Inhibitors of phosphodiesterase-5 (PDE-5) is one of the most widely used and effective types of drug for erectile dysfunction treatment. They temporarily increase blood flow to the penis. Worldwide for treatment three phosphodiesterase-5 inhibitors are used, namely:
- sildenafil – sold under the brand name “Viagra”;
- Tadalafil – sold under the “Cialis” trademark;
- Vardenafil – sold under the brand name of “Levitra”.
Sildenafil and vardenafil operate for about eight hours and are created for “on request”. Cialis works up to 36 hours and is more suitable if you need long-term effects, for example, on the whole weekend.
Depending on PDE-5 inhibitor, the dosage, and type, these medications begin to perform approximately in 30-60 minutes after intake. In the case of sildenafil and vardenafil, effect after reception should last for 1-10 hours. Effects of tadalafil are kept for a maximum of 36 hours.
If you take the medicine with food, it can begin performing later, so you should better take PDE5 inhibitors on an empty stomach. You may take a meal in an hour after taking this medication, and then it will not affect its performance.
Take no more than one pill per day. It doesn’t matter what kind of medication you have taken: Viagra, Levitra or Cialis
You can select which PDE5 inhibitor may be taken – sildenafil, tadalafil and vardenafil, they are likely to be equally effective for almost all men worldwide. Your doctor will explain the benefits of each means and the mechanism of their action. The choice may depend on how often you carry out sexual intercourse, and whether you have taken any medications for potency improvement before.
Many tests were conducted relating to the effectiveness of sildenafil, tadalafil, and vardenafil. On average, after taking one of these agents in 2/3 males have achieved erection improvement.
If the PDE-5 inhibitors do not perform, it may be caused by the following factors:
- not enough time has elapsed after taking means;
- too much time has passed after means reception;
- too low dosage;
- insufficient sexual stimulation.
These means are effective in case of sexual stimulation presence so that for a drug to work, you must be sexually excited.
PDE-5 inhibitors should be taken with caution by men with cardiovascular diseases such as coronary heart disease. However, sexual activity is likely to have a beneficial effect on the health of your cardiovascular system. Your doctor should discuss with you the risks and benefits of PDE-5 inhibitors and prescribe them to you if you are in reasonable physical condition.
PDE-5 inhibitors should be taken with caution in men with disabilities of a penile anatomical structure such as Peyronie’s disease (a disease affecting the penis tissue). However, it will also depend on the particular circumstances, and it is safe to take PDE5 inhibitors for them in some cases..
PDE-5 inhibitors should be used with caution in the following categories of men:
- with an increased priapism risk – a painful erection that can last for several hours;
- taking alpha-blockers with long-acting effect – a drug used to treat a number of diseases, including high blood pressure (hypertension).
Do not take PDE5 inhibitors if you also take recreational drugs that contain nitrates. Combination of these two substances can be dangerous for your heart condition as ell. Organic nitrates are often used to treat angina, and nitrite – a recreational drug, more commonly known as “poppers”.
It should be also taken PDE-5 inhibitors in the following cases:
- your doctor recommended you to abstain from sexual activity or actions that expand your blood vessels;
- you have low blood pressure (hypotension);
- you have recently had a stroke – a medical emergency in which there is cerebral circulation violation;
- you have unstable angina pectoris – chronic heart disease, which causes symptoms such as chest pain;
- you have had a heart attack – emergency condition at which there is a violation of cardiac blood flow;
- in the past, it has been non-arteritic anterior ischaemic optic neuropathy – an eye disease causing sudden vision loss.
In some cases, PDE-5 inhibitors may be used, even if you had one of these diseases. For example, consult a specialist and your therapist may allow you to take PDE5 inhibitors in 3-6 months after a heart attack.
PDE-5 inhibitors may have some side effects, including:
- a headache and migraine;
- skin redness;
- indigestion;
- nausea;
- vomiting;
- stuffy or a runny nose;
- a backache;
- blurred vision;
- muscle pain.
Vacuum Pumps to Improve Sexual Function
Vacuum pump is another method of erectile dysfunction treatment. It is a clear plastic tube connected to a pump that is actuated either manually or by means of a battery.
You put your penis into a tube and it is pumped out of the air. This creates a vacuum, as a result, penis is filled with blood and hardens. Then you pull on rubber ring the base of the penis, so that blood remains in it, and thus maintaining an erection for about 30 minutes.
You may need to use the pump a few times to understand how to use it, but usually, such pumps are very effective. After using vacuum pump nine out of ten men are able to have sex no matter what is erection disappearance cause.
Do not use a vacuum pump, if you have a bleeding disorder or if you are taking anticoagulants – agents that prevent blood clotting (thrombosis). Vacuum pump usage may provoke such side effects as pain and bruising, although this is observed at less than a third of men.
Alprostadil
If the effect of the above methods of treatment is not observed strong enough, you can be prescribed a drug known as alprostadil. It is a synthetic hormone that stimulates blood flow to the penis. Alprostadil is available as:
- the solution for injection that are made directly to the penis – this is called intracavernous introduction;
- small granules which is placed in the urethra ( urethra – an organ through which urine from the bladder reaches penis) – this is called intraurethral administration.
