Impotence Treatment

Goals of Treatment

• Treat the underlying condition that is causing impotence
• Restore sexual intimacy to allow sexual arousal
• Correct treatable impotence
• Provide medical enhancements for non-treatable impotence

Medication Treatments for Impotence

1. Oral Medications sildenafil-Viagra, Revatio, tadalafil- Cialis, vardanefil- Levitra)
2. Penile suppository alprostadil-Muse
3. Injections alprostadil-Caverject, Edex

Oral Medications

A group of medications known as Phosphodiesterase Type 5 Inhibitors (PDE5) have revolutionized the treatment of impotence. The reported success rate of these medications falls between 50 -75%. Effective sexual stimulation and mental sexual arousal are still necessary for these medications to work. Sexual stimulation activates the release of nitric oxide, a neurotransmitter that leads to the release of a chemical (cGMP) that causes the arteries and veins in the penis to relax and fill with blood. Viagra, Cialis and Levitra work by keeping the cGMP active. As long as the smooth muscle of the blood vessels are partially healthy, these medications can work, even when impotence is as a result of psychological causes such as stress or anxiety or in some cases of nerve damage.

The three medications, from this group, that are currently on the market include:

• Viagra- sildenafil
• Cialis-tadalafil
• Levitra-vardanefil

Who can use these medications?

All of these medications have been used effectively for impotence in people:

• who are elderly
• with diabetes
• with hypertension
• with cardiac disease (when patients do not require nitrates)
• with spina bifida
• with spinal cord injuries
• who suffer from depression (with or without medications causing impotence)
• who receive chronic dialysis
• who have had prostate surgery (in those situations where the nerves have been spared)

Who should not use these medications?

Viagra, Cialis and Levitra should not be used by patients:

• who are on nitrates
• who have experienced priapism (abnormal or painful erections), have risk factors for priapism
• who experience symptoms associated with hypotension, have a blood pressure under 90/50, or who must avoid medications that can lower blood pressure.
• who have a resting blood pressure greater than 170/110
• who have had a myocardial infarction within the past six months
• patients taking indinavir, ritonavir, ketoconazole, or itraconazole

Is there much difference between these medications?

In terms of effectiveness there appears to be little difference between these medications. Viagra usually begins to work within 30 minutes and works for up to 4 hours. Cialis usually begins to work within 30 minutes and may be effective for up to 36 hours. Levitra may begin to work as early as 15 minutes and work for up to 5 to 5 hours.

How should these medications be taken?

These medications can be taken with or without food and should not be taken more than once daily. They are most effective when taken at least 25 to 30 minutes before intercourse, although with Levitra, sexual activity may begin within 15 minutes of taking a dose.