What is Erectile Dysfunction?

Erectile dysfunction (ED) is the inability of a man to achieve and maintain an erection for enough time to complete sexual intercourse. ED affects approximately 50 million men throughout Europe and the US and the number of reported cases is growing. The medical community is not sure if that is because more men are actually experiencing ED, or if they are simply becoming more comfortable with sharing this intimate problem.

Regardless, ED can be quite embarrassing, depressing and demoralizing for men who experience it as they cannot perform well sexually and, therefore, feel inadequate in their male role. Although ED or impotence, as it is also known, most commonly occurs in men older than 45 years, various medications, or health and psychological problems can cause it to occur in younger men as well.

Etiologies of Erectile Dysfunction

Diseases and Addictions

Medically, erectile dysfunction occurs due to cardiovascular disorders. The blood vessels which feed the penis can be constricted, preventing sufficient inflow.

Additionally, some of the common medical causes behind ED are:

• diabetes mellitus
• high blood pressure (hypertension)
• alcoholism
• smoking
• prescription or recreational drug abuse
• kidney disease

All of these conditions can restrict the flow of blood to the penis. As many as a full 50 percent of diabetic men will at some point encounter sexual problems due to this reason.

Side Effect

Erectile dysfunction might occur as a side effect during intake of certain Selective serotonin reuptake inhibitor (SSRI) based antidepressants (Celexa, Zoloft, Prozac). In this case depression treatment should be stopped.

Nerve damages

Nerve damages can also be the cause behind impotence. A pelvic or spinal injury can damage nerves running to the groin area. Some surgeries performed on the bladder or prostate may also be behind the disorder from unknowingly severed nerves or tissue damage.

Psychological problems

Psychological problems can also cause erectile dysfunction. Stress, depression, anxiety, fear, guilt and other moods can hinder sexual performance. Although only about 20% of cases are determined to result from such psychological roots in and of themselves, they are found to contribute to the problem in some way in the other 80%.

Hormonal imbalances can lead to erectile dysfunction as well.

Top Performers in ED Treatment

Certain treatments for erectile dysfunction, ranging from orally disintegrating tablets and vacuum pumps to self injections, are present on the market, but the main options nowadays are the oral drugs, belonging to phosphodiesterase-5 inhibitors (PDE5) class, sold under brand names Viagra, Levitra and Cialis.

These assist men in achieving a harder and longer lasting erection. Although providing only a temporary solution to the ED problem and not being a cure, these drugs are good alternatives to expensive surgeries if those are acceptable any particular case.

VIAGRA

Viagra, with sildenafil citrate as an active ingredient, was the first US approved medication indicated for the treatment of erectile dysfunction (ED). The approval of the drug was granted in 1998 by the FDA. Viagra has specifically high efficacy in patients suffering from ED evoked by spinal cord injuries, diabetes mellitus and radical prostatectomy.

Being a pioneer, Viagra enjoys a larger market share of consumer use. Annual revenues from Viagra peaked in 2008 at almost US$ 2 billion.

LEVITRA

Levitra, an oral formulation of vardenafil, was approved in 2003 in the US, and quickly saw a 50% sales increase in prescriptions for newly diagnosed patients. It is recommended to be taken orally between 30 minutes to 1 hour before sexual intercourse, although more recent clinical studies show that it begins working in as little as 16 minutes.

Additionally, Levitra's safety profile is more tolerable than the one in Viagra and Cialis (for example, the drug can be taken along with alcohol with no serious side effects).

In 2010, another formulation of vardenafil, in form of orally disintegrating tablets, was approved by the FDA for the treatment of ED under brand name of STAXYN.

CIALIS

Cialis (tadalafil) was the 3rd medication to be approved by the FDA and used in males for the treatment of impotence. The approval in the United States was granted in 2003. A developing, producing and marketing company was Eli Lilly.

The significance of the newly-approved drug consisted in the duration of action: Cialis, which was later called 'The Weekend Pill', could work up to 36 hours.

PDE5 inhibitors

Basically, erection occurs when nitrogen oxide is released when aroused and binds to an enzyme called guanylate cyclase. This bonding increases a substance called cGMP which causes the smooth muscles to relax in the cavernous body of the penis, allowing dilation of the blood vessels and, thus, increasing blood inflow.

ED is often caused when another enzyme, phosphodiesterase-V (PDE5), overpowers the guanylate cyclase enzyme and works to deteriorate the cGMP which then results in restricted blood flow. Sildenafil citratate, vardenafil and tadalafil, the just approved PDE5 inhibitors, block PDE5 enzyme which obstructs an erection, and restore the proper operation of the male sexual system.

Precautions When Taking PDE5 inhibitors

PDE5 inhibitor based drugs are Rx only medications therefore consultation with a doctor over drug dangers and benefits according to particular health conditions is recommended when considering them as an ED treatment.

Additionally, certain precautions are to be followed.

• The drugs should not be taken by patients suffering from certain ailments or taking nitrate medications for cardiovascular complications.
• The drugs should not be taken by patients with severe liver and kidney diseases.
• While taking PDE5 inhibitors, fatty foods are to be avoided as the fat will hinder the substance from inhibiting the PDE5 enzyme.

Adverse Effects

According to the clinical trials and reported cases, the most common side effects while taking this class of medications are headache, flushing, upset stomach and nausea, dizziness, runny nose and heartburn.

In some occasions, more serious symptoms occur, such as allergic reactions, chest pain or irregular heartbeat, impaired vision, loss of hearing, numbness in the extremities, prolonged erection (more than 4 hours), vomiting, or severe headache. If any of these are experienced, immediate medical treatment should be sought.

Are There Permanent Solutions to ED?

There are no known or approved permanent solutions to the problem of erectile dysfunction since the causes of the problem are varied between individuals. However, some success can be achieved by addressing the root causes, such as quitting smoking or drinking, controlling diabetes, getting more exercise and other health related approaches.

Since psychological effects are proven to be a major contributor in practically all ED cases, getting help in this area produces very good results.

Surgically implanting a penile pump is another option, although a radical one, and the failure rate is quite high.

In most cases, doctors continue to recommend and prescribe such drugs as Viagra, Levitra and Cialis because these represent good, although temporary, options for erectile dysfunction.

Useful Information on ED

• National Kidney & Urologic Diseases Information Clearinghouse (NKUDIC): http://kidney.niddk.nih.gov/kudiseases/pubs/ED/
• Drugs that may cause impotence: http://www.nlm.nih.gov/medlineplus/ency/article/004024.htm
• Cardiovascular Implications of Erectile Dysfunction: http://circ.ahajournals.org/content/123/21/e609.full
• Clinical Trials on ED (you may apply for participation)
• Sexuality for the Man With Cancer

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