Page 28 - CNM_AUGUST_13TH_2012._Neat

CNM | HEALTH
der the influence of nerve impulses, become dilat- use of oral medications known as phosphodiester-
ed, allowing more blood flow in the penis and also ase-5 inhibitors (PDE-5) Inhibitors such as silde-
trapping blood in the penis, once the penis is fully nafil citrate (Viagra) , vardenafil HCl ( Levitra) or
erect. The trapping of blood in the penis increases tadalafil (Cialis) . Men with ED should take these
the length, width, and temperature of the penis. pills 30 minutes to one hour, before beginning
sexual activity . While the effect of Viagra and
The Role of the male Sex Hormone : Levitra can last 4 to 8 hours, that of Cialis can last
Testosterone up to 36 hours. This does not mean that the erection
will last the previously mentioned hours but rather
the patient is likely to achieve an erection within
There are several risk factors for the development
of ED. As men age, the level of circulating testos- this time, “window period”, if sexually stimulated.
terone decreases, which may interfere with normal The drugs are not aphrodisiacs but merely agents
erection. While a low testosterone level itself is which boost the natural nerve signals that are gen-
rarely the cause of ED (5 percent or less), low tes- erated during sexual activity , thereby improving
tosterone can be an additional contributing factor and prolonging the erection itself. Unlike popular
in many men who have other risk factors for ED. believe,these medications are safe and fairly ef-
Low levels of sexual desire, lack of energy, mood fective, with improvement in erection in nearly 80
disturbances and depression can all be symptoms of percent of patients using these drugs. Early con-
low testosterone. A simple blood test can determine cerns about possible adverse effects on the heart
if the testosterone level is abnormally low, and tes- have not proven true; after extensive testing we
tosterone can be replaced using a number of differ- now know that PDE-5 inhibitors medications can
ent delivery systems (e.g., injections, skin patches, be used safely by virtually all heart patients except
those using medications called nitrates because of
Angelo E. Gousse M.D. and gels ) an interaction between these two classes of drugs.
Professor of Urology What Can cause Erectile Patients who have an extremely poor exercise tol-
Dysfunction: erance should be more carefully evaluated prior to
taking these agents.
The most common cause of the development of ED he side effects of PDE-5 inhibitors are mild
is the presence of medical conditions such as high and usually transient, decreasing in inten-
Erectile Dysfunction : blood pressure, diabetes mellitus, high cholesterol sity with continued use. The most com-
levels and cardiovascular disease. These medical Tmon side effects are headache, stuffy nose,
A treatable Condition. conditions, acting over time, can lead to a harden- flushing, heart burn,and muscle aches. In rare cases,
ing of the penile blood vessels, leading to restric-
sildenafil (Viagra) can cause blue-green shading of
tion of blood inflow through the blood vessels and vision due to high blood levels of sildenafil exert-
causing leakage of blood through the veins during ing a brief effect on the retina of the eye. This is of
Erectile Dysfunction erection. . Surgery or radiation therapy for prostate
Definition and , bladder, colon, or rectal cancer can also lead the no long-term risk and is gone within a short time as
the amount of sildenafil in the blood decreases. It is
Epidemiology: development of ED. Cryotherapy for prostate can- important to follow the instructions for using these
cer is highly associated with ED. medications in order to get the best results pssible.
Erectile dysfunction (ED) is a medical condi- Tests have shown that 40 percent of men who do
tion manifested by the inability to achieve and or Avoid Unhealthy Daily Habits: not respond to sildenafil will respond when they
maintain an erect penis adequate for satisfactory receive proper instruction on medication use. For
sexual function. This condition is the most com- Unhealthy daily habits can lead to degeneration instance ,sexual foreplay is important in initiating
mon sexual problem for men. The number of men of the erectile tissue and the development of ED. the effect of the agents . It is also important to avoid
suffering from ED increases steadily with age. It Cigarette smoking, illicit drug use or alcohol abuse, fatty meals when taking Viagra. The previously
is estimated that 25 million American men suffer particularly over a long period of time, will com- mentioned pills are not aphrodisiacs and will have
from ED, although not all men are equally affected promise the blood vessels of the penis. Lack of no positive effect if patients do not receive sexual
by the condition. While approximately 52% of men physical exercise and a sedentary lifestyle will con- stimuli. Furthermore, they will have no positive ef-
will suffer from some degree of ED by the age of tribute to the development of ED. Psychological fect on men who do not suffer from ED.
70, only 15% will have complete ED. stressors and psychogenic disorders can also cause
ED. Correction of these conditions will contribute Aprostadil Penile Injection (Caver-
to overall health and may help correct mild ED. ject) or Suppository (MUSE)
Medical treatment of many medical conditions can
interfere with normal erections. Prescription drugs For men who do not respond to oral medications
used to treat these risk factors listed above may also , other treatments are vailable. A drug called al-
lead to or worsen ED prostadil, is approved for use in men with ED. This
drug comes in two forms: injections that the patient
How is ED diagnosed? delivers directly into the side of the penis with a
tiny needle and a tiny suppository that the patient
For most patients, the diagnosis will require a inserts inside of the urethral canal. Success rates
simple medical history, physical examination and with self-injection can reach 85 percent. Modifying
a few routine blood tests ( blood sugar,cholesterol, alprostadil to allow transurethral delivery avoids
lipid profile, testosterone, ect ). Several validated the need for a shot, but reduces the effectiveness
questionnaires help the clinician verify and grade of the agent to 40 percent. The most common ad-
the severity of the diagnosis. Most patients do not verse effects of alprostadil use are a burning sensa-
require extensive testing before beginning treat- tion in the penis and the risk of over correcting the
ment. The choice of testing and treatment depends problem, resulting in a prolonged erection lasting
How Normal on the goals of the individual. If erection returns over four hours (priapism) and requiring medical
Erection Achieved. with simple treatment like oral medication and the intervention to reverse the erection. Other forms of
patient is satisfied, no further diagnosis and treat- penile injection such as Trimix ,not FDA approved,
A complex process involving psychological stim- ment are necessary. If the initial treatment response is occasionally prescribed. Some authors believe
ulus from the brain, adequate levels of the male is inadequate or the patient is not satisfied, then that Trimix is more frequently associated with un-
sex hormone called testosterone, a normal ner- further steps may be taken. In general, as more in- wanted and dangerous prolonged erections ( lasting
vous system, and healthy blood vessels in the penis vasive treatment options are chosen, testing may be more than 4 hours-priapism ). Trimix should only
chambers is required in order to achieve normal more complex. be used by experienced Urologists.
erections. In the soft (flaccid) state of the penis,
the blood vessels inside the 2 chambers of the pe- Oral Medications for Erection Vaccuum Erection Device:
nis (corpora) are contracted and blood flows easily (PDE-5 Inhibitors)
from the penis to the rest of the body. In the rigid For men who cannot or do not wish to use drug
state (erect) , the blood vessels in the chambers , un- The first line of treatment for uncomplicated ED is therapy, an external vacuum device may be accept-
28 CNM | CARIBBEANNETWORKMAGAZINE.COM