Medication
Oral medications: Phosphodiesterase type 5 (PDE5) inhibitors such as Sildenafil, Tadalafil, and Vardenafil are often the first-line treatment for erectile dysfunction (ED), except in patients with contraindications (e.g., those on nitrates for heart disease or those whose health permits sexual activity). These medications improve penile erection by enhancing blood flow and are typically taken about one hour before sexual activity. Possible side effects include headaches and temporary flushing.
Sublingual medication: Apomorphine, taken under the tongue for about 10 minutes, acts on the paraventricular nucleus (PVN) in the brain, which is involved in erection. This medication has about a 50% efficacy rate and works quickly (within 30 minutes) but may cause nausea and vomiting without severe side effects.
Urethral suppositories: Alprostadil intra-urethral suppositories may be used for those who do not respond to oral medications or as part of combination therapy. This medication is a prostaglandin E-1 that acts as a vasodilator, but inserting it into the urethra requires a higher dose and can cause irritation, burning, and occasional bleeding. The effects typically begin within 8-10 minutes and last 30-60 minutes, necessitating the use of a constriction band to maintain the erection.
Intracavernosal injection therapy: This involves injecting medication directly into the penis to relax the smooth muscles in the corpus cavernosum. Commonly used medications include alprostadil, papaverine, and phentolamine. Dosages vary based on the individual, and patients receive training on how to inject. This method can be used alone or in combination with PDE5 inhibitors to enhance efficacy.
Hormone replacement therapy
In cases of low testosterone levels associated with erectile dysfunction, androgen therapy may be beneficial, particularly in those with severe hypogonadism. Hormone replacement can be administered via oral tablets, injections, topical applications, or transdermal patches.
Assistive devices
Vacuum constriction devices: These devices consist of a plastic cylinder placed over the penis, which creates a vacuum to draw blood into the penis, facilitating an erection. After removing the device, a constriction band is placed at the base to maintain the erection.
Surgical options
Penile prosthesis implantation: This surgical option is typically considered when other treatments have failed. It involves placing a penile implant and is often a last resort. The success rate exceeds 90%, but the procedure should only be performed by a qualified urologic surgeon. Commonly used are 3-piece implants, which consist of two cylinders, a pump, and a reservoir. The surgery has a small incision at the base of the penis and scrotum, and may also involve repairing blood vessels to enhance blood flow to the penis.
Conclusion
Erectile dysfunction is a concern that affects both partners, requiring joint problem-solving and treatment. Open communication and mutual support can lead to improved relationships. Patients should not feel embarrassed about their condition or hide the issue, as this can lead to worsening mental health and family problems in the future.
