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Treatment strategies and effect on sexual behavior
Although efficacy and safety are two important characteristics when choosing a pharmacological treatment for ED, the ideal therapy should be reliable during maintenance. Furthermore, beyond erection and penetration, intercourse success and overall satisfaction needs have to be considered. The primary goal in the treatment of ED should be the restoration of sexual life rather than […]
The clinical evidence: safety of tadalafil in ED
Most of the side effects reported in the clinical trials are dose-dependent and consistent with the vasodilatatory effect of PDE-5 inhibition. When tadalafil (Cialis) was administered on an on-demand basis headache and dyspepsia were the most frequent symptoms, followed by back pain, nasal congestion, myalgia, and flushing. Subgroup analyses have revealed no differences between incidences […]
The clinical evidence: efficacy of tadalafil in ED
The most important outcome for an ED therapy is the patient’s perception of success. When patients with ED experience a successful intercourse after treatment, they feel cured of their problem. Furthermore, they express the desire of unplanned, unpremeditated or spontaneous sexual intercourse. In this sense, one possible use of the self-administered questionnaire International Index of […]
A clinical pharmacological approach to the effective and safe use of tadalafil
The mechanism of action leading to penile erection involves inhibition of PDE5, the major cyclic guanosine monophospate (cGMP) hydrolyzing enzyme located in the vascular smooth muscle cells of corpus cavernosum. Sexual stimulation triggers the release of the endothelium dependent relaxing factor nitric oxide (NO), stimulating through the protein kinase G the release of guanylyl cyclase […]
Medical treatment of erectile dysfunction: Other treatments
ORAL AGENTS Trazodone The antidepressant trazodone was noted to occasionally induce priapism and therefore interest developed in its possible role in treatment of erectile dysfunction. There are reports of good erectogenic activity with trazodone, although no significant benefit was found in a placebo-controlled trial. There are also troublesome side-effects, including drowsiness, orthostatic hypotension, nausea and […]
External vacuum devices
For patients with erectile dysfunction who cannot tolerate or do not respond to intracavernosal injections, there is a choice between a penile prosthesis or a vacuum device. A vacuum device works by creating penile congestion and enough rigidity to allow penetration (figure l). There are no comparative controlled studies and most of the questionnaire reviews […]
Testosterone replacement and supplementation
Testosterone can be given orally, by injection or implant, and now by a transdermal route (patch). Oral administration of testosterone is an unreliable route for increasing testosterone levels and injections or implants, both invasive techniques, are needed to sustain increased levels. The testosterone patch is a convenient and noninvasive method of obtaining controlled and sustained […]