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I. Introduction
Might surgery to treat impotence be necessary? Why or why not?
Additional treatments men with diabetes might want to consider include intracavernous injection therapy, vacuum constriction devices, intraurethral therapy, and sex therapy.
Received 19 December 2005
The experimental drug bremelanotide (formerly PT-141) does not act on the vascular system like the former compounds but allegedly increases sexual desire and drive in males as well as females. It is applied as a nasal spray. Bremelanotide allegedly works by activating melanocortin receptors in the brain. It is currently in Phase IIb trials.
The table below lists homeopathic treatments for specific symptoms of erectile dysfunction (ED). Also included in the table are personal characteristics that may be demonstrated by the individual afflicted with ED.
It is always wise to notify your physician of any homeopathic remedies or other complementary or alternative medicine you may use. Some remedies can interfere or interact with prescription drugs or other allopathic treatments.
These drugs are included in a family of medications called phosphodiesterase type 5 (PDE-5) inhibitors.
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The end result: The couple can stop communicating altogether -- not only in the bedroom, but in all aspects of their relationship. And that, say experts, can only make problems worse for both partners.
ED is a very common condition, particularly in older men. It is estimated that half of all men between 40 and 70 years of age will experience ED at least once.
Nutritional Supplements: nutritional supplements including the amino acid arginine, bioflavonoids, zinc, Vitamin C, Vitamin E, and flaxseed meal have been used to improve erectile function. In addition, certain ED patients with low levels of the hormone dehydroepiandrosterone (DHEA) showed improvement in erectile function after receiving supplemental doses of DHEA. However, because the long-term safety of DHEA is not known, most experts do not recommend its use.
Some common side effects of birth control pills are nausea, headaches, acne, increased blood pressure, breast tenderness, bloating, weight gain and depression. However, not every woman who takes the pill will have side effects. You may have to try several types of birth control pills before you find the type that is best for you. The pill may reduce cramping and shorten the number of days of bleeding during the menstrual period. The pill may also help premenstrual syndrome (PMS). Women who take the pill should not smoke.
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Diabetes mellitus also causes erectile dysfunction by damaging both sensory and autonomic nerves, a condition called diabetic neuropathy. Smoking cigarettes, obesity, poor control of blood glucose levels, and having diabetes mellitus for a long time further increases the risk of erectile dysfunction in diabetes. In addition to atherosclerosis and/or neuropathy causing ED in diabetes, many diabetic men develop a myopathy (muscle disease) as their cause of ED in which the compliance of the muscle in the corpora cavernosa is decreased and clinically this presents as an inability to maintain the erection. For additional information, please read the Diabetes article.
Vasoactive drugs may also be injected intracavernosally. Such therapy represents an important second-line therapy for erectile dysfunction. It is the most effective pharmacologic treatment but has a high dropout rate because of the associated pain and apprehension involved. Phentolamine is an -blocker that was used in initial studies; its efficacy is poor, but it may be used in combination with other agents. Papaverine is a nonspecific PDE inhibitor and was the first effective intracavernosal therapy for erectile dysfunction. Currently, intracavernosal alprostadil therapy is preferred; it is more effective than other agents and produces fewer side effects. In a comparison study comparing alprostadil, a papaverine–phentolamine combination and papaverine alone, rates of success (ability to achieve and maintain an erection) of 72%, 61% and 31% were reported respectively.54 No patients in the alprostadil group experienced priapism, as compared with 2% and 4% of patients in the combination therapy and papaverine-only groups respectively. On the other hand, patients who used alprostadil were the only ones to report penile pain. For patients who do not respond to or do not tolerate alprostadil monotherapy, a triple mixture of papaverine, phentolamine and alprostadil may be prescribed. Such combination therapy has been shown to be more effective and, because of a lower dose of alprostadil, results in less pain.62 Complications of intracavernosal injections include pain, priapism and fibrotic changes at injection sites.
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