In 1998, the release of ViagraTM, heralded the era in America of treating erectile dysfunction using pills. With the release of this drug, the discussion of erectile dysfunction (ED) was brought out of the bedroom, and into the physician's office. Numerous TV commercials and print ads can be seen that address this issue. Today there are 3 orals agents as well as other pharmacological treatments, and surgical and non-surgical therapies to correct erectile dysfunction.
Fortunately, the treatments are very effective and do not require carrying a bathtub with you at all times as you may be led to believe by Lily, nor do you have to talk to your self in a mirror prior to walking into your doctor's office to receive the Pfizer product. Due to the excellent understanding of the disease and the treatment options that are available, patients no longer need to suffer in silence.
It has been estimated that up to 50% of men over age 60 are effected by this condition. ED has been estimated to have an incidence between 15 and 30 million people. Advancing age has been associated with an increasing incidence of the disease, however advancing age does not preclude being able to maintain a healthy sex life, and many patients well into their 70's and even 80's are able to have sexual relations. Physical causes such as other underlying diseases, injury or very commonly side effects from numerous drugs have been associated with erectile dysfunction. Some of the disease processes that are commonly associated with erectile dysfunction include heart disease, elevated cholesterol, hypertension, diabetes and prostatic disease.
Stress, depression, and smoking may also be related to erectile dysfunction. Neurologic conditions such as stroke, spinal cord injuries, Parkinson's disease, and multiple sclerosis have also been associated with erectile dysfunction. Lifestyle factors such as obesity and a sedentary lifestyle may also be causative.
The oral agents sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) have very similar mechanisms of action by inhibiting phosphodisterase 5. When this occurs with sexual stimulation, the relaxation of the smooth muscle of the penis is maximized, resulting in an erection. These agents should not be used by patients who are using nitrate containing drugs due to the risk of developing profound hypotension. The length of effectiveness of these medications vary, and lifestyle can help Urologists prescribe the appropriate drug.
Despite what the commercials claim oral agents are not going to work for all patients. Some patients are not able to use these drugs due to other medications that could result in a serious adverse event. However, the good news is that other alternatives exist for these patients.
Medications that are injected directly into the penis preceded the use of oral agents by more than 25 years. At the 1983 meeting of the American Urological Association, the British physiologist Gile Brindley shocked the audience when he revealed an erection that was created by a self- injection of phenoxybenzamine.
