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A class of drugs known as phosphodiesterase type 5
(PDE-5) inhibitors now forms the backbone of medical
therapy for Erectile dysfunction. Sildenafil citrate (Viagra®), was the
first of these drugs approved by the U.S. Food and Drug
Administration (FDA) for Erectile dysfunction. It became available in
1998. Media attention about the drug led to greater
public awareness of Erectile dysfunction. The FDA approved vardenafil HCI
(Levitra®) and tadalafil (Cialis®) in 2003.
When a man is sexually excited, brain sends messages
through the nerves to the penis. These nerves release a
substance that relaxes the smooth muscle in the penis
and allows for increased blood flow. The PDE-5
inhibitors temporarily prevent (or inhibit) the
breakdown of that natural substance and thereby helping
to produce a rigid erection.
Though the three drugs have a similar action, they
differ in their dosages, duration of action and side
effects. These have been shown to be effective in over
2/3rd of the patients with Erectile dysfunction regardless of the cause.
As with any drug, there are some side effects associated
with PDE-5 inhibitors. Most common are headaches,
flushing (redness) of the face, running or stuffy nose,
upset stomach, dizziness and muscle aches. These drugs
rarely cause severe complications like precipitation of
a heart attack, or loss of vision. Thus a thorough
medical evaluation is needed before starting these
medications and unsupervised self medication can be
dangerous.
Self Injection Therapy
This involves self injection of medicines directly into
the spongy chambers of the penis, where they cause
relaxation of the smooth muscles and increase blood
flow. Though the technique may sound scary, actually
does not cause much discomfort. This technique is first
taught in doctor’s office, under close supervision and
later can be practiced at home in privacy before sex.
The most serious but rare side effect is priapism (an
erection that lasts too long). This might damage spongy
tissues in the penis, thus a person with erection
lasting for more than four hours should immediately seek
medical attention.
Transurethral Therapy
A tiny medicated pellet or paste is introduced into the
urethra. This is absorbed and causes erection in a
manner similar to the injection therapy. Although
generally safe and easier, this method is less effective
than self-injection therapy. This may cause mild itching
in the female partner. This therapy is contraindicated
in couples planning for pregnancy, or if the partner is
pregnant.
Vacuum Erection Devices
These can be used by any man with Erectile dysfunction. The device
consists of a plastic cylinder that fits over the penis,
this is fitted with a pump to draw out air creating a
partial vacuum around the penis. The negative pressure
draws blood into the penis, causing an erection to form.
Once an erection is achieved, an elastic ring is slipped
around the base of the penis. The ring helps hold the
blood in the penis and can be left in place safely for
up to 30 minutes.
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