What is Erectile Dysfunction?
Erection is obtained by nerve stimulation, which relaxes muscle cells of the corpora cavernosa and fills the cavernous cavities with blood. This ensures passive compression of exhalation channels, so that erection can be maintained with a very low arterial inflow.
Erectile dysfunction (ED) is the inability to achieve and / or maintain an erection, so coitus is impossible.
Most cases of ED have organic cause. But there are often psychological causes (for example, anxiety) connected, so that the condition worsens.
Organic underlying conditions may be cardiovascular disease, dyslipidemia, metabolic syndrome, alcohol and smoking, etc. The prevalence of ED among healthy 40-year-old males is about 20%, rising to approx. 50% among 70-year-olds. In patients with known underlying causes the prevalence is higher. For example, almost all patients with diabetes mellitus or multiple sclerosis suffer from ED during lifetime.
ED maybe also caused by medicines, especially antihypertensives, β-blocking agents and drugs. Discontinuation or change of antihypertensive medication or β-blocking drug might lead to relieving the patient’s ED.
Open procedures, such as radical prostatectomy, can lead to ED very often, while transurethral interventions, such as transurethral resection of the prostate, rarely damage erectile ability.
Oral treatment with phosphodiesterase 5 inhibitors (PDE5 inhibitors) is the first class treatment of ED, because this treatment is the most effective (success rate is approx. 70%), and can be applied to Erectile Dysfunctions of any etiologies, organic, psychogenic or mixed.
The main oral Sexual Dysfunction Drugs from PDE5 inhibitors class are:
These widely prescribed ED drugs are the same in mechanism of action, but have different effects and range of application. Only doctor can decide which drug is better for any specific form of Erectile Dysfunction.
Other treatment option is alprostadil, or a combination product of aviptadil / phentolamine in form of injection. Erections can be induced within 10 min. and last until the pharmacological effect has subsided. Alprostadil is also available as urethral suppository, which has somewhat lower success rate.
In case of severe erectile dysfunction which does not respond to drug treatment, a patient can insert an inflatable penile erection prosthesis.
Such treatment as yohimbine has no more than marginal effect and is not included into the range of commonly used treatments. The product can be only used for light cases of ED.
Since treatment of the Erectile Dysfunction (ED) is usually the same regardless of the cause of the condition, it seems reasonable to include into the therapy course monitoring of the underlying diseases (cardiovascular disease, diabetes mellitus, dyslipidemia, metabolic syndrome, smoking).