For many men, there’s nothing more stressful than dealing with erectile dysfunction (ED), which affects over 150 million men globally. This number may reach 320 million by 2025. It’s a problem that plagues men all over the world and is far more common than most people think.
But what is ED exactly and what type of ED therapies exist out there? To summarize, it’s a sexual dysfunction, somewhat akin to premature ejaculation. However, with ED, men find it difficult to gain or keep an erection long enough to have satisfying sex.
If you’re struggling with ED, understand that you’re not alone and there are options out there for treatment. Arm yourself with the information below, and you’ll see that there’s very little to worry about. ED is very treatable, and you can still enjoy a fulfilling life. Read on to learn more.
A Little Background
Just like other organ systems, the endocrine system loses function because of aging. Testosterone production suffers as a result, leading to reduced blood supply to the penis. This makes it difficult for the patient to get or sustain an erection as he did in his youth.
While the production decline is not life-threatening, it can impact his relationship with his partner. In addition, ED can be a symptom of a larger, undiagnosed condition, such as diabetes, high cholesterol or coronary artery disease (CAD).
ED may be accompanied by other forms of sexual dysfunction like low libido or premature ejaculation. These are all linked to the decline in testosterone production. Men usually experience sporadic episodes of ED, with the instances increasing as they get older.
Pre-existing conditions like diabetes, cardiovascular disease (CVD), hypertension and mental health issues like stress, depression, and anxiety worsen ED in middle-aged and older men.
Hypertension and CVD make blood vessels harder and narrower, reducing blood circulation. Diabetes can affect both nerves and vessels supplying blood to the penis. Diabetic men, therefore, experience ED 10-15 years earlier than non-diabetic men.
History of ED Treatments
Early civilizations in Ancient China and later Mesopotamia and Ancient Egypt describe different potions to curb ED.
In modern medicine, an implantable inflatable prosthesis was studied in 1973, and it’s still in use today.
The most significant breakthrough, however, was the approval of sildenafil citrate in 1998, an oral drug that improves blood flow to the penis. In 2003, similar phosphodiesterase-5 (PDE-5) inhibitors got approved, namely Vardenafil and Tadalafil. These are available under five brand names: Viagra, Levitra, Staxyn, Stendra, and Cialis.
The major problem these drugs have had is the long waiting period before taking effect. Additionally, food and alcohol reduce the bioavailability and hence efficacy of the treatment.
Emerging Treatments and Therapies for ED
Scientists are now focused on offering treatments that work faster and more effectively with fewer or no side effects. Apart from oral drugs, therapies like gene therapy, topical creams, hormone replacement, and shock therapy are being researched.
Scientists have been testing new medications for ED. Here a few you need to know:
Uprima (apomorphine) is a tablet that dissolves under the tongue. It works by stimulating the production of dopamine, which increases sexual sensations and enjoyment.
However, it can cause some nausea and vomiting, and some users have passed out after use. US distribution of Uprima is on hold to allow for further studies, but it is available in Europe. A nasal spray, which causes less nausea is still in the clinical trial phase.
2. Melanocortin Activators
These drugs work differently from the PDE-5 inhibitors above. They are ideal for patients who have mild ED as a result of psychological rather than physical causes.
This is because melanocortin activators work on the central nervous system (CNS), primarily the brain. Patients administer them through the nose. Animal studies have shown that erections result while initial human trials show nasal administration to be the most effective route.
More studies are necessary to demonstrate the overall efficacy and safety of the drugs before they are available in the market.
3. Topical Cream – Topiglan
Topiglan has the active ingredient is Alprostadil or prostaglandin E1 (PGE1), and it is still under investigation pending FDA approval. Alprostadil is mixed with a chemical that increases absorption through the skin. This causes blood to rush into the penis, causing an erection.
Researchers have shown that Topiglan works even where other drugs have not been successful. In addition, because it is topical and applied locally, there are fewer precautions and side effects.
