- Low blood pressure at rest- Retinitis pigmentosa - a hereditary disease that affects the retina
Sildenafil (Viagra)Sildenafil (Viagra) is the first oral drug with proven effectiveness as a form of treatment for erectile dysfunction. Studies have shown that sildenafil is effective in achieving and maintaining penile erection, even in patients with diabetes, hypertension, resection of the prostate, depression, etc..The drug's side effects refer to headaches, stomach problems, vision disturbances, hypotension, especially if sildenafil is associated with other drugs (nitroglycerin, for example).
Sildenafil is used by about 30 -60 minutes before intercourse. It is recommended to take daily medication. Sexual stimulation is needed for obtaining an erection. An increased capacity of developing erection is observed for up to 24 hours, but overall the effect is limited to 6-8 hours.
Vardenafil (Levitra)Vardenafil is found in three doses (5, 10 or 20 mg) and acts in 20 minutes. Efficiency and its side effects are comparable with those of the drug sildenafil (Viagra).
Tadalafil (Cialis)Tadalafil is available in three doses (5, 10 or 20 mg) and may take action during its more than 36 hours in some people. Unlike the first two drugs, tadalafil action after 1-2 hours, providing more flexibility.Tadalafil has been shown to improve endothelial function in men with erectile dysfunction.
Yohimbine
Before the advent of PDE-5 inhibitor, was prescribed Yohimbine men suffering from erectile dysfunction. Yohimbine is an extract from the bark of a tree coming to Africa. Action to the pharmaceutical and associated side effects and contraindications are similar to those of PDE-5 inhibitors. Although there were no comparative clinical studies, it is believed that Yohimbine is generally less effective than PDE-5 inhibitors, but its use involve less risk.
Intraurethral therapy
In cases where PDE-5 inhibitors are not effective or when their use is contraindicated, the physician may prescribe vasoactive substances, which the patient learns to self-administration in their penis 20 minutes before sexual activity. These drugs are sometimes given as a small suppository inserted into the urinary meatus.Intraurethral therapy is often abandoned because of management difficulties. Moreover, it is effective only in 40% of cases.Alprostadil, for example, can be effective in men with vascular disease, diabetes or who have undergone prostate surgery. The drug may be useful for men who do not want to resort to intracavernous injections, oral medications or who had no success.In addition, it is important that the dosage or to be adapted to avoid priapism (abnormal maintain an erection that lasts more than 4 hours penile cancer, whose treatment is a medical emergency).
Intracavernous injections
Intracavernous injection therapy is available only by prescription and consists of injecting a medication (Alprostadil, papaverine, phentolamine, or associates of these drugs) in the corpus cavernosum of the penis.These drugs act by relaxing smooth muscles in the penis, which increases blood flow in less than 15 minutes. Penile erection is achieved even in the absence of sexual stimulation and lasts an average of 30 minutes. Although not used by many patients because of its mode of administration, this therapy is effective in 85% of patients.Patients should be instructed about how to perform injections.Doses are adjusted to achieve an erection for more than 90 minutes. Alprostadil is the main agent used for intracavernous injections.The main side effects are painful erections, priapism or scars at the injection site.
Vacuum Devices
Vacuum device consists of a plastic cylinder placed around the erection. As air is drawn, it creates a vacuum inside the cylinder resulting in a erection, maintained by a resilient compression ring, placed at the base of the penis.This method is effective to about 60-90% of patients, and erection can be maintained for 30 minutes (erection lasts until the removal of the compression ring, but it does not recommend keeping more than 30 minutes).Vacuum devices are relatively risk free, although they were observed bruising, petechiae and bruising. Other adverse effects relate to pain, numbness, absent or painful ejaculation. Many of these problems can be reduced by proper choice of ring compression and displacement. The devices are used more easily as their frequent use.
Penile prosthesis
In the past, the use of penile prosthesis was the only effective method to treat erectile dysfunction. The implants are currently used by men when other therapies have failed or who require a penis reconstruction. Men who underwent prostatectomy (removal of the prostate) for prostate cancer generally do not respond to treatment with PDE-5 inhibitors and are candidates for a penile implant.There are two types of penile prostheses, which require permanent implantation of semi-rigid rods or inflatable system. Semi-rigid prosthesis consists of two cylinders of silicon implanted in the corpus cavernosum and leading to an artificial erection, but permanently. The main drawbacks of this type consists in the appearance of penile implant penis (erect semi-permanently) and irreversible destruction of erectile tissue in the implanted prosthesis.Recent models include two inflatable sticks placed in the corpus cavernosum of the penis, connected to a pump driven by a switch placed under the skin of the abdomen or scrotum. The patient can activate the pump, causing an artificial penis erection. This type of prosthesis is functional penis for 7-10 years, after this time his replacement becomes necessary. Complications refers to infection, 2% of patients or painful erections at 1% of patients.