Means and methods for treating erectile dysfunction

Erectile dysfunction is symptomatic.

The goal of ED treatment is to restore an erection sufficient for full sexual intercourse.

Therapy for ED includes drug treatment orally (tablets) or intracavernous injections, as well as surgical treatment.

Therapy for ED has changed significantly over the past decades:

1970s: psychosexual therapy and penile prosthesis (penis prosthesis)

1980s: revascularisations, vacuum constrictor devices and intracavernous drug administration

1990s: transurethral administration and oral drug administration

1998: The introduction of the first phosphodiesterase type 5 inhibitor (PDE-5) to the market revolutionized the treatment of ED.

The main advantage of all drugs in this group: effectiveness in all forms of ED and good tolerability. PDE-5 inhibitors are used on demand for a certain time before sexual intercourse, and sexual stimulation is necessary for the onset of the effect. Doses are selected individually.

During sexual stimulation, when a man is aroused, nerve impulses are transmitted from the brain to the penis

There is a special enzyme, phosphodiesterase type 5 PDE-5, that breaks down chemicals that allow muscles to relax. This causes the muscles of the penis to contract again, resulting in reduced blood flow and the penis returning to a flaccid state.

PDE inhibitors - 5 blocks the enzyme, thereby contributing to the relaxation of the smooth muscles of the cavernous bodies, blood flow to the penis and erection.

The first PDE inhibitor is the 5th most studied medicinal substance, showing the greatest effectiveness in the treatment of patients with ED among the molecules of the PDE-5 inhibitor group. Can be used at a dose of 25-100 mg one hour before the intended sexual contact. The maximum plasma concentration on an empty stomach of the drug is reached 30-120 minutes after administration. The effect lasts for 4 hours. At the same time, the effect of the drug begins after 14 minutes.

The most widely used group of drugs for the treatment of ED, PDE-5 inhibitors, are prescribed in 96% of cases, and A-blockers, sedatives, androgens, adaptogens, and others are used in 4% of cases.

2 2nd line therapy: If oral medications fail, intracavernous injections of vasoactive drugs may be used. The advantages of the method include high efficiency, ease of use, low risk of developing priapism (prolonged, usually painful erection that is not associated with sexual arousal), minimal side effects and systemic manifestations, rare relative contraindications. Disadvantages: invasiveness of injection, pain at the injection site, the patient's fear of an injection into the penis, the possibility of developing ecchymosis.

Also, in some cases, intraurethral administration of drugs (alprostadil) is used.

3rd line therapy includes penile prosthetics.