Modern treatment of erectile dysfunction is a comprehensive process. It includes anisotropic therapy (aimed at eliminating the cause of the disorder) and nootropic or pathogenetic therapy (aimed at the functional activity of the structures involved in the process of erection). Main principles of therapy are based on the recommendations of the European Urologic Association developed in 2007. They include sequential therapy of erectile dysfunction with three lines of execution of basic therapeutic interventions. The backbone of sequential therapy is that after the diagnostics, the first stage of the treatment begins. If there is no required effect, then specialists pass to the execution of the second line, and then, if necessary – to the third line.
The first line of erectile dysfunction treatment includes the use of oral drugs relating to the category of selective PDE-5 inhibitors. The mechanism of action of these drugs is based on the increasing of nitrogen oxide in the cavernous body of the penis, which causes relaxing of blood vessels walls and blood inflow to the penis.
There are several imperative conditions of PDE-5 inhibitors efficiency, including the following:
• Normal libido of the man (sex drive towards women).
• Sufficient testosterone level in the blood of the man (some andrologists add hormone replacement therapy on this stage, if testosterone level is not high enough).
• Sexual stimulation during accumulating of the active agent of the drug in the blood (usually sexual stimulation gives the best effect in 15-20 minutes after the taking of the drug).
One of the most progressive drugs of this category is Cialis – oral pills with long-lasting effect up to 36 hours and minimum side effects. The most frequent negative effects include a headache and dizziness.
If the treatment with oral drugs doesn’t give the desired effect, a doctor can prescribe treatment relating to the second stage of therapy, which includes intracavernous and intraurethral injections of vasoactive agents. This supposes administration of medication right into the cavernous body of the penis. The effectiveness of such treatment is about 70%. Medications for intracavernous injections include papaverine, phentolamine, and prostaglandins. All the drugs in this category have a favorable effect on the state of cavernous body, stimulating blood inflow and, as a result, erection of the penis. This method has some downsides, though – the procedure is painful enough and erection is often uncontrolled and doesn’t depend on sexual stimulation.
If both stages haven’t brought any results, the third line of therapy may be prescribed. It includes surgical repair of arteries of the penis. Such operative treatment is usually more effective in younger men with local occlusion (perfusion of one or more arteries of the penis). For older men suffering from the arterial sclerotic disease, the need for surgical interference is questionable, and positive effect doesn’t last long. This is why older men are commonly prescribed only oral pills for symptomatic treatment.