Treatment of erection problems and erectile dysfunction
The initial step for all men with erection problems has to be a reduction in alcohol
intake and cessation of smoking. Any indication of diabetes or the failure of
control of that condition needs to be monitored; if necessary, the drug regime
of the patient needs to be changed, although substitution of alternative anti-hypertensive
drugs seldom improves erectile function.
As you might expect, almost all men who
experience erectile
dysfunction will experience some degree of psychological effects, no matter what
the cause of their erection problems. Therapy and counseling is helpful and
needs to be conducted with the man and his partner. Counseling can both reassure the
impotent man and reduce the stress the couple are experiencing. Transient or temporary erection
problems rarely require medical intervention, although temporary use of Viagra
may be helpful in restoring sexual self-confidence.
Drug therapy for erection problems
Most men want to be treated with drugs: there are
many available. Yohimbine is not effective, because of its weak alpha adrenoreceptor blocking ability,
and its side effects of anxiety, raised pulse rate, sweating and possibly
headache.
Oral phentolamine and Apomorphine (a
dopamine receptor agonist) have received attention in some places, but the most
effective and safe drug so far for orally administered treatment of erectile
dysfunction is Sildenafil (Viagra).
Sildenafil (Viagra)
Sildenafil is phosphodiasterase
inhibitor which was developed for heart problems and then discovered to have the
ability to increase the number of erections in men in the study. It is rapidly absorbed after
being taken orally, and needs to be ingested 60 minutes before sex is expected
to take place;
its effects last for between four and eight hours.
The
drug is available in 25, 50 and 100 mg tablets: a standard dose would be 50 mg,
which suits most men.
Viagra does not itself produce an erection: it
acts to enhance the relaxation of smooth muscle fibers in the corpus cavernosum.
This relaxation is initiated by nitric oxide, and the Viagra inhibits the
enzymes responsible for the breakdown of nitric oxide, thereby enhancing the
erection. Viagra is not suitable for men taking nitrates for circulatory
problems.
As is now well established, Viagra does not work
in 100% of the men who take it. In fact, its success rate is around 40 to 80%,
which is a wide range but depends on the etiology of the condition in the men
taking the drug. In particular, Viagra will not work where profound relationship
issues are contributing to the erectile dysfunction. Nonetheless, Viagra has
proved to be extremely effective in enhancing the sex lives of many men with
erection problems. It has a comparatively low side effect rate, and the
side-effects are usually quite tolerable, consisting as they do of headache in
about 16% of men, flushing of the face and cheeks in particular in about 10% of
men, and discomfort in the stomach in around 7% of men.
It affects the vision of around 3% of men, adding
a bluish tinge to the visual field. The side-effects are all correlated with the
dosage. Viagra does not work as efficiently if it is taken with fat-containing
food or alcohol, and although splitting the tablets is often recommended as a
means to economy, over time this the effectiveness of the unused half tablet
will reduce.
Transurethral administration of alprostadil
Alprostadil was first licensed to be used as an
intracavernous injection for the treatment of erectile problems. Now it has been
incorporated in a pellet that can be introduced into the urethra by the man
himself. It's a synthetic version of the naturally occurring prostaglandin E1.
Alprostadil is introduced into the urethra by
means of a disposable applicator which the man introduces himself using during
as natural lubricant. Absorption can be facilitated if a man rolls his penis
between his fingers after injecting the palette into the urethra. There are
various other ways to increase the efficiency of our absorption of the
alprostadil, including placing a constriction ring around the base of the shaft
of the penis.
The erection takes about 10 minutes to develop
and requires a dose of between 150 and 1000 PG. About 43% of the men who tried
Muse have been able to have intercourse with the treatment, but there is a high
dropout rate, just as there is with intracavernosal injections. The most common
side effect of alprostadil is a pain in the penis which occurs in around one
third of the men who try the technique, and a sensation of burning in the
urethra which occurs about 10% of the men who take the drug; a few experience
minor bleeding.
No doubt good tuition from the doctor enables a
man to achieve a higher success rate, as does video instruction which takes the
man through the process of application step-by-step.
Vacuum devices do indeed have the merit of being
simple and non-invasive, which is a major advantage for many men who hate the
thought of injection or introduction of pellets into the urethra. The plastic
cylinder is placed around the penis with a seal at the base of the shaft, and a
hand pump is used to maintain a slight vacuum within the container.
This draws blood into the container, and allows
them and maintain a degree of tumescence, although usually not rigidity, in his
erection. There are few side effects, but some men report that the penis feels
cold due to the lack of circulation, and some men experienced bruising.
Even so, this has proved a useful technique for
older men in stable relationships, though it is not suitable for men who are
dating due to the cumbersome and intrusive equipment. The erection is maintained
by the placing of a constricting band around the base of the penis. It's also
useful technique to augment the effects of pharmaceuticals.
Most difficult for many men to use is
intracavernosal injection therapy, a procedure initiated in 1980 with the use of
papaverine. It requires some skill and some specialist knowledge on the part of
both the doctor and patient, not least because priapism is one of the possible
side-effects. The dose must therefore be carefully calculated to avoid the
unintended effect of a prolonged erection which will not go down, and one way of
achieving this is to use an auto injection device to help men get the correct
dosage and find the right site in the corpus cavernosum.
Erection occurs about 10 minutes after inhection,
and may be enhanced by sexual stimulation. Experience of pain is not unusual
with this technique, and penile fibrosis is a less pleasant long-term
side-effects.
Alprostadil is the most common injection agent,
which works in about 80% of men, and has less side-effects than other
pharmaceutical agents for erectile dysfunction. It is often used in combination
with papaverine and phentolamine for greater efficiency and less frequency of
priapism; this is called tri-mix.
Surgery is an uncommon treatment for erectile
dysfunction nowadays because of its low success rate. However it is used in some
cases, such as arterial reconstruction in men under the age of 40 who have a
traumatic arterial lesion and no risk factors (these would include smoking
diabetes and hypertension). Usually the inferior epigastric artery is used in
surgery, being rerouted and anastomosed with the dorsal penile artery or vein.
There is a success rate of about 65% at one year after surgery. Surgery for veno-occlusion
is less successful.
A penile prosthesis is only used in men who fail
to respond to any less invasive treatment. This does not produce an erection,
but merely gives the impression of rigidity to the penis and allows intercourse.
[ Home ] [ Background information on erection problems ] [ Erection problems ] [ Erection problems in young men ] [ Erection problems in young men (2) ] [ Overview of erection problems ] [ Overview of erectile problems continued ] [ Group therapy and Viagra therapy in the treatment of erection problems ] [ Erection problems - tests for erection problems ] [ Erectile dysfunction and diabetes ] [ Erectile dysfunction: summary ] [ Overview of erectile difficulties ] [ Further overview of erection problems ]
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