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Current Treatments for Erectile Dysfunction
The term impotence has usually been employed to indicate the inability of the male to attain and maintain erection of the penis sufficient to permit satisfactory sexual intercourse. The preferred term is now erectile dysfunction (ED). ED is a common problem, especially among older men. In the U.S. alone, approximately 10 million men suffer from ED. According to the National Center for Health Statistics (1989), ED results in nearly a half-million outpatient visits. While erectile function may not be the most important indicator of sexual satisfaction, ED may contribute to mental stress that affects interactions with family and associates.
A comprehensive review of the pharmacology of various agents used in the treatment of ED reveals a continuing emergence of knowledge about their mechanism(s) of action and their clinical efficacy. Both systemic and locally-active agents are available. Their site(s) of action may be peripheral or central acting. Sometimes, a combination of agents is effective, but often this is determined by the etiology of the ED. Significant insight has been gained in the last decade with respect to the pharmacologic action of drugs used in the treatment of ED.
While testosterone can enhance male sexual function, testosterone therapy for the treatment of ED should be discouraged unless the etiology is clearly related to low testosterone levels. Testosterone therapy in men with normal levels may enhance sexual behavior, but is without significant effects upon erectile function. Transdermal patches (e.g., Testoderm, Androderm) and topical testosterone gel (e.g., Androgel) are commercially available. Improvements following testosterone (transdermal) may require several months of therapy. Transdermal delivery systems may provide better consistency in serum testosterone than injections, but are perhaps more expensive. There is always the chance of the patches falling off while showering or skin irritations, which require removal of the patches.
Urology 2000 Oct 1;56(4):647-52
Baniel J, Isarailov S, Engelstein D, Shmueli J, Segenreich E, Livne PM.
Institute of Urology, Rabin Medical Center, Beilinson Campus, Petah Tiqva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
OBJECTIVES: To perform a comparative evaluation and follow-up of patients with erectile dysfunction (ED) who were treated with intracavernous injection of vasoactive drugs, starting with simple drugs and advancing to complex combinations.