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The most important component of diagnosing erectile dysfunction is obtaining a complete medical and sexual history. It is important to distinguish the condition from other sexual dysfunctions, such as premature ejaculation and loss of libido. Several formalized sexual questionnaires, such as the IIEF (Internation Index of Erectile Function) and EDITS (Erectile Dysfunction Inventory of Treatment Satisfaction), allow one to detect the presence and grade the severity of erectile dysfunction. The complete IIEF is composed of 15 questions; an abridged 5-item version, called the sexual health inventory for men (SHIM), has been developed and validated.29 Allowing a patient to complete such a questionnaire before his first clinical encounter may produce a more comfortable clinical environment.30 The duration of the problem, time of onset and degree of patient and partner concern should also be elucidated. The circumstances surrounding erectile dysfunction may be helpful in determining whether a situational or nonorganic factor is involved. Sudden onset, maintenance of nocturnal erections, presence of psychological problems and concurrent major life events or relationship issues may be associated with nonorganic erectile dysfunction.31 Concurrent medical illnesses and any medications the patient may be taking should be reviewed. Erectile dysfunction is often a component of generalized medical illness and may represent the initial presentation of cardiovascular disease or diabetes. The history may also reveal certain reversible or modifiable risk factors, such as tobacco use or inadequate diabetes control.
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Medical Treatment Oral Medication Oral medications used to treat erectile dysfunction include selective enzyme inhibitors (e.g., sildenafil [Viagra], vardenafil HCl [Levitra], tadalafil [Cialis]) and yohimbine (Yohimbine, Yocon).
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The experimental drug bremelanotide (formerly PT-141) does not act on the vascular system like the former compounds but allegedly increases sexual desire and drive in males as well as females. It is applied as a nasal spray. Bremelanotide allegedly works by activating melanocortin receptors in the brain. It is currently in Phase IIb trials.
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"A lot of men don't have physicians," Thompson explained. "They may not know what their blood pressure is or their lipid profiles, or they may be smokers, and they may never have been counseled to stop smoking or to reduce their weight.
Vardenafil was evaluated in four multicenter, randomized, placebo-controlled trials involving more than 2400 men (78% white, 7% black, 2% Asian, 3% Hispanic) with erectile dysfunction. Two of these trials were conducted in special erectile dysfunction populations; one in men with diabetes mellitus, another in men who developed erectile dysfunction after prostate surgery. The doses of vardenafil in the four studies were 5 mg, 10 mg, and 20 mg.
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The effects of Viagra will last, on-average, for up to 4 hours and its metabolites are excreted in the feces and urine. Viagras effect is to inhibit an enzyme known as phosphodiesterase type-5 (PDE5), which naturally occurs in erectile tissue. PDE5 can break down cyclic GMP, the substance that is produced during sexual arousal and causes vascular and muscular changes that eventual lead to an erection. (2)
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An erection begins in the brain. Physical and/or mental stimulation cause nerves in the brain to send chemical messages to nerves in the penis telling the penile blood vessels to relax so that blood can flow freely into the penis. Once in the penis, high pressure traps the blood within both corpora cavernosa to sustain an erection. This causes the penis to expand, creating an erection.
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"This is very exciting -- the researchers have been working on this for a long time in a variety of different organs. It's not yet clinically available, but if it works and proves safe and effective, it would be a tremendous advance," said Dr. Ira Sharlip, a spokesman for the American Urological Association and a clinical professor of urology at the University of California, San Francisco.
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Depression and anxiety: Psychological factors may be responsible for erectile dysfunction. These factors include stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure. For more information, please visit the Depression Center.
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