Treatment of Erectile Dysfunction (ED) varies widely based on cause, severity, patient health status, and individual choice. This section details the major approaches to ED treatment and their characteristics.
HIRO CLINIC’s recommended prescription
Improvement of lifestyle habits Basics.
In many cases of ED, underlying lifestyle and health problems are associated. Therefore, the following lifestyle modifications are recommended:
- Quit Smoking:
Smoking narrows blood vessels and impedes blood flow throughout the body. Smoking cessation can improve blood flow and decrease the risk of ED (erectile dysfunction). - Moderate exercise:
Regular exercise promotes cardiovascular health and smoking cessation. Aerobic exercise, in particular, improves blood flow throughout the body and contributes to improved sexual function. - Healthy Eating:
A balanced diet, including a Mediterranean diet that supports cardiovascular health, is recommended. This includes an abundance of vegetables, whole grains, fish, and fruits, which reduce risk factors for ED (erectile dysfunction) such as heart disease and diabetes. - Weight management:
Obesity increases the risk of ED. Proper weight management normalizes testosterone levels and decreases the risk of ED (erectile dysfunction).
Drug therapy Inexpensive and effective.
Various types of medications are used to treat ED (erectile dysfunction).
PDE5 inhibitors:
PDE5 inhibitor mechanism of action
PDE5 inhibitors aid erection by suppressing the action of the enzyme phosphodiesterase 5 (PDE5 ).Normally, when sexual arousal occurs, blood vessels in the penis dilate and blood flow increases, resulting in an erection. This process involves the secretion of nitric oxide (NO), which produces a substance called cyclic GMP (cGMP), which causes the blood vessels to dilate.
PDE5 is an enzyme that degrades cGMP and works to inhibit erection; PDE5 inhibitors block the action of this enzyme, thereby increasing the concentration of cGMP, promoting vasodilation, and increasing blood flow to the penis.
As a result, erection is promoted when sexually stimulated, leading to improvement of erectile dysfunction (ED).
Common Cautions for PDE5 Inhibitors
Sexual stimulation is required: PDE5 inhibitors are not effective without sexual stimulation. Taking the drug alone does not stimulate an erection; the effect is produced by the addition of sexual arousal.
Side effects: Common side effects include headache, facial burning, nasal congestion, and visual disturbances. These side effects are often temporary, but if you are concerned, consult your doctor.
Be careful with concomitant medications: If you are using nitrate (a drug used to treat heart disease), taking a PDE5 inhibitor is contraindicated because of the risk of a sudden drop in blood pressure. Always consult your physician.
Sildenafil (Viagra)
Characteristics: Sildenafil was the first of the PDE5 inhibitors and was approved in 1998. Effects appear 30 minutes to an hour after taking the drug and last approximately 4 to 6 hours.
Usage: Usually taken approximately one hour prior to sexual activity, it is effective. It is easily affected by food, especially oily food, which may delay absorption and decrease its effectiveness.
Advantages: Immediate and short-lasting effects, making it easy to use in a planned manner.
Cautions: It has a short duration and must be timed for sexual activity. It is also most effective when taken on an empty stomach, as it is affected by food.
Tadalafil (Cialis)
Characteristics: Tadalafil has the longest duration of any PDE5 inhibitor, with effects lasting up to 36 hours. For this reason, it is sometimes referred to as a “weekend drug. It takes effect within one to two hours after administration and is long-acting.
Usage: Take a few hours before sexual activity or take a low dose of tadalafil daily to promote a natural erection without worrying about timing.
Advantages: It can be taken regardless of food, as it is largely unaffected by food. Also, because of its long-lasting effect, it is not necessary to worry much about the timing of sexual activity.
Note: While it has a longer duration, it may take a little longer to show its effects than sildenafil or vardenafil. It may not be suitable for those who want immediate effects after taking the drug.
Vardenafil (Levitra)
Characteristics: Vardenafil, like sildenafil, takes effect about 30 minutes to an hour after administration, and the duration of effect is about 4-6 hours. Because it is more potent than sildenafil, even a small dose is sufficient.
Usage: It is most effective when taken one hour before sexual activity and on an empty stomach. The effect of food is not as great as that of sildenafil, so a small amount of food will maintain the effect.
Advantages: It has the same immediate effect as sildenafil, but is less affected by meals, so it can be taken after a meal and still be effective. It is also characterized by its powerful effects.
Note: It tends to be more expensive than sildenafil. Also, if you have a pre-existing condition, such as heart disease, you should consult with your physician before taking it.
Testosterone replacement therapy:
When hormone levels are low, testosterone replacement is considered. This can take the form of gels, patches, or injections.
Alprostadil:
This drug is injected directly into the corpus Cavernosum of the penis or inserted into the urethra to stimulate an erection.
Mechanical devices. Not strongly recommended.
- Penile Pump:
Penile pumps apply vacuum pressure to the penis to draw blood and promote an erection. After erection, a ring is placed around the base of the penis to prevent blood from flowing out and maintaining the erection. - Penile Implants:
In cases of severe ED, surgery to insert artificial rods into the penis may be an option. This allows the patient to achieve an erection whenever needed.
Psychotherapy Consult with a psychotherapist.
ED is often also caused by psychological factors. Resolving sexual anxiety and communication problems with partners through psychotherapy, including couples therapy and cognitive behavioral therapy, is recommended.
Comprehensive Treatment Approach.
Often, these treatments are combined. For example, the success rate of ED treatment can be increased by basing it on lifestyle modifications, using pharmacotherapy and mechanical devices as needed, and adding psychological support.
Because ED is a multifaceted problem, it is important to develop a customized treatment plan tailored to the needs of the individual patient. A thorough consultation with a physician is necessary before treatment is initiated.
