Nearly every day on every channel commercials for medications aiding erectile dysfunction (ED) are aired during the dinner hour. There are several treatment options available. Some will be explored here.
Erectile dysfunction affects about 8% of the male population in the United States, with an increased percentage as men age. Organic causes are varied, and include vascular issues (cardiovascular disease, hypertension), diabetes, neurological (spinal cord injury, multiple sclerosis, Parkinson’s disease), as well as behavior related causes (alcohol or drug use, frequent bicycle riding, sedentary lifestyle). Another prevalent cause of ED can be types of medications that are taken which have known side effects affecting erections.
Some of the common medications that may be associated with erectile dysfunction are:
- Antihistamines such as Benadryl
- H2 agonists such as Cimetadine
- Pain medications such as opioids as well as NSAIDS (Ibuprofen)
- Antihypertensives such as thiazide diuretics (hydrochlorothiazide) and beta blockers (Atenolol)
- Antifungals such as ketoconazole
Treatment options:
Review of medications
A very important part of the overall assessment is to review current medications. Many, as identified above, may be responsible for this side effect. At times, merely changing the medications may resolve the problem.
Could there be low testosterone?
Low testosterone may be an indication for testosterone replacement therapy. Replacement may improve libido in men, however, there has been insufficient evidence that replacement improves erections or quality of the sexual intercourse.
Alternative options:
One potentially beneficial supplement currently under study is L-citrulline. In a small study patients who took L-citrulline (1.5 g/d in divided doses) reported increased satisfaction in their sexual functioning. No adverse effects were reported.
Other options include prosthetic implants, vacuum erection devices, and vascular surgery.
PDE-5 Inhibitors
These are the medications that are commonly prescribed for ED in men. All three, sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra), have demonstrated improvement in maintaining erections. No one drug has been found to be better than the other. These drugs require sexual stimulation to work and should be taken approximately 1 hour prior to sexual activity. Side effects may include headache, flushing, myalgia, back pain, and visual difficulties. All of these medications are contraindicated in men who are taking long-acting nitrates or nitroglycerin.
ED is now openly discussed. Understand the many treatment options are available to help with this very personal issue.
References:
- Qaseem A, Snow V, Denberg TD, et al. Hormonal testing and pharmacologic treatment of erectile dysfunction: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2009, 15 (9):630-649.
- Carmio L, De Siati M, Lorusso F. et al. Oral L-citrulline supplementation improves erection hardness in men with mild erectile dysfunction. Urology. 2011, 77(1):119-122.
- Fink HA, MacDonald R, Rutks IR, et al. Sildenafil for male erectile dysfunction: a systematic review and meta-analysis. Arch intern Med. 2002, 16(12):1349-1360.
- Raheem AA, Kell P. Patient preference and satisfaction in erectile dysfunction therapy: a comparison of the three phosphodiesterase-5 inhibitors sildenafil, vardenafil, and tadalafil. Patient Prefer Adherence. 2009;3:99-104.
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
Rosemary King - Stay well; stay healthy; stay focused.
