Impotence 24.info - treatment

• medical symptoms
• medical diagnosis
• pathophysiology
• treatment
• history
• prevalence
• viagra (sildenafil)
• cialis (tadalafil)
• levitra (vardenafil)
• propecia (finasteride)
• flomax (tamsulosin)
• erectile dysfunction
• impotence
• erection
• clitoris
  

Treatment
Treatment depends on the cause. Testosterone supplements may be used for cases due to hormonal deficiency. However, the cause is more usually lack of adequate penile blood supply as a result of damage to inner walls of blood vessels. This damage is more frequent in older men, and often associated with disease, in particular diabetes.

Treatments (with the exception of testosterone supplementation, where effective) work on a temporary basis: they enable an erection to be attained and maintained long enough for intercourse, but do not permanently improve the underlying condition.

ED can in many cases be treated by drugs taken orally, injected, or as penile suppositories. These drugs increase the efficacy of NO, which dilates the blood vessels of corpora cavernosa. When oral drugs or suppositories fail, injections (e.g. of apomorphine) into the erectile tissue of the penile shaft may work.

When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the penis to maintain it. These pumps should be distinguished from other "penis pumps" (supplied without compression rings) which, rather than being used for temporary treatment of impotence, are claimed to increase penis length if used frequently, or vibrate as an aid to masturbation.

More drastically, inflatable or rigid penile implants may be fitted surgically. Implants are irreversible and costly.

All these mechanical methods are based on simple principles of hydraulics and mechanics and are quite reliable, but have their disadvantages.

In a few cases there is a vascular problem which can be treated surgically.

Uncontroversial treatments
PDE5 Inhibitors
The cyclic nucleotide phosphodiesterases constitute a group of enzymes that catalyze the hydrolysis of the cyclic nucleotides cyclic AMP and cyclic GMP. They exist in different molecular forms and are unevenly distributed throughout the body. These multiple forms or subtypes of phosphodiesterase were initially isolated from rat brain by Uzunov and Weiss in 1972 and were soon afterward shown to be selectively inhibited by a variety of drugs in brain and other tissues (Weiss,1975; Fertel and Weiss, 1976). The potential for selective phosphodisterase inhibitors to be used as therapeutic agents was predicted as early as 1977 by Weiss and Hait. This prediction has now come to pass in a variety of fields, one of which is in the pharmacologic treatment of erectile dysfunction

One of the forms of phophodiesterase is termed PDE5. The prescription PDE5 inhibitors sildenafil (Viagra®), vardenafil (Levitra®) and tadalafil (Cialis®) are prescription drugs which are taken orally. They work by blocking the action of PDE5, which causes cGMP to degrade. CGMP specific phosphodiesterase type 5|cGMP]] causes the smooth muscle of the arteries in the penis to relax, allowing the corpus cavernosum to fill with blood.