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Medication to Treat SEXUAL DYSFUNCTION By SafetyPills.com
“Keep that Spark Alive” • As per reliable data, about 30-40% of world population suffers from Sexual Dysfunction • It becomes prevalent with age. • Normally, medical treatment of male sexual dysfunction is given more significance than female.
Sexual Dysfunction in MEN Major sexual problems in men include • Erectile Dysfunction (ED): An inability to acquire or maintain an erection satisfactory for sexual intercourse. • Diminished Libido: Lack of interest in sexual activity. • Premature / Delayed or Inhibited Ejaculation • Most prevalent disorder is erectile dysfunction. As per estimates, approximately three-hundred and twenty two million men world wide suffer from be affected by erectile dysfunction.
What is Erectile Dysfunction Erectile dysfunction (ED) or impotence is sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual activity. A penile erection is the hydraulic effect of blood entering and being retained in sponge-like bodies within the penis. The process is often initiated as a result of sexual arousal, when signals are transmitted from the brain to nerves in the penis. The most important organic causes are cardiovascular disease and diabetes, neurological problems (for example, trauma from prostatectomy surgery), hormonal insufficiencies (hypogonadism) and drug side effects.
What Causes of ED? • Drugs (anti-depressants (SSRIs) and nicotine are most common) • Neurogenic disorders • Cavernosal disorders (Peyronie's disease) • Performance anxiety, stress, mental disorders,psychological problems, negative feelings • Surgery • Aging • Kidney failure • Smoking • Diseases such as diabetes and multiple sclerosis (MS). While these two causes have not been proven they're likely suspects as they cause issues with both the blood flow and nervous systems
Factors that cause the onset of Erectile Dysfunction • Psychological causes include, but are not limited to: fatigue, stress, performance anxiety, poor self image or lack of communication with sexual partner/s. • Major Depressive Disorder (MDD) also has a strong correlation with sexual dysfunction in men and women. • Physical causes include: Urological, Vascular, neural, Endocrine (hypogonadism or Hyperprolactinaemia), Iatrogenic, Pelvic trauma or dietary.
Diagnosis for Erectile Dysfunction • Duplex ultrasound • Penile nerves function • Nocturnal penile tumescence (NPT) • Penile biothesiometry • Dynamic infusion cavernosometry (DICC) • Corpus cavernosometry • Magnetic resonance angiography (MRA)
Treatment for Erectile Dysfunction • Treatment depends on the cause • Exercise, particularly aerobic exercise during midlife is an effective for preventing ED • Oral medication - Phosphodiesterase type 5 inhibitors • Topical medication -Alprostadil • Injected medication - Papaverine, Phentolamine, and Prostaglandin E1 • Pumps • Surgery • Alternative medicine
PDE5 Inhibitors: Sildenafil, Tadalafil, Vardenafil • Men who have erectile dysfunction often produce insufficient amounts of NO. So although they are producing a small amount of cGMP, it is being broken down at the same rate, so they cannot maintain an erection. Viagra, Tadalafil, and Vardenafil work by selectively inhibiting PDE5, by binding with PDE5's active site. This prevents the hydrolysis of cGMP to inactive GMP, allowing cGMP to accumulate and prolong the vasodilation effect, resulting in a stronger and longer erection. • All 3 drugs work regardless of the cause of ED, but all require sexual stimulation for activation.
Sildenafil(VIAGRA) • Viagra is the most popular of the PDE5 inhibitors. It is estimated that it has worked for 20 million men worldwide. It is administered in 25, 50 and 100mg doses. • Taken 1 hour before sexual intercourse • Maximum dose is once daily • Window of opportunity: 30 minutes to 4-5 hrs. • But can be effective for up to 12 hrs. • Side effects, such as: headache, facial flushing, dyspepsia, dizziness, rhinitis and abnormal vision.
Tadalafil (Cialis) • Administered orally in 10mg and 20mg doses • Instructed to take Tadalafil two hours before sexual intercourse • Its efficacy is maintained for at least 36 hours • The maximum dosing frequency is once every other day • Improved erections were reported by 82.8% of treated men. Thirty-six hours after administration of Tadalafil, 59.2% of intercourse attempts were successful. • Side effects: headache, flushing, rhinitis and back pain/myalagia. • Safety concern: it also serves as an inhibitor of PDE11, an enzyme in the testes, so there is concern on the effect that it has one sperm and spermatogenesis
Vardenafil(Levitra) • Higher in vitro potency, more rapid binding to PDE5, and slower dissociation from this enzyme than Sildenafil and Tadalafil. • Administered orally on demand in 5, 10 and 20mg doses • Maximum dose administration frequency is once daily. • There is a window of opportunity from 30 minutes to 4-5 hours after administration. But, the earliest time to onset of action leading to successful intercourse can be just 10 minutes! • 75% of intercourse attempts were successful for patients using vardenafil compare with the 40% success in the placebo group • Treatment with vardenafil in patients with erectile dysfunction that were previously unresponsive to sildenafil produced significant improvements in erectile function domain score and maintenance of an erection. • Side effects: headache, flushing and rhinitis
Sildenafil, Vardenafil, Tadalafil... Which one is the best? • They all are all PDE5 inhibitors with the same mechanism of action and similar adverse effects. • They all require sexual stimulation as a prerequisite and are effective regardless of the cause of erectile dysfunction. • Viagra has been around the longest and thus has the benefit of having long-term safety data. It also has the highest use and lowest discontinuity of the three drugs. However, Viagra is also administered in higher doses than the others. • Tadalafil has the longest period of onset (2 hours) and lasts up to 36 hours, whereas as sildenafil is effective up to 12 hours and vardenafil is only effective 4-5 hours after administration. • Vardenafil, however, is the most potent (lowest maximal concentration) and binds to PDE5 more rapidly than the others, thus it has a potential time of onset of 10 minutes.
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