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Impotence/Erectile Dysfunction (cont.)

Types of Medical Therapy

Types of Medical Therapy Available to Manage Erectile Dysfunction
Medication Advantages Disadvantages
Hormonal (testosterone) therapy No surgery required
Painless
Simple
May restore sexual desire
If unsuccessful, does not interfere with other treatments
Patches and gel now available
Inexpensive (injections)
Useful only in the few men with abnormal hormone levels
Need to take medications regularly
Significant side effects (such as fluid retention, liver damage)
Limited effectiveness
Highly variable blood levels when injections used
Absorption may be unreliable with patches and gels
Expensive (patches and gel)
Sildenafil (Viagra) Safe
No surgery required
Painless
May use treatment only when desired
Easily hidden and transportable
If unsuccessful, does not interfere with other treatments
Can be used in combination with other therapies under proper supervision
Maximum use is once per day
Benefit lasts 4-6 hours or up to 24 hours in some cases
FDA approved
Side effects, if present, usually quite mild
Very effective with overall success rate of 65-70%
Inexpensive
Frequent side effects (40%) include headache, indigestion, facial flushing, nasal stuffiness and rarely visual changes (temporary blue tint)
Potentially lethal interaction when used together with nitrate medications such as nitroglycerine, Imdur, Isordil
Risk of an interaction is present for 24 hours after taking sildenafil
Must be taken on an empty stomach
Maximum effect takes 45-60 minutes
Does not "cure" underlying problem
No effect on libido (desire) or sensation
Vasodilators (nitroglycerine) Safe
No surgery required
Painless
May use treatment only when desired
If unsuccessful, does not interfere with other treatments
Inexpensive
Condom use required
No reports on long-term use
Possibly common side effects (headaches)
Lack of scientific studies on effectiveness
Very high failure rate
Very limited effectiveness
Very dangerous if used with sildenafil (Viagra)
No longer in general clinical use for ED
Yohimbine (Yocon) Safe
No surgery required
Painless
Side effects uncommon
May increase sexual desire
If unsuccessful, does not interfere with other treatments
20-25% success rate
Inexpensive
May be of some use in combination with sildenafil (Viagra)
Need to take medication every day
No reports on long-term use
Side effects, including nervousness, headache, dizziness, and nausea
75-80% failure rate
Limited effectiveness
Trental (Pentoxifylline) Safe
No surgery required
Painless
Side effects uncommon
If unsuccessful, does not interfere with other treatments
50% success rate in selected patients
Inexpensive
Need to take medication every day
No reports on long-term use
Side effects, including headache, dizziness, and stomach upset
May only help with marginal penile blood
50% failure rate
Trazodone (Desyrel) Safe
No surgery required
Painless
Side effects uncommon
May improve success and reduce side effects of yohimbine
If unsuccessful, does not interfere with other treatments
25% estimated success rate
Inexpensive
Need to take medication every day
No reports proving benefit
No reports on long-term use
Side effects, including lethargy and drowsiness
Optimal dosage unknown
75% failure rate
Limited effectiveness
Priapism
Penile injection therapy No surgery required
Usually painless
May use treatment only when desired
Newer medications may reduce risks
Easily hidden and transportable
Refrigeration not required
If unsuccessful, does not interfere with other treatments
70-75% success rate
Highly effective
Inexpensive
Can be used in combination with other treatments such as sildenafil (Viagra)
Requires injections directly into the penis
Risk of infection, bruises, pain, and permanent scarring inside the penis
Possible painful permanent erection (priapism)
No completely acceptable medication currently available
Optimal combination of drugs not known
Lacks formal FDA approval (except for prostaglandin [Caverject, Edex])
May not be covered by some insurance companies
Usually not effective in men with blood flow problems or vascular disease
Most effective form (Trimix) not covered by most insurance plans and may be quite expensive
Cannot be used by patients on MAOIs* or blood thinners
Intraurethral pellet therapy (MUSE) No surgery required
Painless
May use treatment only when desired
Easily hidden and transportable
If unsuccessful, does not interfere with other treatments
Maximum usage up to 2 times per day
No needles, injections, or scarring
Approved by FDA
45% success rate
Reasonably effective
Inexpensive
45-65% success rate
Can be part of a combination therapy plan if properly supervised
Pellet must be inserted directly into penis through urethral opening
Requires refrigeration
Mild occasional burning or discomfort (experienced by about one third of uses)
Possible priapism (rare <1%)
Can cause mild dizziness, faintness, or low blood pressure
Only 4 dosages are available
May require a tension ring or penile tourniquet for best results
External vacuum therapy Safe
No surgery required
Painless
May use treatment only when desired
May improve natural erections in some users
If unsuccessful, does not interfere with other treatments
75-85% success rate
Highly effective
Inexpensive
Requires some manual dexterity and strength
Not easily hidden
Somewhat bulky to transport
Removing tension ring within 30 minutes recommended
Tension ring necessary to maintain erection
Possibly uncomfortable ejaculation
May need to interrupt foreplay
Proper tension ring size crucial for best results
Requires practice

*Monoamine oxidase inhibitors

Medically Reviewed by a Doctor on 3/6/2014
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