Question:
Viagra, Cialis, Levitra - pills for Erectile Dysfunction Treatment
Answer:
A wide variety of options exist for treating erectile dysfunction.
They include everything from medications and simple mechanical devices
to surgery and psychological counseling. The cause and severity of
your condition are important factors in determining the best treatment
or combination of treatments for you. You and your doctor may also
want to consider how much money you're willing to spend and the
personal preferences of you and your partner. If erectile dysfunction
is the result of a medical condition, the cost of treatment may be
covered by insurance.
Oral medications
Three oral medications are available to treat ED. These include:
* Sildenafil (Viagra)
* Tadalafil (Cialis)
* Vardenafil (Levitra)
The Food and Drug Administration (FDA) approved Viagra in 1998, and it
became the first oral medication for erectile dysfunction on the
market. Since then, doctors have written millions of prescriptions for
the blue, diamond-shaped tablets. But Viagra is no longer the only
pill that treats this condition. Levitra and Cialis are two other
options.
Viagra, Levitra and Cialis work
in much the same way. Chemically known as phosphodiesterase
inhibitors, these drugs enhance the effects of nitric oxide, a
chemical messenger that relaxes smooth muscles in the penis. This
increases the amount of blood and allows a natural sequence to occur -
an erection in response to sexual stimulation. These medications don't
automatically produce an erection. Instead they allow an erection to
occur after physical and psychological stimulation. Many men
experience improvement in erectile function after taking these
medications regardless of the cause of their impotence.
These medications share many similarities, but they have differences
as well. They vary in dosage, duration of effectiveness and possible
side effects. Other distinctions - for example, which drug is best for
certain types of men - aren't yet known. No study has directly
compared these three medications.
Although these medications can help many people, not all men can or
should take them to treat erectile dysfunction. If you've had a heart
attack, stroke or life-threatening heart rhythm during the last six
months, don't take these medications. If you've been told that sexual
activity could trigger a cardiac event, discuss other options with
your doctor. In addition, don't take Viagra, Levitra or Cialis with
nitrate medications, such as the heart drug nitroglycerin. The
combination of these medications, which work to widen (dilate) blood
vessels, can cause dizziness, low blood pressure, and circulation and
heart problems.
Don't expect these medications to fix your impotence immediately,
because that's not always the case. Dosages may need adjusting. Or you
may need to alter when you take the medication. Before taking any
medication, make sure to discuss with your doctor its potential
benefits and side effects.
Non-surgical ED Treatment Treatment Sex Therapy
A significant number of men develop impotence from psychological
causes that can be overcome. When a physiological cause is treated,
subsequent self-esteem problems may continue to impair normal function
and performance. Qualified therapists (e.g., sex counselors,
psychotherapists) work with couples to reduce tension, improve sexual
communication, and create realistic expectations for sex, all of which
can improve erectile function. Psychological therapy may be effective
in conjunction with medical or surgical treatment. Sex therapists
emphasize the need for men and their partners to be motivated and
willing to adapt to psychological and behavioral modifications,
including those that result from medical or surgical treatment.
Medical Treatment Oral Medication Oral medications used to treat
erectile dysfunction include selective enzyme inhibitors (e.g.,
sildenafil Viagra® , vardenafil HCl [Levitra®], tadalafil [Cialis®])
and yohimbine (Yohimbine®, Yocon®).
Selective enzyme inhibitors are available by prescription and may be
taken up to once a day to treat ED. They improve partial erections by
inhibiting the enzyme that facilitates their reduction and increase
levels of cyclic guanosine monophosphate (cGMP, a chemical factor in
metabolism), which causes the smooth muscles of the penis to relax,
enabling blood to flow into the corpora cavernosa. Patients taking
nitrate drugs (used to treat chest pain) and those taking alpha-
blockers (used to treat high blood pressure and benign prostatic
hyperplasia) should not take selective enzyme inhibitors.
Men who have had a heart attack or stroke within the past 6 months and
those with certain medical conditions (e.g., uncontrolled high blood
pressure, severe low blood pressure or liver disease, unstable angina)
that make sexual activity inadvisable should not take [6]Cialis®.
Dosages of the drug should be limited in patients with kidney or liver
disorders.
