More than 150 million men worldwide have trouble having or maintain an erection, a condition known as erectile dysfunction(ED). If you're among them, your first step should be to discuss the situation with your doctor.
Erectile Dysfunction has numerous possible causes. It may signal such serious underlying medical conditions as cardiovascular disease or diabetes. It could result from such unhealthy behaviors as smoking or heavy alcohol use. It could even occur as an adverse effect of certain medications.
Once you and your doctor have addressed the controllable risk factors, you 'll probably need to discuss further treatment as well. First-line medical therapy is an oral drug in the class known as phosphodiesterase type-5 (PDE-5) inhibitors. Three are available: Cialis, Levitra, and Viagra.
A normal erection results from a complex series of events, triggered by sexual stimulation and involving the brain, nerves, hormones, and blood vessels. When all are functioning properly, sexual stimulation causes the chemical nitric oxide to be released from the nerve endings and the cells lining the blood vessels of the penis. Nitric oxide has two functions: (1) it transmits message from nerves to cells throughout the body, and (2) with the help of the transcellular substance cyclic guanosine monophosphate (cGMP), it helps blood vessels dilate to improve blood flow.
When nitric oxide enters the penile erection chambers, known as the corpora cavernosa, the smoose muscle tissue of the small cavernosal arteries (arterioles) relax. This causes the penile erection chambers to fill with blood, producing erection.
By blocking the action of the PDE-5 enzyme, which breaks down cGMP, PDE-5 inhibitors increase the amount of cMGP available to help relax and dilate penile arterioles. This helps the penis become engorged, making it easier for you to have and maintain erection.
It's important to remember that PDE-5 inhibitors can be effective only if you are sexually aroused. They cannot increase your sexual drive.
All three PDE-5 inhibitors have proven safe, and their safety continues to be tracked. Adverse effects are infrequent and, generally, short-lived. The most common of these are headache, facial flushing, indigestion, and nasal congestion. The biggest risk occurs if PDE-5 inhibitors are mixed with a nitrate.
Men with heat disease who are healthy enough to have sex may use PDE-5 inhibitors. In fact, with exception of nitrates, men who use a PDE-5 inhibitor may be given most standard therapies for heart disease.
Men who are over age 65 years and those with impaired liver or kidney function may require lower doses of the PDE-5 inhibitor. Also certain drugs-including some used to treat lower urinary tract symptoms and high blood pressure, protease inhibitors, some antifungal agents, and erythromycin-may either interact with PDE-5 inhibitors or affect their absorption. When such drugs are administered concurrently with PDE-5 inhibitor, precautions need to be taken. Be sure to tell your doctor about all medications you take before starting any new therapy.
The U.S. Food and Drug Administration (FDA) has received some reports (fewer than 50 since the first PDE-5 inhibitor was approved in 1998) of a serious eye disorder known as nonarteritic anterior ischemic optic neuropathy (NAION) occurring in men using PDE-5 inhibitors. The majority of these men had known NAION risk factors, such as diabetes, hypertension, or heart disease. Since the number of cases is so small and the majority involved men who were considered at risk for the condition, the FDA has been unable to determine whether there is any direct relationship between NAION and PDE-5 inhibitor use. Retrospective reviews of men taking Viagra for ED revealed no increase incidence of NAION among them.
Nevertheless, if you have a history of NAION or any other ophthalmogic conditions, be sure to discuss it with your doctor before you start taking a PDE-5 inhibitor. If you experience sudden loss of vision in one or both eyes while taking a PDE-5 inhibitor, stop taking the drug and seek immediate medical attention.
Not every man may take a PDE-5 inhibitor. Generally, they are not recommended for use by men with disorders that were not studied in clinical trials, including severe or unstable heart conditions, poorly controlled blood pressure, or a recent history of heart attack.
Although PDE-5 inhibitors are effective in treating ED with wide range of possible causes, about 30% of men don't respond to treatment or are dissatisfied with their response. If you've made at least five or six attempts to have sex since you started using PDE-5 inhibitor, it's time to follow up with your doctor or consult a urologist. It may be that your PDE-5 inhibitor dose needs to be adjusted, or you may require supplemental therapy with male hormone testosterone or relationship counseling.
Men who do not benefit from oral treatments should discuss other treatment options with their doctor. These include penile injections, transurethral medications, and such mechanical aids as vacuum erection device or a penile prosthesis.
Sexual Medicine Society of North America and Quadrant Medical Education grant permission to reprint this handout for patient education, not for sale or commercial reproduction.
1. Reprinted from: Men's Sexual Health Consult Collection. (A Supplement to Physicians' Travel & Meeting Guide). Annenberg Center for Health Sciences at Eisenhower. November 2006
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