The primary goal in the treatment of erectile dysfunction is to identify the cause of erectile dysfunction and, if possible, to eliminate it, rather than just fight the symptoms. In most cases, problems with potency arise from factors that can be influenced, such as lifestyle, psycho-emotional background or taking medication. Modern medicine can successfully treat erectile dysfunction (ED), but unfortunately, is not able to cure it completely. The exception is psychogenic ED, as well as ED caused by hormonal disorders.
Risk factors for erectile dysfunction are the same as in cardiovascular diseases:
- low physical activity (physical inactivity),
- alcohol abuse (see the effect of alcohol on potency),
- metabolic syndrome – a combination of three factors: excess weight, high blood pressure, high blood sugar.
Statistics show that men who have started sports in the middle of life, the risk of ED is reduced by 70%. Studies of scientists have confirmed that reducing body weight to normal, exercise, quit smoking, normalize blood pressure restores male strength in half of middle-aged patients.
Identification and elimination of the causes of decreased potency
As already mentioned, erectile dysfunction is a symptom that may indicate very serious health problems: progressive atherosclerosis, arterial hypertension, heart or kidney failure, diabetes mellitus, etc. In addition, the restoration of normal sexual life in middle-aged men is evidence of successful treatment of the described diseases.
However, there are diseases in which erectile dysfunction is the main, if not the only symptom.
1. Testosterone deficiency – male sex hormone (see low testosterone in men). This disease is correlated with testosterone replacement therapy. This drug is prescribed internally, intramuscular or skin, in the form of gels or creams rubbed into the skin.
2. Psychogenic ED – problems with potency are caused by mental or emotional factors, most often it is chronic stress. Restoration of male strength with psychogenic ED is carried out using the following methods:
- elimination of chronic stress – normalization of sleep (but not sleeping pills that can aggravate ED), exercise, massage, acupuncture,
- anatorium treatment, etc., sometimes a two-week vacation is enough to restore the man’s sexual strength;
- hypnosis – allows identifying and eliminating the underlying psychological causes of ED;
- Neurolinguistic programming (NLP) – in capable hands becomes an excellent tool in the treatment of chronic neurosis;
- psychological counseling – pursues the same goals as hypnosis, but achieves them by other means.
Any center for the treatment of erectile dysfunction has a psychologist on its staff, as competent psychological counseling can help 25% of men who complain about potency disorders.
3. Men’s sexual infections – urethritis, prostatitis, etc. are also treated. Urologists of the “old school”, as well as private clinics that sell services for the treatment of male infections will “one vote” on the need to treat these very infections, if ED is available. However, recent studies have not shown a convincing link between male genital infections and erectile dysfunction. This does not mean that prostatitis or urethritis need not be treated. These diseases can lead to infertility, but it is impossible to link them to ED.
The only group of drugs that have proven to be effective in treating ED are phosphodiesterase inhibitors-5 (PDE-5). Their use leads to relaxation of smooth muscles in the penis and dilates blood vessels in it, improving blood flow. All this leads to a normal erection, in response to natural stimulation. The year 1998 was a milestone in the treatment of male potency disorders. It was in this year, the American Commission on Food and Drug Administration (FDA) approved the use of Viagra, which is still the gold standard in the treatment of ED of any etiology.
Sildenafil (Viagra, Kamagra) is the first of the available PDE-5 inhibitors. The drug is available in tablets of 25, 50 and 100mg, the most popular is the dosage of 50mg. After taking Sildenafil inside, an erection occurs after 30-60 minutes, heavy fatty food can reduce the effectiveness of the drug by inhibiting its absorption. Erection occurs in 54 – 84% of patients, regardless of the cause of ED. Naturally, Sildenafil shows the best results in psychogenic ED (84%), and the worst results in diabetes mellitus and pelvic atherosclerosis (54 – 66%). Click here to read about generic Viagra.
Tadalafil (Cialis) – approved for use in 2003. Available in tablets of 2.5, 5, 10 and 20mg, the recommended initial dose – 10mg. The drug action begins 30 minutes after taking and lasts 36 hours. The maximum effect is observed in 2 hours after ingestion, the food affects the effectiveness of tadalafil much less. More about Cialis in UK.
Vardenafil (Levitra) – approved for use in 2003. Available in tablets of 5, 10 and 20mg, the recommended initial dose – 10mg. The effect of the drug comes 30 min. after taking, heavy food weakens its action.
All three drugs show absolutely the same statistical results in terms of both effectiveness and side effects, and some of the advantages of one over the other, as a rule, fit into the mathematical error, or research singles out engagement. However, there is evidence of somewhat better vardenafil efficiency in diabetic patients (72%). Therefore, the choice of a drug is based on personal preferences and the price component.
