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Modern drug therapy for ED made a significant advance in 1983 when British physiologist Giles Brindley, Ph.D. dropped his trousers and demonstrated to a shocked American Urological Association audience his phentolamine-induced erection. The drug Brindley injected into his penis was a non-specific vasodilator, an alpha-blocking agent, and the mechanism of action was clearly corporal smooth muscle relaxation. The effect that Brindley discovered established the fundamentals for the later development of specific, safe, orally-effective drug therapies.
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During these trials, the side effects noted have been mild urethral pain, a feeling of urethral burning, penile fullness and redness at the application site. Most of the adverse events were mild and transient and all naturally resolved in a short time, without requiring any medical treatment.
Erectile dysfunction (ED, "male impotence") is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis sufficient for satisfactory sexual performance.
Venous leak: If the veins in the penis cannot prevent blood from leaving the penis during an erection, an erection cannot be maintained. This is known as a venous leak, and can be a result of injury or disease.
Problems in your relationship with your sexual partner can also cause erectile dysfunction. Improving your relationship may help your sex life. If you decide to seek therapy, it will probably be most effective if your sex partner is included. Couples can learn new ways to please one another and to show affection. This can reduce anxiety about having erections.
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In addition to using a behavioral method, you may want to try thought distractions. For example, while you’re being sexually stimulated, think about the names of players on your favorite sports team.
Drinking too much alcohol, smoking too much and abusing drugs can also cause erectile dysfunction.
The researchers also reviewed the results of studies on erectile dysfunction in men with chronic heart failure. They noted that erectile dysfunction may arise from reduced blood flow to the penis, and that certain drugs used to treat chronic heart failure might actually exacerbate this problem.
A number of specialized investigations exist for the evaluation of erectile dysfunction but need not be part of the routine evaluation. The penile brachial index involves measuring penile pressure and comparing it with arm pressure. It has limited clinical utility because the data are based on superficial and deep penile arterial pressure, whereas erectile function depends on the deep arteries exclusively. Duplex ultrasonography allows for refined assessment of the penile circulation. The information it provides, however, is operator dependent and rarely alters patient management. Selective pudendal arteriography combined with intracavernous injection of a vasoactive drug should be limited to the small group of patients who are candidates for penile revascularization surgery. These patients include nonsmoking men less than 40 years old with a history of pelvic trauma who have sustained a penile arterial disruption.30
That's one argument doctors may bring up if drug companies ever lobby to make erectile dysfunction drugs available over the counter. Impotence isn't a problem that exists in a vacuum; and although the drugs to treat it appear to be safe for most men, doctors believe they need to keep a close eye on those who are taking them.
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There were 99 deaths in this group of patients between October 2001 and December 2002. Heart attack claimed the lives of 27 patients, while heart disease accounted for nine deaths and lung cancer for five deaths. In 21 cases, the cause of death could not be established by the researchers.
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