Until recently, individuals who sought medical treatment for Erectile Dysfunction were told "It's all in your head".  Physicians labeled these individuals with a psychological disorder and they were referred to counseling.  Today, there are many treatment options available. The treatment option you choose should be specific and responsive to your needs and expectations as well as your partners.  The following is a summary of various treatment options available today:

Oral Medications -currently there are three oral medications on the market today, Viagra, and Cialis.

Viagra (sildenafil citrate) has change the course of treatment for Erectile Dysfunction. Viagra is dispensed as a pill and ingested orally.  Approximately 30-60 minutes later the drug is absorbed in the bloodstream. 

The physiologic mechanism of erection of the penis involves release of nitric oxide (NO) in the corpus cavernosum during sexual stimulation. NO then activates the enzyme guanylate cyclase, which results in increased levels of cyclic guanosine monophosphate (cGMP), producing smooth muscle relaxation in the corpus cavernosum and allowing inflow of blood. Viagra has no direct relaxant effect on isolated human corpus cavernosum, but enhances the effect of nitric oxide (NO) by inhibiting phosphodiesterase type 5 (PDE5), which is responsible for degradation of cGMP in the corpus cavernosum. When sexual stimulation causes local release of NO, inhibition of PDE5 by sildenafil causes increased levels of cGMP in the corpus cavernosum, resulting in smooth muscle relaxation and inflow of blood to the corpus cavernosum. Click here to view the diagram.

In all of these clinical trial Viagra as proven to be the most trusted treatment option for impotence. There is no substitute for experience, some 600,000 physicians have prescribed Viagra to more than 20 million individuals worldwide. The following graph depicts how men rate the long term use of Viagra for the treatment of impotence:

Viagra (sildenafil citrate) has changed the course of treatment for Erectile Dysfunction. Rarely has there ever been so much enthusiasm surrounding a prescription medication.

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Cialis represents a new class of medications known as PDE-5 inhibitors. These medications are used to treat erectile dysfunction (impotence). Cialis has been approved by the  European Commission for the treatment of erectile dysfunction and is expected to be in pharmacies by spring of 2003.

In technical terms Cialis exerts its action by effecting two enzymes, Cyclic guanosine monophosphate (cGMP) and phosphodiesterase type 5 (PDE5)  that play important roles in erectile function. Sexual stimulation triggers the local release of nitric oxide (NO) from nerves and endothelial cells in the penis. NO stimulates an enzyme that catalyzes formation of cGMP from the nucleotide guanosine 5-triphospate (GTP) in the penile blood vessels and corpus cavernosum walls.

The cGMP causes vasodilation of arteries, allowing the influx of blood into the corpus cavernosum. Increased blood flow into the penis causes the erectile tissue to expand. When the erectile tissue has expanded sufficiently, the veins draining the corpus cavernosum become compressed. This decreases the outflow of blood from the penis, and the blood remains in the corpus cavernosum to keep the penis erect.

The enzyme PDE5 eventually causes degradation of the cGMP, and the erection ends. Click here to view the diagram.

Cialis is a prescription impotence treatment medication. Cialis (pronounced see-AL-iss) was shown to improve erections for up to 36 hours following the initial dose. During clinical studies, some men reported improved erections as quick as thirty minutes after taking Cialis. The impotence medication, Cialis, is being called the "weekender" because men only have to take Cialis once for an entire weekend of impotence treatment.

Cialis quick facts:

	Cialis has less reported side effects when compared to Viagra
	Cialis works quickly, most men report improved erections within thirty minutes of taking Cialis
	Cialis has been called the "weekender" individuals can take the medication Friday afternoon and have improved erections for the entire weekend.
	Cialis has now been approved in both the United States and Europe for the treatment of impotence

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Levitra is a new class of medication to help men with erectile dysfunction (impotence) Viagra was the first of the so called  "PDE-5 inhibitors" and Levitra is known in the same class to significantly help individual overcome their erectile dysfunction (impotence).

Similar to Viagra, Levitra increases the quantity of blood supplied to the penis improving the erection. Levitra is very selective in inhibiting the  PDE-5 without affecting other isoenzymes. This allows a smaller dose of Levitra to have a more pronounced effect as a larger dose of Viagra (the standard dose of Levitra dose is 10mg while the standard dose of  Viagra dose is 50mg). Through this action, smooth muscle in the penis remains relaxed for a longer period.  This allows for increased blood flow into the cavernous tissue of the penis thereby generating an erection.  Levitra is unique in that it increases a natural occurring process, therefore, only through sexual stimulation will an erection occur.  

