The treatment of erectile
dysfunction
Most
physicians suggest that treatments proceed from least to most
invasive. Cutting back on any drugs with harmful side effects
is considered first. 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 Erectile Dysfunction using techniques that
decrease the anxiety associated with relations. The patient's
partner can help with the techniques, which include gradual developmalest
of intimacy and stimulation. Such techniques also can help relieve
anxiety when Erectile Dysfunction from physical causes is being treated.
Drug Therapy
Drugs for treating Erectile Dysfunction 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 Erectile Dysfunction. In August 2003, the FDA gave
approval to a second oral medicine, vardenafil hydrochloride
(Levitra). Additional oral medicines are being tested for safety
and effectiveness.
Viagra and Levitra
Taken an hour before sexual activity, Viagra and Levitra 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 Levitra is 10 mg, and the physician may adjust this dose
to 20 mg if 10 mg is insufficient. Lower doses of 5 mg and 2.5
mg are available for patients who take other medicines or have
conditions that may decrease the body's ability to use Levitra.
Neither Viagra nor Levitra should be used more than once a day.
Males 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, Levitra should not
be taken with any of the drugs called alpha-blockers, which are
used to treat prostate enlargemalest or high blood pressure.
Oral Testosterone
Oral testosterone can reduce Erectile Dysfunction in some males 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 improvemalest will occur.
Many males 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 Erectile Dysfunction is expanding rapidly. Patients
should ask their doctor about the latest advances.
Vacuum Devices
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 sexual relations by preventing blood from flowing
back into the body.
A vacuum-constrictor device causes an erection by creating
a partial vacuum around the penis, which draws blood into the corpora
cavernosa. Pictured here are the necessary components: (a) a plastic
cylinder, which covers the penis; (b) a pump, which draws air out
of the cylinder; and (c) an elastic ring, which, when fitted over
the base of the penis, traps the blood and sustains the erection
after the cylinder is removed.
One variation of the vacuum device involves a semirigid rubber
sheath that is placed on the penis and remains there after erection
is attained and during relations.
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 males with Erectile Dysfunction. 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. Adjustmalest
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 (see figure 3). 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.
With an inflatable implant,
erection is produced by squeezing a small pump (a) implanted
in a scrotum. The pump causes
fluid to flow from a reservoir (b) residing in the lower pelvis
to two cylinders (c) residing in the penis. The cylinders expand
to create the erection.
Surgery to repair arteries can reduce
Erectile Dysfunction caused by obstructions that block the flow
of blood. The best candidates for such surgery
are young males 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 males 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.
Hope Through Research
Advances in suppositories, injectable medications, implants, and
vacuum devices have expanded the options for males seeking treatmalest
for Erectile Dysfunction. These advances have also helped increase the number of
males seeking treatmalest. Gene therapy for Erectile Dysfunction is now being tested
in several centers and may offer a long-lasting therapeutic approach
for Erectile Dysfunction.
The National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK) sponsors programs aimed at understanding the causes of
erectile dysfunction and finding treatments to reverse its effects.
NIDDK's Division of Kidney, Urologic, and Hematologic Diseases
supported the researchers who developed Viagra and continue to
support basic research into the mechanisms of erection and the
diseases that impair normal function at the cellular and molecular
levels, including diabetes and high blood pressure.
Points to Remember
- Erectile dysfunction is the repeated inability to get or
keep an erection firm enough for sexual relations.
- Erectile Dysfunction
affects 15 to 30 million American males.
- Erectile Dysfunction
usually has a physical cause.
- Erectile Dysfunction is treatable
at all ages.
Treatments include psychotherapy, drug therapy, vacuum devices,
and surgery.
|
