LEARN ABOUT AND CURE ERECTION DISORDERS

Seventeen percent of males between the ages of 18 and 55 (occasionally) suffer from erection problems. Six percent of males in that age group have a problem with erections on a regular basis or even permanently. Of the males above age 55, about one in three has an occasional erection problem or worse. Most of the men in that age group regularly consult their general practitioner for some reason or another. If both patient and doctor are not too shy to bring up the problem, then those contacts may prove to be a good opportunity to determine the cause of the erection problem and maybe start therapy.

The term erectile dysfunction is used to designate a problem with penile erections, when the penis does not harden enough or not at all, or when the erections does not last long enough during sexual encounters. Therefore, different types of erectile dysfunction exist. The impotence may be complete, i.e. 'nothing happens', or partial, when something does happen but the penis does not get hard enough to allow intercourse. A third possibility is that the penis does get erect rather normally, but falls limp again too quickly.
There is also a difference when we look at the duration of the erection disorder: some men have always had problems with erections, while others had good erections before, but these have become a problem later in life. Lastly, some erection disorders only come up in certain situations, while, in general, erections are okay.
These different types of erection problems are important when it comes to determining a cause, which in turn leads to a decision about the type of therapy.
Most erection disorders are caused by a combination of physical and psychological problems. It is important to keep this in mind when it comes to treating the problem.

Causes of erection disorders are:

• Psychological
• Physical
• Mixed - psychological and physical

Treatment options are:

• psychotherapy or sex therapy
• medication
• hormonal therapy
• vacuum therapy
• pressure rings
• self-injection therapy
• prosthesis implantation
• vascular surgery

Viagra^® (sildenafil) was introduced by Pfizer.
Acts by narrowing the exit of the blood from the cavernous bodies (part of penis), thus enhancing and prolonging erection. The tablets were shown to work in 80% of men with erection problems.
The effect of Viagra will commence after about 45 minutes and will last for 3-4 hours.
Side effects: headaches, dyspepsia, flushes and a blue discoloration of vision.
Not to be taken with nitrates (the combination of Viagra and nitrates may prove hazardous to the heart as it could cause blood pressure to drop to an unsafe level.)
Nitrates include:

In the U.S.-

• Deponit
• Minitran
• Nitro-Bid
• Nitrodisc
• Nitro-Dur
• Nitrol
• Transderm-Nitro

In Canada-

• Minitran
• Nitro-Dur
• Nitrol
• Transderm-Nitro

Levitra^® (vardenafil), manufactured by Bayer and GlaxoSmithKline.
Works in the same way as Viagra and supposedly works faster and should have less side-effects. But for all practical purposes, it works as fast as Viagra and has the same side effects.
Some studies report less effect of Levitra compared to Viagra.
Levitra should also not be taken with nitrates.
The starting dose of LEVITRA is 10 mg taken no more than once per day. Your doctor will decide the dose that is right for you.

The active ingredients in Viagra (sildenafil citrate) and Levitra (vardenafil HCl) increase blood flow to the penis. The drugs, accompanied by appropriate stimulation, help most men with erectile dysfunction get and maintain an erection suitable for sexual intercourse. Viagra and Levitra have a positive effect on sexual response in men with medical conditions, such as diabetes, and in men who have had their prostate removed (prostatectomy). Neither drug is an aphrodisiac.

Some of the common side effects of the drugs are temporary flushing, headache, dizziness and stomach upset. An uncommon side effect that requires immediate medical attention is an erection that lasts more than four hours (priapism).

Cialis^® (tadalafil) by Eli Lilly
Is another lookalike, but with a difference. Cialis starts having effect faster than Viagra and Levitra (about 20-30 minutes), but works longer. Although up to 36 hours are claimed, in reality Cialis will remain active for about 20 hours in most men. This is an advantage compared to the other two pills, which generally stop working after 3-4 hours. So with Cialis, there is no rush to have sex before the pill wears out, which often has a relaxing effect on men who do not perform well under pressure. The side effects of Cialis are the same but in some men it can also cause back pain and muscle ached that usually go away by themselves within 48 hours.
Dosage: CIALIS is designed to be taken in a single 20 mg, 10 mg, or 5 mg dose as prescribed.