Levitra is extremely effective in treating erectile dysfunction (impotence) following prostate cancer surgery. Some 71% of men who had undergone prostate removal reported significant improvements in erections with Levrita (20mg) versus 12 per cent in men taking placebo (sugar pill). The study concluded that this was an important finding for Levitra, as erectile dysfunction (impotence) following prostate surgery is usually severe.

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Herbal Approaches - have become very popular as an initial treatment for the treatment of impotence

Herbal supplements for the treatment erectile dysfunction should contain a combination of the following ingredients: Yohimbe (bark), Maca (root), Horny Goat Weed (leaf), Saw Palmetto (berry), Schizandra (berry), Guarana (seed) Tribulus Terrestris (aerial part), Ashwagandha (root), Asparagus Racemosus (aerial part), Ginger (root) Cayenne Pepper (berry), L Tyrosine, and L Histidine.

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Penile Injection Therapy uses a hypodermic needle to inject medication that is a mixture of papaverine, phentolamine and prostoglandin into the side of the penis. The medication relaxes the smooth muscle tissue of the penis allowing for an erection.  These injections can be painful, result in scare tissue formation at the injection site and cause priapism, the prolonged and painful engorgement of the penis).

Urethral Inserts consists of a disposable applicator, small enough to fit into the urethra.  The applicator is inserted into the urethra approximately one inch and the prostaglandin E-1 medication is released.  As a result, an erection occurs lasting 30-60 minutes.  Patient acceptance is still an issue secondary to expense and the low success rate as compared to other treatments for Impotence


 

Vacuum Therapy works by placing a cylinder with an attached pump over the penis.  The pump creates a vacuum in the cylinder, which pulls blood into the penis to create an erection.  The cylinder is then removed while simultaneously a constriction band is placed at the base of the penis.  This will usually keep the penis erect for up to thirty minutes, These devices range from $150.00-400.00 and can be purchased through Mentor Urology, POST-T-VAC, Inc., and American Med Tech, Inc.
 

Hormonal Therapy is used to treat the small percentage of individuals who have abnormally low levels of testosterone. During the initial consultation, a physician will likely order LH and Prolactin hormone test to exclude other causes of low testosterone levels.  If appropriate, testosterone is available in a transdermal adhesive patch.  The patches available are Androderm (SmithKline Beecham) and Testroderm (Alza Pharmaceuticals),at a cost of $20.00 per patch.

Vascular Surgery may involve both the arterial and venous systems.  Venous ligation has been reported to be effective in patients with venous leakage.  However, it is often difficult to diagnose individuals with this condition with the current testing capabilities; therefore, it is difficult to predict their outcome prior to surgery.  Arterial re-vasculation procedures are limited to congenital or traumatic vascular abnormalities.  Similar to venous testing, complete standardization diagnostic testing has not been established, so difficulties persists in predicting surgical results.

Penile Implants requires surgical insertion of a prosthetic device.  Three forms of penile prosthesis are currently available flexible, malleable and inflatable. Flexible or Malleable rods consist of two semi-rigid, flexible rods that make the penis firm enough for intercourse.  There are also inflatable prosthetic devices that produce a more natural erection.  When an erection is desired the pump (located in the scrotum) is squeezed, this in turn inflates a cylinder, which creates an erection. 

Following intercourse, the pump is released and the penis returns too normal.  These devices have been associated with postoperative infections, mechanical failure, silicon particle shedding and the risk of the initial surgery.  These prosthetics are available through American Medical Systems and Mentor Urology.

Psychotherapy and/or Behavioral Therapy have been found to be beneficial in treating Erectile Dysfunction.  Although the majority of causes of Erectile Dysfunction are physical, there are quite frequently underlying psychosocial factors involved as well.  Psychotherapy and/or behavioral therapy may be helpful in individuals whom no organic cause for Erectile Dysfunction has been detected.  Therapy often focuses on complications surrounding performance anxiety, dysfunctional relationships, loss of a partner, psychotic disorders, substance abuse, etc.


 

Partners can provide support for individuals with Erectile Dysfunction.  The condition affects the relationships of more than 50 million Americans.  If you are a partner, you can make a difference through support and education.  For a list of Impotence Anonymous (IA®) and I-ANON® chapters, call 1-800-669-1603.