You can learn how to inject alprostadil properly. If your partner is pregnant, use a condom during sexual intercourse, if you enter alprostadil into urethra.
Alprostadil usually causes an erection in 5-15 minutes. The erection duration depends on the dosage of taken medication.
People who do not respond to PDE5 inhibitors, alprostadil injections give a positive result in 85 cases out of 100. Alprostadil, injected into urethra, gives a positive result in 2/3 of the men in maximum.
Alprostadil should not be used:
- people with priapism risk (a painful erection that can last for a few hours) – for example, patients with sickle cell anemia;
- together with other drugs directed to increase sexual function;
- if it was carried out prosthetic penis operation.
Intraurethral administration may be prohibited in the following cases:
- people with anatomical penile abnormalities (under which its structure changes);
- people with penile infections such as balanitis (glans inflammation).
Alprostadil may have certain side effects, including:
- blood pressure shifts;
- dizziness;
- a headache;
- pain in the penis;
- burning sensation or bleeding in urethra;
- reaction at injection site, such as swelling.
Hormone Therapy for Erectile Dysfunction
If erectile dysfunction is caused by the hormonal failure, you may be referred to an endocrinologist. The endocrinologist is a doctor who specializes on hormonal disorders treatment.
Hormones are chemicals that are produced by human body. Many hormonal disorders can be treated with injections of synthetic (artificial) hormone to restore normal hormone levels.
Watch the video about Erectile Dysfunction and ED Treatment Hormone Therapy:
Surgery for Impotence
Surgery for erectile dysfunction is prescribed only in those cases when all other treatment methods have failed. Operation is possible in the following cases:
- young people who have suffered a serious injury in the groin area – for example, get injuries in a car accident;
- men with substantial anatomical deviations in penile structure.
Recently operations were recommended in case of apparent cessation of blood flow to the penis. The surgeon can release the blood vessels and restore normal blood flow. However, researches show that such operations are not effective as a long term treatment, it is unlikely that you will make it.
Penile Prosthesis
There is also the possibility of penile prosthesis implantation. They are of two types:
- semi-rigid prostheses – suitable for elderly people whose sexual life is irregular;
- inflatable prostheses – consist of two or three parts, which are inflated and provide a more natural erection.
About 3/4 of men are satisfied with the results of such an operation.
As in any other surgery with a prosthetic penis, there is a risk of infection emergence. If you are taking prophylactic antibiotics (drugs to combat infections caused by bacteria), the probability of infection emergence is 2-3%. In 5% of cases in the first five years, there are mechanical problems with dentures.
Psychological Treatment in Erectile Function Violation
If your erectile dysfunction is caused by psychological causes, you can use the following type of treatment, which is called sensual focus. If problems are associated with anxiety or depression, you can attend psychotherapy.
Sensual focus is a type of sexual therapy, in which you and your partner participate. At first, you agree that you will not have sex for several weeks or months. At this time, you can touch each other, but not in the genital area (and breast in women). Jut focus on each other. You can do massage, touching and stroking each other’s clothes or naked. The goal of sensory focus is to explore your partner’s body, knowing that sex will not be going further.
After a set period of time has passed, you can begin to touch genitals of your partner. Over the next few weeks, you will gradually increase the frequency of touches. You can also begin to touch the mouth of the partner, for example, to kiss. In the end, you are able to have sexual intercourse.
Psychosexual therapy is a type of psychotherapy in which you and your partner can discuss any issues related to sex and emotions that cause you erectile function violation. Talking about these issues, you can remove anxiety. The therapist can also give you some practical advice about sex, such as foreplay, and how best to use other treatment methods to improve your sexual life. Results of psychosexual therapy may not appear immediately, and different pairs reach different results.
Psychosexual counselling or Cognitive Behavior Therapy (CBT) is another form of psychotherapy, which can help in case of erectile function reduction. CBT is based on the principle that what you feel is partly dependent on how you think about it. CBT helps you understand that your problems are more often created by your consciousness. The problem is looked through the idea of ho you react on the problem itself. Your CBT therapist can help you identify bad or unrealistic thoughts that can reduce the potency, for example:
- your self-esteem (how you evaluate yourself);
- your sexuality;
- your personal relationships.
The specialist will help you start thinking about it more realistically and to eliminate any harmful thoughts.
Exercises for Pelvic Floor Muscles
Some studies suggest that in some cases it is useful to train the pelvic floor muscles. This is a group of muscles located below bladder and rectum, as well as at the root of the penis.
Exercises for pelvic floor muscles help to strengthen the muscles that are used for control of anus (back passage) and when urinating. If your doctor believes that such exercises can go in your favor, you should discuss with a therapist how to do them properly. By exercising and strengthening those muscles, you can remove erectile dysfunction symptoms.
Additional Treatment
It is believed that some of the complementary therapy methods, such as acupuncture, can also help with erectile dysfunction treatment. However, there is little indication that they are effective. In some cases, this treatment uses ingredients which may interact with other medications taken and as a result cause side effects. Be sure to talk with your doctor before starting any complementary therapy.
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