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Treatment of Erectile Dysfunction with Medications

Natural herbal remedies
There are a number of so-called ‘natural treatments’ claiming the ability to treat erectile dysfunction. However, there is limited scientific evidence to show that these treatments are effective. Some of these treatments can be extremely dangerous as there is no control over what ingredients they contain and in what quantities.

Prescription medicines for erectile dysfunction
The Phosphodiesterase Type 5 Inhibitors (PDE-5’s)
These drugs have provided a highly effective convenient treatment solution for most men with ED. After addressing the lifestyle factors and treating any relationship or psychological problems, they are usually the first treatment choice. They work by inhibiting or blocking an enzyme in the penis called phosphodiesterase type 5 (PDE-5). This results in increased levels of the chemical which causes increased blood flow into the penis. They restore normal sexual function which means that you won’t get an erection without sexual stimulation. This means that you will still need to be ‘turned on’ by touching, kissing and visual stimulation in order to get an erection. It also means that if you are experiencing relationship problems resulting in you not being turned on by your partner, then these drugs will not provide a magical solution.

How to take PDE-5 Inhibitors
Ensure that you obtain your medication from a reputable pharmacy or doctor as there are many fake products and counterfeits which should be avoided. Take the medicine according to your doctor’s instructions.

The time that they take to work and the length of time for which they work differs depending on which PDE-5 inhibitor your doctor has prescribed.

Tips for successful treatment with PDE-5s

1. Take your partner with you to your appointment so that they also have an understanding of the treatment. Getting your partner’s involvement and cooperation can improve your chances of success.
2. When taking the medication for the first time consider doing so without your partner as this will reduce the potential for “performance anxiety”.
3. Set aside enough time for sex. Make sure that you have enough time for an unhurried and relaxed sexual encounter. Ensure that there will be no interruptions from telephones, children etc.
4. Avoid a heavy meal and excessive alcohol intake before taking the medication as these can make you sluggish and impair sexual performance
5. Ensure that you have adequate sexual stimulation. It is important that your partner knows what ‘turns you on’ the most. Remember that as men get older they require more direct stimulation of the penis for a longer period of time in order to achieve an erection.
6. Foreplay. Spend time on foreplay before attempting to penetrate your partner.

These drugs will not always work the first time that you take them. It can take up to 8 separate attempts for them to be effective. If they have still not worked after a number of attempts you should see your doctor as you may require a higher dose or another type of treatment.

These drugs cannot be used by patients taking nitrates as the combination of the two drugs can cause a fatal drop in blood pressure.

Side effects of PDE-5s
The most common side effects that occur with the PDE-5 inhibitor drugs include
– Facial flushing
– Headaches
– Dizziness
– Indigestion
– A blocked nose

These side effects tend to be mild to moderate and usually only last for a few hours.
What if PDE-5s don’t work?

In order to maximize success with PDE-5 treatment you should ensure that you have done everything possible to enable the medications to work. This includes:

Trying the maximum dose of the drug
If you have been prescribed a PDE-5 and have tried it on at least 4 occasions without success you may require a higher dose. However, you also need to check the points below.

Giving the medication enough time to work
Once you have taken the medication it takes time to be absorbed by the body and reach the maximum levels (peak plasma levels). This can vary from person to person and with the different medications.

Adequate stimulation
Ensure that your partner is stimulating you in a way that provides you with the highest level of arousal.

Check if the medication that you are using is affected by food
Vardenafil and sildenafil work best when they have not been taken with fatty foods or on a full stomach. For optimal effect don’t eat for 2 hours before taking them.

Alcohol Intake
Avoid any alcohol intake on the day that you use the medication.

Smart D. The SASHA Guide to Erections and Erection Problems. © Ronin-Do (Pty) Ltd 2004.
Lissoos I. Know your manhood. KYB Pocket Books 1984.
Hackett G et al. British Society for Sexual Medicine Guidelines on the Management of Erectile Dysfunction. J Sex Med 2008; 5:1841–1865