Impotence Health Article

Allopathic treatment

Years ago, the standard treatment for impotence was a penile implant or long-term psychotherapy. Although physical causes are now more readily diagnosed and treated, individual or marital counseling is still an effective treatment for impotence when emotional factors play a role. Fortunately, other approaches are now available to treat the physical causes of impotence.

The most common treatment today is with the prescription drug sildenafil citrate, sold under the brand name Viagra. An estimated 20 million prescriptions for the pill have been filled since it was approved by the FDA in March 1998. It is also the most effective treatment, with a success rate of more than 60%. The drug boosts levels of a substance called cyclic GMP, which is responsible for widening the blood vessels of the penis. In clinical studies, Viagra produced headaches in 16% of men who took it, and other side effects included flushing, indigestion, and stuffy nose.

The primary drawback to Viagra, which works about an hour after it is taken, is that the FDA cautions men with heart disease or low blood pressure to be thoroughly examined by a physician before obtaining a prescription. At least 130 men have died while taking Viagra. Shortly after use of the drug skyrocketed, concerns were expressed over cardiovascular effects from Viagra. However, studies reported in 2002 that sildenafil had no effect on cardiac symptoms in older men who used it. Instead, cardiac events reported with use of Viagra are more likely the result of the physical demands of sexual activity in patients using the drug who were already at higher risk for cardiovascular disease.

In the summer of 2002, two investigational drugs were announced to become available in the near future to also treat erectile dysfunction. Vardenafil and tadalafil both helped men who also had such conditions as diabetes, high blood pressure and benign prostatic hypertrophy. The drugs are awaiting final FDA approval.

Vardenafil and tadalafil belong to the same group of chemical compounds as sildenafil, namely phosphodiesterase type 5 (PDE-5) inhibitors. Some men cannot benefit from sildenafil or the two newer PDE-5 inhibitors because they have low levels of nitric oxide. British investigators reported in late 2002 that three different types of compounds are being studied as possible medications for men with low levels of nitric oxide. They are Rho-kinase inhibitors, soluble guanylate cyclase activators, and nitric oxide-releasing PDE-5 inhibitors.

Other medications under investigation as treatments for impotence are topical agents. Topical means that they are applied externally to the skin rather than being injected or taken by mouth. If approved, these drugs would provide a noninvasive alternative for men who cannot take sildenafil or other oral medications for impotence.

Other traditional therapies for impotence include vacuum pump therapy, injection therapy involving injecting a substance into the penis to enhance blood flow, and a penile implantation device. In rare cases, if narrowed or diseased veins are responsible for impotence, surgeons may reroute the blood flow into the corpus cavernosa or remove leaking vessels.

A newer approach to the treatment of erectile dysfunction is gene therapy. As of late 2002, several preclinical studies have shown promise, but none of the gene-based strategies so far have yet been tested for safety.

Expected results

With proper diagnosis, impotence can nearly always be treated or coped with successfully. Unfortunately, fewer than 10% of impotent men seek treatment.

Prevention

There is no specific treatment to prevent impotence. Perhaps the most important measure is to maintain general good health and avoid atherosclerosis by exercising regularly, controlling weight, controlling hypertension and high cholesterol levels, and not smoking. Avoiding excessive alcohol intake may also help.

BOOKS

"Erectile Dysfunction." Section 17, Chapter 220 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.

Miller, Lucinda G., and Wallace J. Murray, eds. Herbal Medicinals: A Clinician's Guide. Binghamton, N.Y.: Haworth Press, 1999.

Pelletier, Kenneth R., MD. The Best Alternative Medicine, Part II, "CAM Therapies for Specific Conditions: Impotence." New York: Simon & Schuster, 2002.

Robbers, James E., and Varro E. Tyler. Tyler's Herbs of Choice: The Therapeutic Use of Phytomedicinals. Binghamton, N.Y.: Haworth Press, 1998.

Ryan, George. Reclaiming Male Sexuality: A Guide to Potency, Vitality, and Prowess. New York: M. Evans and Co., 1997.