Options for Treating Impotence (Besides Viagra)!

Diagram showing nine tendons and median nerve passing thru canal formed on the underside of the wrist by the wrist bones and the carpal tunnel ligament With about 30 million US men affected by erectile dysfunction (ED), Viagra became wildly popular after hitting the market in 1998. Cialis and Levitra, drugs in the same family, followed soon after. But, like all prescription medications, it can cause some undesirable side effects and isn't appropriate for everyone.

Fortunately, there are some other options for treating ED.

Drug Substitutions

Viagra and its relatives, Cialis and Levitra, are not an option for everyone. Certain medications, including some high blood pressure medications, are thought to contribute to ED. When that is the case, a change in medication treatments (usually with drugs not known to have effects on sexual function) may offer a simple and effective alternative. When lifestyle change fails, prescribed medications are not the cause, and Viagra-like drugs are contraindicated or otherwise undesirable, then the treatments discussed below may become important.

Injection Therapy

Some medical treatments, like injection therapy, which existed when Viagra was released, are still being used.

"Once men get used to injections at the base of the penis, they love it," says Steven Lamm, MD, assistant professor of medicine at New York University and author of The Virility Solution . "It's felt as a tiny bee sting because the shot is put into a relatively insensitive part of the organ with a very fine needle."

The medication injected into the penis is alprostadil, which increases penile blood flow. It's known by the trade names Caverject and Edex. These injections can be used by most men who can't take Viagra-like drugs, but treatment cannot be used safely by men who use blood thinners. On the medical horizon in the United States is Invicorp, another intracavernous injection that treats moderate to severe ED and has been approved for use in some European countries. Inserted Medication MUSE is a pre-filled, single-use, plastic applicator containing a suppository of the drug alprostadil, which is also given by direct injection into the penis. You insert the medication into the urethra opening at the end of the penis and let it dissolve. A topical cream containing the same medication is in development. MUSE is effective in men with diabetes, but because it opens blood vessels, it does not work well in those with severely compromised circulation to the penis. Men with significant nerve damage also do not respond well to this medication. Vacuum Devices There is also a vacuum pump that draws blood into the penis and engorges it. A band is placed at the base of the penis to prevent blood from flowing out again. These devices are cumbersome but can be effective. They are best tolerated by people with a moderate degree of ED, in comparison to mild or severe dysfunction. At least one study suggests that a sizeable proportion of men who get comparable benefit from vacuum devices and Viagra prefer to continue with the devices rather than the medication.
Oral Medication Many men over the age of 60 have relatively low testosterone levels. While hormone replacement therapy for such men remains controversial because the risk/benefit balance has not been adequately defined, testosterone might improve ED in some men. Testosterone is thought to be primarily effective in improving sexual desire or libido, but it may also have other beneficial effects on ED. The combination of testosterone and Viagra may be more effective than Viagra alone under some clinical circumstances. For now, men should probably receive testosterone replacement only under the care of an endocrinologist. Other drugs may have some positive effect on ED as well. When giving smokers the drug bupropion hydrochloride (Wellbutrin) to help them quit, researchers found that the smokers experienced enhanced libido. So some men who have other reasons to take bupropion (ie, smoking cessation, depression) may choose to take that drug in the hopes of improving libido and possibly erectile dysfunction as well. There is as yet no solid medical evidence establishing the effectiveness of bupropion in treating ED. Yohimbine despite its popularity as an aphrodisiac has been primarily used for patients with apparent psychogenic erectile dysfunction. Treatment is limited by occurrence of side effects including dizziness, flushing, nausea, and headache.
Penile Implants For more serious cases of ED, surgical implants are available. Some of these devices add permanent stiffness to the penis, while others have an inflatable balloon, which allows men to produce an erection mechanically. While the promotion of Viagra has perhaps led to decreased interest in surgical implant procedures, at least one study suggests that, in relatively long term follow-up, the results from surgery are better than those from drugs (including Viagra). These results should, however, be interpreted with caution because they have not been widely confirmed. Also, men should be warned that once they have the devices implanted, they might never again be able to independently have an erection because the implants can damage the erectile tissue. Surgery For men with damaged blood vessels, surgery can be performed to bypass blocked arteries to the penis, or tie off leaky veins that allow blood to escape from the penis during an erection. Drugs on the Horizon Another drug, apomorphine hydrochloride, which showed initially some promise, recently has done rather poorly in a clinical trial and has been largely found to be ineffective. Another medication, a topical form of alprostadil, called Topiglan, is still under investigation.
RESOURCES: Urology HealthyAmerican Urological Association http://www.impotence.org CANADIAN RESOURCES: BC Health Guidehttp://www.bchealthguide.org/ Health Canadahttp://www.hc-sc.gc.ca/index_e.html References Montague, DK, Jarow, JP, Broderick, GA, et al. Chapter 1: The management of erectile dysfunction: an AUA update. J Urol 2005; 174:230. Porst, H, Padma-Nathan, H, Giuliano, F, Anglin, G. Efficacy of tadalafil for the treatment of erectile dysfunction at 24 and 36 hours after dosing: a randomized controlled trial. Urology 2003; 62:121. Rajpurkar A, Dhabuwala CB. Comparison of satisfaction rates and erectile function in patients treated with sildenafil, intracavernous prostaglandin E1, and penile implant surgery for erectile dysfunction in urology practice. J Urol. 2003;170:159-163. Chen J, Mabjeesh NJ, Greenstein A. Sildenafil versus the vacuum erection device: patient preference. J of Urol. 2001;166:1779-1781. Last reviewed March 2008 by Marcin Chwistek, MD Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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