How common is impotence?
Erectile dysfunction (ED) is more common than one thinks.
Around 40% of men over 40 years are afflicted and the number increases with age.
Why it is important to seek medical attention if you experience impotence?
There is so much that can be done to alleviate the weight that a men carries and restore a good quality of sexual life.
One has to remember that penile erection is largely a vascular process. Seeking medical help is a must as erectile problems can reflect that the heart, which is the main pump of the body may be showing a red flag. Erectile dysfunction precedes heart disease, stroke, and peripheral vascular (arterial) disease by an average of 3 years.
Prostate cancer needs to be excluded as well as this could be a sign of presentation.
What happens during the consultation?
A detailed history will be taken, and a clinical examination will be performed.
A set of bloods will be ordered this typically includes a full blood count, kidney and liver function, hormonal profile (testosterone/ prolactin/ thyroid/ leutenising hormone/follicle stimulating hormone), PSA, lipid profile and sugar levels are checked.
What is the first line of treatment for impotence?
Lifestyle changes are key, one must lose weight, exercise, eat healthy, stop smoking, and decrease the alcohol intake. These all impact on the circulation and are the essential building blocks to construct a plan.
Can there be a psychological impact that impairs good erections?
Psychological influence is importantPsychotherapy or counselling are treatment options that could be explored.
What oral medication as erectile dysfunction treatment are available?
The above lifestyle changes are combined with oral treatment medications called phosphodiesterase inhibitors in short referred as PDE5i
What types of PDE5 inhibitors are available on the market?
The four major types of PDE5 inhibitors available include:
- Sildanefil (Viagra)
- Tadalafil (Cialis)
- Verdanefil (Levitra or Staxyn)
- Avanfil (Stendra)
Without sexual arousal PDE5 inhibitors, don’t work.
Sildenafil (Viagra)
The fist tablet on the market and was FDA-approved in 1998 under the name Viagra. Usually it starts working within an hour and lasts about 4 hours but in some men it can last as long as 12 hours. The dosage is 25mg or 50mg or 100 mg per day.
Common side effects include: headaches, flushing, indigestion, nasal congestion, flu like symptoms, vision issues.
Tadalafil (Cialis)
Available since 2003. It usually takes effect within 20 minutes and should be taken at least half an hour before intercourse with its effect lasting anything from 24 to 36 hours (in view of this it has been named weekend pill).
A typical daily dose varies from about 2.5 to 20 mg.
Common side effects include: headaches, flushing, indigestion, nasal congestion, flu like symptoms, vision issues, back pain and muscle pain.
Vardenafil (Levitra or Staxyn)
Available since 2003. It has the shortest onset of action as it takes effect within 10 minutes and lasts for 5 to 7 hours. A typical dose of vardenafil is 5 to 20 mg per day.
Common side effects include: headaches, flushing, indigestion, nasal congestion, flu like symptoms.
Avanafil (Stendra)
Available since 2012. If does take 30 to 45 minutes to take effect and usually lasts up to 5 hours. The dosage 50 to 200 mg per day.
Common side effects include: headaches, flushing, indigestion, nasal congestion, flu like symptoms.
How do oral medications for impotence work?
PDE5 inhibitors help the blood vessels to relax and increase blood flow by increasing the availability of nitric oxide.
Is there any food or fluid that affects the treatment?
Tadalafil may be taken with fatty foods without disrupting its absorption.
Are there any medications which interact with the oral PDE5i?
Any simultaneous use of organic nitrates, including sublingual nitroglycerin, amyl nitrite, and isosorbide mononitrate or dinitrate, is contraindicated.
Nitroglycerin must be withheld at least 24 hours following the last dose of sildenafil or vardenafil, 48 hours following that of tadalafil, and 12 hours following that of avanafil.
Are there any medical conditions which limit the use of PDE5i?
All PDE5i should not be given if
1) Heart attack, stroke, or life-threatening irregular beating of heart in the last 6 months;
2) resting blood pressure is very low <90/50 mmHg or very high (BP >170/100 mmHg);
3) uncontrolled angina or severe chronic heart failure
Are there foods that contain PDE5 inhibitors?
The horny goat weed – Epimedium; a flowering plant native to Eastern Asia.
The chemical icariin is found in the leaves that may increase nitric oxide production in the penis, and have a number of possible benefits for erection problems. Studies still need to be done.
The black (Thai) ginger - Kaempferia parviflora, possible moderate benefit but further studies need to be done.
Tribulus terrestris a leafy plant that grows in Europe, Asia, and Africa and Malculra pomifera (osage orange) may have PDE5-inhibiting effects. Studies are much needed to prove if there is a role.
Men who have their prostate removed are prescribed oral PDE5i. Why?
Men who are planned for robotic prostatectomy, unless there is a contraindication, should start on oral PDE5i daily two weeks prior to surgery and continue post surgery. This is as per NICE guidelines. The upkeeping of nitric oxide aides may play a role in earlier recovery for those that underwent robotic surgery.
What alternatives to oral medications for impotence exist?
- Vacuum therapy
- Vitaros Cream
- Penile Injections
- Penile Prosthesis