Combination with other drugs
- The joint use of PDE-5 inhibitors and nitrates (nitroglycerin, isosorbide mono- and dinitrate, etc.) is strongly contraindicated. This combination of medications may cause a critical decrease in blood pressure.
- The combined use of alpha-blockers and PDE-5 inhibitors may also cause a critical drop in blood pressure, so this combination of drugs is prohibited in the United States. The group of alpha-blockers is quite extensive, it includes hypotensive drugs (doxazosin), drugs for the treatment of prostate adenoma (hyperprost, omnik) and others (prasosin, sermion). Some of the alpha-blockers are used in the treatment of ED – yohimbine, delequamine.
Reasons for the ineffectiveness of PDE-5 inhibitors
Most often, the reason lies in improper use of the drug:
- Lack of adequate sexual stimulation.
- Insufficient time between taking the drug and trying to have sex. Although the drug action begins 30 minutes after taking, most men need 1 hour for a quality erection when using Sildenafil and wardenaphyl, and 2 hours for treatment with Tadalafil.
- Eating heavy fatty foods together with PDE-5 inhibitors not only delays the onset, but also weakens the efficacy, even in tadalafil.
- The interval between the use of the drug and an attempt to have intercourse is too long. The therapeutic efficacy of Sildenafil and wardenafil is preserved for 6 – 8 hours, in tadalafil this period can exceed one day.
- Inadequate dose. There is one reason for this – financial. Patients buy pills with the lowest dose or use a drug of dubious origin.
- Apomorphine – improves potency by affecting the center of erection in the brain. It is appointed for the language of 2 – 3mg. Significantly less effective than PDE-5 inhibitors, so it is prescribed in light cases, in psychogenic ED, and in the presence of contraindications to Viagra.
- Selective alpha-adrenoblockers – yohimbine and deloquamine.
- The root of ginseng.
In addition to apomorphine and ginseng root, the effectiveness of these drugs has not been proven or is comparable to placebo.
Other means for ED treatment
Local application of drugs
rubbing into the skin of the penis of some drugs (nitroglycerin, papaverine, minoxidine) can cause an erection. Since the dense protein cover of the penis prevents the absorption of drugs, in gels and creams to increase potency are added substances that improve the permeability of the penis shells. This technique can cause undesirable phenomena: itching and burning, redness of the penis, allergic reactions, side effects in the partner (pressure drop, headache), so in many countries are not approved for use.
Vacuum devices for erection
The penis is placed in a special device that creates a negative pressure around it, ensuring that the cave bodies are filled with blood, after the procedure, the root of the penis is put on a special ring that prevents blood flow. This procedure is called vacuum-constrictor therapy. The erection created by this method is not physiological, but the efficiency of the device is up to 90%.
Introduction of the drug into the penis before intercourse with a shot. In the U.S., only one drug is approved – alprostadil. The effectiveness of the method reaches 70%, but due to the large number of side effects (penis pain, too long erection, penis fibrosis) is used only when PDE-5 inhibitors are ineffective or contraindicated.
Folk methods of treatment
At the beginning of this chapter we will remember an old anecdote: “How to use the root of ginseng in impotence? Take a thicker root and tie it tighter”.
Let’s list the most popular “folk remedies”: royal jelly, walnut, golden root (rhodiola pink), ginseng, Chinese lemongrass, eleuterococcus. As it is not funny, but only the ginseng root is effective against ED (see other folk recipes for potency). Other “folk remedies” do not work better than placebo.
Treatment of erectile dysfunction in doctors
Urologist – the initial appeal in complaints about a decrease in sexual function.
Endocrinologist – in the detection of excess body weight (waist circumference length over 94 cm), hypogonadism, diabetes mellitus and any other pathological abnormalities of hormone content in the blood.
Cardiologist – upon detection of arterial hypertension, dyslipidemia, coronary heart disease, heart rhythm disorders, clinical manifestations of atherosclerosis, acute circulatory disorders in the history.
Neurologist – in the diagnosis of diseases of the central and/or peripheral nervous system, polyneuropathy.
Psychotherapist / sexologist – in the detection of anxious and / or depressive syndrome, neurosis, persistent traumatic experiences, personality accentuation.
When it is not necessary to treat erectile dysfunction?
In bed the mistresses have finished their days in the U.S. Vice President Nelson Rockefeller, British Prime Minister Henry Palmerston and even Pope Leo VII. Therefore, there is no need to treat ED in cases where sex is contraindicated in principle: severe heart failure, acute period after a heart attack or stroke.