Nonsurgical Treatment for Impotence
Sex Therapy & ED
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 & ED
Oral Medication to Treat ED
Oral medications used to treat erectile dysfunction include selective enzyme inhibitors (phosphodiesterase type 5 [PDE5] inhibitors; e.g., sildenafil [Viagra®], vardenafil HCl [Levitra®], tadalafil [Cialis®]) and yohimbine (Yohimbine®, Yocon®). In April 2012, the U.S. Food and Drug Administration (FDA) approved the PDE5 inhibitor avanafil (Stendra®) to treat ED.
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 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 sexual activity. Results vary depending on the cause of 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, 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.
Stendra® is taken as needed 30 minutes before sexual activity. It is available in 50 mg, 100 mg and 200 mg doses. Physicians should prescribe the lowest dosage that provides benefit. It should not be used in men who take nitrates for angina.
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.
In October 2007, the Food and Drug Administration (FDA) approved important changes to the drug labeling information for these medications. Selective enzyme inhibitors may be associated with a potential risk for sudden hearing or vision loss, which may be accompanied by ringing in the ears (tinnitus) and dizziness (vertigo). Patients who experience sudden hearing loss in one or both ears or changes in vision while taking these medications for ED should stop taking the drug and contact a health care provider.
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.