Muse^® by Abbott
Consists of a very small tablet to be introduced into the opening of the penis (the urethra) using a special tube-like device. Muse consists of a prostaglandin , a hormone with a limited and largely unknown function, which is capable of narrowing the blood vessels exiting the cavernous bodies, the same way as Viagra does. It works in over 50% of cases, but is rather expensive.An erection should occur within 5 to 20 minutes after you use the medication, and should last for 30 to 60 minutes.Side effects include penile pain and irritation of the urethra.
Dosage: Start 0.25 mg/Max. 1 mg

Uprima^® (apomorphine), also by Abbott.
Apomorphine is a cousin of morphine. In very small dosages, the tablets can be administered sublingually(underneath the tongue), so that the apomorphine can get into the blood stream rapidly (within 20 minutes). It works very different from the other medication mentioned above. Uprima acts directly on the brain, thereby provoking easier erections by enhancing the 'erection signals' from brain to penis. The main reported side effect is nausea.Uprima should not be used if you are under treatment with nitrates (See a list of most common nitrates above)
Dosage:Start 2mg/max 3mg)

Yohimbine (Pausinystalia yohimbe)

Yohimbe bark is traditionally used for increased sexual vitality in men and women. Pharmaceutically, yohimbine is isolated from yohimbe and used in male erectile dysfunction.It has central nervous system stimulatory activity. Aphrodisiac activity may be due to enlargement of the vasculature in the genitals, increase of nerve impulses to genital tissue, and an increased transmission of reflex excitability in the sacral region of the spinal cord. Contraindicated in pregnancy. Do not use in individuals taking MAO inhibitors or antihypertensives; do not use in hypertensive individuals or cardiovascular disease. Toxic doses may trigger psychosis, hypotension, and cardiac failure. Based on pharmacological activity, use with caution in individuals receiving alpha2 blockers; may cause anxiety, insomnia, hypertension, and tachycardia.
DOSAGE — Oral: 500-750 mg twice daily

Some men may choose to use alternative treatments in addition to traditional treatments for erectile dysfunction (ED). If you are considering an alternative form of treatment for ED, you should seek the advice of a healthcare provider.

What is an alternative treatment?

A health treatment that is not classified as standard Western medical practice is referred to as "alternative" or "complementary." Alternative treatments include nutritional supplements, herbal remedies, and acupuncture.

Nutritional supplements

Patients with ED have used nutritional supplements including bioflavonoids, zinc, Vitamin C, Vitamin E, and flaxseed meal. Supplemental doses of the amino acid arginine have helped some men with ED, according to research. In addition, certain ED patients with low levels of the hormone dehydroepiandrosterone (DHEA) showed improvement in erectile function after receiving supplemental doses of DHEA. Experts have concerns about the safe use of DHEA, however, because long-term safety data do not exist.

Herbal remedies

Many herbal therapies are used as alternative treatments for ED. These include Asian ginseng and Ginkgo biloba. Some people claim that herbal remedies can have a positive effect on male sexual function. You should consult a doctor before taking any herbal supplement. Health care professionals can help weigh the risks and potential benefits of herbal remedies.

Acupuncture

This technique is an ancient Chinese method of healing that involves sticking very fine, solid needles into specific points on the body. Acupuncture stimulates the body's ability to resist or overcome illnesses and conditions by correcting imbalances. Acupuncture has helped some men with ED.

Mechanical Devices

For men who cannot or do not wish to use drug therapy, an external vacuum device may be acceptable.This device combines a plastic cylinder or tube that slips over the penis, making a seal with the skin of the body. A pump on the opposite end of the cylinder creates a low-pressure vacuum around the erectile tissue, which results in an erection.To keep the erection, once the plastic cylinder is removed, a rubber constriction band goes around the base of the penis and this maintains the erection.

Recommendations for diabetic men with erectile dysfunction are the same as those for men without diabetes: Because of their efficacy, ease of use, and favorable side effect profile, I recommend the phosphodiesterase inhibitors as first-line therapy. Sildenafil (Viagra®), vardenafil (Levitra®), and tadalafil (Cialis®) appear to be equally effective, but tadalafil has a longer duration of action. All three drugs are available in Europe. Sildenafil and vardenafil are available in the United States, but tadalafil has not yet been FDA approved. Second-line therapies include penile self-injectable drugs, intraurethral alprostadil (Muse®), and vacuum devices. Surgical treatment should be reserved for men who cannot use or who have not responded to first and second-line therapies.

CANADIAN BRAND NAMES — Viagra®

INTERNATIONAL BRAND NAMES — Anaus® (AR); Aphrodil® (HK, JO, KW, LB, MT, MY, RO); Bifort® (AR); Caverta® (IN); Diserec® (CO); Ejertol® (CO); Elebra® (CO); Erefil® (CO); Erilin® (CO); Eroxim-fast® (CO); Eroxim® (CO); Firmel® (AR); Hormotone® (CO); Lumix® (AR); Penegra® (IN); Segurex® (AR); Sex-Men® (CO); Sildefil® (AR); Sildegra® (TR); Sildenafil Genfar® (CO); Sildenafil MK® (CO); Sildenafil® (CO); Tranky® (CO); Viagra® (AT, AU, BE, CA, CH, CL, CO, CZ, DE, DK, ES, FI, FR, GB, HR, HU, ID, IE, IL, IT, MX, NL, NO, NZ, PL, PT, RO, RU, SE, SG, SI, TH, TR, YU, ZA); Vigradina® (CO); Vigrande® (TR); Vimax® (AR); Vorst® (AR)