Drug interactions are also reduced because the action is localized around the genitals. This means that you can take your food, alcohol or other medication without worrying about reducing the efficacy of Topiglan.
Topiglan works almost immediately after application, which is great for encouraging spontaneity in sexual relations.
However, Topiglan will not increase sex drive if that’s also a problem. Some people have noticed itching and redness because of allergies. Also, you need to use it sparingly because it can lead to sustained erections which can be painful.
Testosterone Replacement Therapy (TRT)
If you have ED as a result of inadequate testosterone production, TRT may be the right solution for you.
Men’s bodies gradually reduce testosterone levels from the age of 30 years till death. However, some events can cause a decline in production. These include:
- Infection, injury or removal of one or both testicles
- Radiotherapy or chemotherapy to treat cancer
- Too much iron in the body (hemochromatosis)
- Genetic abnormality (e.g. Klinefelter Syndrome – carrying an extra X chromosome)
- Pituitary gland or hypothalamus dysfunction
- Many chronic or inflammatory illnesses – liver, kidney, autoimmune diseases, obesity
- Psychological issues
Low testosterone levels can cause a decline in muscle mass, high cholesterol, mild anemia, osteoporosis (fragile bones) and alopecia (hair loss) among others.
If suspected, your doctor will test your testosterone levels at different times of the day. If low, you may start using TRT. There are various methods of administration; the right one depends on what your body needs.
While generally safe, TRT is not recommended if you have breast or prostate cancer (or a high risk of developing them). Also, undiagnosed severe apnea, severe UTI and untreated heart conditions are contraindicated for TRT. The doctor will recommend PSA tests and rectal exam to rule out prostate cancer risk before starting this therapy.
Some side effects include acne, some fluid retention, breast enlargement, high risk of clotting, worsening of sleep apnea, shrinking testicles, mood swings, and aggression. TRT may also increase the risk of getting strokes or heart attacks. You should not use it if you have had blood clotting and are on blood thinners.
Gene therapy is one of the newer treatments for ED still in its early stages of research. The idea is to deliver genes to produce the necessary proteins and other molecules to ensure proper penile tissue function. Patients can get the gene through self-injections to the base of the penis.
Animal studies have shown some improvements in erectile function after gene therapy. Human studies are currently underway, but researchers are hopeful that the results will be positive.
The advantage of gene therapy is that it merely supplies a missing gene instead of introducing foreign chemicals that could have more side effects. Therefore, the user’s body will now function as it would have in normal cases.
Gene therapy can also address the problem of oral drugs that may cause sustained erections. cGMP, which the gene produces to stimulate protein production, has a very short half-life and breaks down quickly.
The first GT study was published in 2004, and since then there have been over 30 studies and two clinical trials. However, because of ethical concerns around gene therapy and stem cell research, it may take time before approval.
Low-Intensity Shockwave Therapy
The final emerging therapy is low-intensity shockwave therapy (LIST). Before research into ED, doctors used LIST in kidney stone patients, to stimulate them to dissolve. They also used it to produce new blood vessels to help to heal in heart disease patients.
Recently, scientists noted that LIST applied to the penis helps to create new vessels and increase blood flow into the organ.
It was first tried in Israel in 2010 on men with vascular ED (caused by poor blood flow rather than nerve damage). They had two treatments a week for three weeks, then took three weeks off before repeating the treatments.
One month after the conclusion of the studies, all men in the study had some improvement. The treatment lasted six months with no side effects. A larger group with worse ED (older men) also showed good results – 72 percent had erections firm enough for vaginal penetration.
All therapies discussed above predate approval of Viagra in 1998; LIST is the only one that scientists have developed since. Because of this, LIST is still an experimental treatment, and it’s not widely available. But many other studies have offered positive results.
We can expect approval in the not-too-distant future.
New ED Therapy – Final Thoughts
The curtain around erectile dysfunction is now being torn, and you can see that there are many options for treatment depending on your needs. If you think you might have ED, talk to your urologist or GP to help you determine the underlying cause and advise treatment.
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