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Impotence (Erectile Dysfunction)
What are the recent Trends in the treatment of
Impotency?
The treatment for impotence starts from non-invasive to most invasive
- To reduce or cut down the doses of harmful drugs.
- To Clear Myths and Misconceptions.
- To impart correct Sex - Knowledge.
- Psychotherapy and behavior modification.
- Oral Drugs:
- Yohimbine, Testosterone, Sildenafid (Viagra) etc .
- Non-Invasive Procedures:
- External Vaccum Device.
- Trans Urethral Suppositories.
- Hormone Replacement Therapy.
- Intrapenile Cavernosal Injection Therapy.
- Penile Implants (Prosthesis).
- Surgery for Vascular Corrections.
Oral Drugs
Yohimbine:
It is obtained from the bark of the Yohimbehe tree. It's side effects may be
headache, excessive sweating , dizziness, nausea etc.
Testosterone:
An acute deficiency of male hormone, testosterone can cause impotence. The hormone
should be replaced up to acceptable levels for effectiveness.
Sildenafil (Viagra):
It may enhances the erection by regulating vasodilatations in the penis but
it neither cure impotence, nor increases libido.
Sidenafil is a known Phosphodiesterase5 (PDE5) inhibitor. By
inhibiting the PDE5 enzyme, which is present mainly into the penis, Sildenafil
allow the chemical produced during sexual stimulation, cyclic GMP, to persist.
The longer cyclic GMP persists, the better chance for increased blood flow and
hence an erection.
One suffering from Diabetes, High blood pressure, Cardiac problems,
Sickle Cell Anemia, Bleeding Disorders, Multiple Myeloma, Gasteric Ulcers etc.
should not take Sildenafil without medical supervision.
Newer drugs under research:
- VASOMAX
- TAP
- Oral Phentolamine
External Vaccum Device:
The External Vaccum Device with one or more rubber tension bands are used for
the treatment. When the penis is not erect, it is placed in the vaccum chamber
and then pump to produce an erection. Once the erection is achieved, the rubber
tension band is slipped around the base of the penis as a result the outflow
of blood from penis is stopped and penis remains engorged and hence erection.
Band should not be kept around penis for more than 30 minutes to prevent
the permanent damage to the penis.
Trans Urethral Suppository:
MUSE is a non - injectable delivery system for alprostadil, for the treatment
of impotence. After Urination, a small applicator tip is inserted just over
an inch in to the Urethra. A dose of Alprostadil, in the form of a suppository,
is delivered by applicator. The drug is absorbed through the Urethral Wall i.e.,(Urethra
Mucosa) As a result, relaxation of smooth muscles of penis occurs resulting
in increased Penile blood inflow and thus rigidity. The action of the drug (MUSE)
begins in 5- 10 minutes.
Hormone Replacement Therapy:
Impotence may also occur with the disturbance in the levels of hormones like
Testosterone, Prolactin and Estrogen. This can be treated by replacing the hormone
under strict medical supervision.
Intra Penile Cavernosal Injection Therapy:
This therapy produces a firm erection within few minutes and last for a longer
time. Person can himself inject the medicine before play. It is almost painless.Several
drugs are available which if injected directly in to the Corpora Cavernosa of
the penis, would produce an erection with in a few minutes. The first drug used
was Papavarine, secondly Phentolamine, an alpha blocker and later on Prostaglandin
E1 as an additive.
Advantages:
Intrapenile Cavernosal injections have the advantages of getting long lasting
erection on demand. Also the erection may prolong even after ejaculation or
Orgasm.
Side Effects:
Pain, Priapism etc. Priapism is a condition in which one gets an unwanted,
prolonged , painful erection. It is an medical emergency.
Penile Prosthesis:
This is the surgical placement of movable or stationary device in to the penis.
One can bring the erection at desirable time. There are three varieties of implants
available but advised to the patient only after trying other treatment.
- Semirigid rods.
- Self - Contained mechanical.
- Self-Contained inflatable.
With a prostheses in place, a man can bring an erection on demand.
The erection is rigid enough for sexual intercourse. The man will have natural
sensation on skin and will have a normal and natural orgasm. But remember, once
a Prostheses is implanted, it is not possible for a patient to change his mind
and choose another treatment option. Removal of Prostheses also requires another
operation. Failure of device may also occur. Another complication may be post
surgical infection. So one should choose Penile Prostheses as last choice.
Surgery for Vascular Corrections:
This is indicated in patients with Vascular blockages and blood flow problems
caused by injuries to the Pelvic area.
Counselling by a trained Sex - Therapist and Counsellor:
Counselling plays a major role in the treatment of Impotence. Because usually
the impotence may be the combination of psychological and physical factors both.
This helps patients by reducing anxiety and depression.
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