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Hard facts about erectile dysfunction

December 08, 2016 | Faysal A. Yafi, MD
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The development of effective drugs for erectile dysfunction did more than enhance the sexual relationships of untold numbers of couples. It also brought what had previously been a largely taboo subject out into the open.

As an andrologist — a specialist in men’s sexual, reproductive and urinary health — I’m glad to see men feeling more comfortable talking about and seeking help for sexual issues. These are discussions I welcome with patients I see at the UCI Health Center for Urological Care.

The existing drugs for erectile dysfunction (ED) work very well for most men. The main difference among them is how long they last and under what conditions they should be taken.

Viagra and more

The best known of them is, of course, the little blue pill, Viagra, which was the first oral medication for ED, approved for that use in 1998.

Its discovery was a lucky accident: Researchers were examining a certain drug as a possible remedy for high blood pressure, and found that by dilating blood vessels, it increased blood flow to the penis, creating an erection. This particular medication should be taken 30 minutes to an hour before intercourse.

But now there are other medications on the market, all in the same class of drugs but each with its own advantages and disadvantages.

One is known as the “weekend drug” because it is effective for up to 36 hours, but it also can cause muscle pain in some men. Another works slightly faster, within 15 to 30 minutes after taking it. With all of these drugs, though, the man has to be sexually aroused for them to work.

What about ED drug side effects?

Some men have concerns about reported side effects:

  • As mentioned in ads, there is a possibility of sustained erection that can become painful or even damaging. But sustained erections are also rare and are almost always caused by patients who decide to take more than their prescribed dose.
  • Sudden blindness or loss of vision has occurred a few dozen times among the tens of millions of men worldwide who take ED drugs, and even then it’s not known whether all of those cases were caused by the medication. The risk is considered extremely small.

No melanoma risk

Another worry I hear from patients is that Viagra will increase their chances of melanoma, a deadly skin disease, or cause heart attacks. The melanoma fear arose after a study found slightly elevated rates of the disease in men taking the drug, but later trials never replicated that finding.

Other studies refuted these findings by demonstrating that men who take Viagra are more likely to have other factors that predispose them toward melanoma, such as lighter skin complexion and higher socio-economic status with higher sun exposure.

One study indicated that men who had had prostate cancer might be at higher risk of relapse if they took ED medications, but other studies came up with different findings, and a history of prostate cancer is not considered a reason to avoid the pills at this point.

There is also no evidence that these drugs cause any cardiac problems. However, ED medications aren’t safe for men who take nitrate drugs for chest pain because the drug can cause a precipitous drop in blood pressure.

Also, the medications don’t work well in diabetics because of the vascular problems associated with that disease.

Alternatives to ED medications

Though most men find help through these oral medications, they aren’t effective for a significant minority – up to about 40 percent.

At that point, men should consult a specialist in men’s sexual health. The answer doesn’t lie in multiplying the prescribed dose, but in diagnosing other factors that might be impeding the drugs’ effectiveness:

  • Sometimes, it’s just a matter of modifying some habits. For example, eating a fatty meal before taking the pills will make some of these drugs less effective.
  • Testing patients for possible low testosterone levels is often helpful. Testosterone replacement therapy can improve their response to medication.
  • In the relatively few cases when none of this works, a penile vascular study can pinpoint the cause of the problem and help determine the best treatment.

There are other options, including injections of a medication to dilate the blood vessels, and a vacuum suction device than can be used to create an erection. In addition, patients might have a choice of two different kinds of penile prostheses that can be surgically implanted.

The bottom line is that men don’t need to feel embarrassed or hopeless about erectile dysfunction. Oral ED medications — properly prescribed and used — have been a major factor helping them realize that.

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