To learn how ED treatments work, the medical condition itself must be understood. When a man is sexually aroused, increased blood flow to the penis makes it firm (an erection). Both physical and mental problems can interfere with this process. Blood vessel, nerve, hormonal or emotional problems, or a combination, can all cause ED. Certain medications (see Table 1) can also contribute to the problem.
Pre-existing conditions can also cause ED. Anxiety, Alzheimer disease, depression, diabetes, high blood pressure, or hypothyroidism (underactive thyroid) can all play a role. Problems with the prostate (the gland that sits at the base of a man's bladder) may bring on ED.
Lifestyle choices, such as smoking and drinking excessive amounts of alcohol, can damage blood vessels in the penis, causing ED.
It is important that assistance for ED fits the specific need. It might include counselling for an emotional problem or surgery for certain physical problems. ED drug treatments may also help. Your doctor can help you decide if you are a candidate for medications that treat ED. Several ED medications are commonly used. Learning about the options can help you understand the choices available.
Phosphodiesterase type 5 (PDE5) inhibitors
Undoubtedly, the most common medication for ED is that little blue pill, Viagra.™ Its chemical name is sildenafil. Viagra™ belongs to a class of medications called PDE5 inhibitors. Other PDE5 inhibitors include Cialis™ (tadalafil) and Levitra™ (vardenafil). All three are only available from a pharmacy with a prescription from your doctor. PDE5 inhibitors work by blocking the action of PDE5 in the body. This indirectly causes the smooth muscles in the penis to relax and allows blood to flow into the penis. If the man is sexually aroused, increased blood flow will cause an erection. Although none of the PDE5 inhibitors are currently found to be effective or safe in women, scientists are still doing research on this topic.
The most common side effects for all three PDE5 inhibitors include headache, nasal congestion, indigestion, and flushing of the face. Viagra™ may also affect vision more than the other two medications. Visual side effects can include altered color perception and blurred vision. All of these side effects usually go away over time, or in some people, once medication has been stopped.
None of the three PDE5 inhibitors can be taken with any alpha-blockers or nitroglycerin products, such as nitrate sprays, patches or tablets. Combining PDE5 inhibitors with nitrates or alpha-blockers will make blood pressure drop significantly in a short period of time. This can be life-threatening.
However, it is difficult to avoid nitrates altogether because they are frequently used in emergency situations, such as in heart attacks. So, nitrates should not be given within 24 hours of taking Viagra™ or Levitra,™ and not within 48 hours after Cialis.™
If you are taking certain medications, the dose of PDE5 inhibitors should be decreased. Various antifungals, antibiotics, and other medications are part of this list. Feel free to talk with your doctor or pharmacist about whether any of your medications conflict with PDE5 inhibitors.
The following medications can interact with PDE5 inhibitors:
Viagra™ should be taken on an empty stomach. If it is taken after a high-fat meal, the medication would not absorb well into the body and would be less effective. High-fat meals affect Levitra™ the same way they affect Viagra™. However, Cialis™ is not affected by the presence of food or high fat meals at all. Medication should be taken about an hour before sexual activity.
Cialis™ is marketed as the longest-acting, with effects lasting up to 36 hours after taking it. Viagra™ and Levitra™ are effective for up to six to eight hours. Again, it should be stressed that an erection will only occur in these time frames if the man is sexually stimulated. PDE5 inhibitors should also not be taken more than once per day or more than the amount prescribed. Those with kidney or liver diseases may be prescribed lower doses.
It may be hard to tell which PDE5 inhibitor is best for you. The three have not yet been compared in a research study. As a result, there is no concrete scientific evidence pointing to the best PDE5 inhibitor for everyone. Different men have various successes with each one. Speak to your doctor or pharmacist about which you should try for the best results.
Alprostadil is also known as prostaglandin E1. It increases production of another chemical in the smooth muscle of the penis. The smooth muscle then relaxes, allowing blood flow into the penis and an erection.
Alprostadil is available in two different forms. One is Muse,™ a pellet containing alprostadil inserted into the urethra (see illustration). (The urethra is the tube that carries urine from the bladder out of the body.) The other is Caverject,™ or alprostadil, which is injected into the corpora cavernosa of the penis. The injection has been found to be more effective than the insert.
Both methods of medication delivery have the side effect of pain in the penis with an erection. Both are effective within 15 minutes of application. Priapism (a long-lasting erection) can occur with both routes, too. If an erection lasts for four hours or more, medical attention should be sought. This is a medical emergency. The partner of a man using the insert may experience irritation of the vagina, such as itching, burning, or even pain.
Both the alprostadil injection and insert are highly effective. However, many people find them inconvenient and not spontaneous. Talk to your doctor or pharmacist first to decide if the injection or insert may be right for you.
Testosterone replacement therapies
Testosterone replacement therapies are prescribed for hypogonadism (when sex glands do not release enough or any hormones). Blood tests can confirm low levels of testosterone. Since low levels are linked to decreased sex drive (libido), this may cause ED in some men. Testosterone replacement products help correct the hormone imbalance. If low testosterone levels are causing ED, this will correct the problem
Testosterone replacement therapies are available orally as tablets or capsules, by intra-muscular injection, or as topical gels or patches that are applied to the skin. The injection is the most effective and least expensive version. Though oral forms may cause liver toxicity, this is not a problem with the injection. Still, many people do not choose this method since injections are invasive and painful. Testosterone gels and patches are the most expensive form. However, many people find these products comfortable and easy to use.
Testosterone products can cause side effects, including gynecomastia (breast tissue growth in men), retaining of sodium, acne, and increased LDL (bad) cholesterol with decreased HDL (good) cholesterol. Worsened prostate cancer or benign prostatic hyperplasia (where the prostate has grown larger) can also result. As previously mentioned, oral testosterone can also be toxic to the liver.
Testosterone replacement products are not right for everyone. Proper blood tests and diagnosis by your doctor are necessary when considering these medications. If you think that they might help you, talk with your doctor.
ED is a serious problem for many men and can make relationships difficult. If you have the courage to face this medical condition, you can treat and possibly overcome ED. Take advantage of the resources around you, and talk to your doctor and pharmacist about what can be done for you.