Viagra® is absorbed and processed rapidly by the body and is usually
taken 30 minutes to 1 hour before intercourse. Results vary depending
on the cause of [7]erectile dysfunction, but studies have shown that
Viagra is effective in 75% of cases. It helps men with erectile
dysfunction associated with diabetes mellitus (57%), spinal cord
injuries (83%), and radical prostatectomy (43%).
In clinical studies, [8]Levitra® has been shown to work quickly,
provide consistent results, and improve sexual function in most men
the first time they take the drug. It also has shown to be effective
in men of all ages, in patients with diabetes mellitus, and in men who
have undergone radical prostatectomy. Cialis® has been shown in
clinical trials to stay in the body longer than the other selective
enzyme inhibitors. It promotes erection within 30 minutes and enhances
the ability to achieve erection for up to 36 hours.
Common side effects of selective enzyme inhibitors include headache,
reddening of the face and neck (flushing), indigestion, and nasal
congestion. Cialis® may cause muscle aches and back pain, which
usually resolve on their own within 48 hours. Yohimbine improves
erections for a small percentage of men. It stimulates the
parasympathetic nervous system, which is linked to erection, and may
increase libido. It is necessary to take the medication for 6 to 8
weeks before determining whether it will work or not. Yohimbine has a
stimulatory effect and side effects include elevated heart rate and
blood pressure, mild dizziness, nervousness, and irritability.
Yohimbine's effects have not been studied thoroughly, but some studies
suggest that 10% to 20% of men respond to treatment with the drug.
Ease of administration makes oral medication advantageous. Some drugs,
however, are suitable for only a relatively small group of men, and in
many cases, oral medications may by less effective than other
treatments.
Self-Injection Self-injection involves using a short needle to inject
medication through the side of the penis directly into the corpus
cavernosum, which produces an erection that lasts from 30 minutes to
several hours. Prostaglandin (alprostadil, Caverject®, Edex®), and
phentolamine (Regitine®) produce results similar to Viagra but are
localized in the penis after injection. They cause vascular dilation
and a relaxation of smooth muscle. Prostaglandin is the only substance
currently approved for erectile dysfunction treatment. Phentolamine is
a heart medication with similar effects used by some physicians to
treat impotence. These drugs have been shown to produce erections in
80% of men who inject them. Some men claim that they produce erections
that feel natural and improve sex. The injections are relatively
painless and create an erection that begins about 5 to 15 minutes
after the injection. It is recommended that self-injection be
performed no more than once every 4 to 7 days. Side effects include
infection, bleeding, and bruising at the injection site, dizziness,
heart palpitations, and flushing. There is a small risk for priapism
(an erection that lasts for more than 6 hours and requires medical
relief). Repeated injection may cause scarring of erectile tissue,
which can further impair erection.
Urethral suppositories containing prostaglandin (aprostadil), like
Muse® (Medicated Urethral System for Erections), may be an alternative
to injection. Using a hand-held delivery device, a man inserts a
prostaglandin pellet through the meatus (penis opening) into the
urethra. Prostaglandin is absorbed through the urethral mucosa and
into the surrounding erectile tissue. It is available with a
prescription, is well tolerated, and may improve erections in 60% of
men who use it.
In addition to the side effects associated with injecting aprostadil,
pain in the penis and perineum (area between scrotum and rectum) may
occur with suppository use. Vacuum Devices Vacuum devices work by
manually creating an erection. The penis is inserted into a plastic
tube, which is pressed against the body to form a seal. A hand pump
attached to the tube is used to create a vacuum that draws blood into
the penis, causing the penis to become engorged. After 1 to 3 minutes
in the vacuum, an adequate erection is created. The penis is removed
from the tube and a soft rubber O-ring is placed around the base of
the penis to trap blood and maintain the erection until removed. The
ring can be left in place for 25 to 30 minutes.
Vacuum devices work best in men who are able to achieve partial
erections on their own. They are easy to use at home, require no other
procedure, and typically improve erections regardless of the cause of
impotence. Some men experience a numbing feeling after placing the O-
ring. Since the penis is flaccid between the ring and the body, the
erection may be somewhat floppy.
