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Sildenafil is available as oral tablets at doses of 25, 50, and 100 mg. It should be taken approximately one hour before sexual activity. In some men, the onset of action of the drug may be as early as 11-20 minutes. Sildenafil should be taken on an empty stomach for best results since absorption and effectiveness of sildenafil can be diminished if it is taken shortly after a meal, particularly a meal that is high in fat.
The development of future medical options will emphasize the restoration of physiologic function. A better understanding of the molecular biology of ED will allow the development of new classes of agents. Research involving gene therapy is beginning to show promise.
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A psychosocial examination using an interview and questionnaire may reveal psychological factors contributing to erectile dysfunction. The sexual partner also may be interviewed to determine expectations and perceptions encountered during sexual intercourse.
The medication, in addition to its use as a popular treatment for impotence, has already been approved by the U.S. Food and Drug Administration for the treatment of the chronic version of such blood pressure spikes, known as pulmonary arterial hypertension (PAH). The drug has been marketed specifically for this purpose under the trade name Revatio. Another drug -- bosentan -- is also approved for similar purposes.
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Psychological causes: stress, mental disorders (clinical depression, schizophrenia, substance abuse, panic disorder, generalized anxiety disorder, personality disorders or traits.), psychological problems, negative feelings.
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Alprostadil, PGE1, has been formulated into a small suppository that can be inserted into the urethra. In a selected group of men, the agent was effective in 65%. This agent may be effective in men with vascular disease, diabetes, and status post prostate surgery. This is a useful agent for men who do not want to use self-injections or for men in whom oral medications have failed. It has been successfully used together with sildenafil in cases in which each agent alone failed. Few adverse effects occur, and the most common is a painful erection and urethral burning, which occurs in less than 10% of the patients.
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The history should include the frequency and duration of symptoms, the presence or absence of morning erections and the quality of the relationship with the sexual partner. The sudden onset of erectile dysfunction in association with normal morning erections or a poor relationship suggests psychogenic impotence.4
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In the past, the placement of prosthetic devices within the corpora was the only effective therapy for men with organic ED. Now, this is the last option considered, even though more than 90% of men with an implant would recommend the procedure to their friends and relatives.
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