Drugs for the treatment of erectile dysfunction

It is known that a number of such reasons include ^[1] :

• poor physical development or physical fatigue, ^[2]
• malnutrition, ^[3]

• Endocrine disorders
  • hypogonadism or insufficient testosterone
  • age-related changes like age-related androgen deficiency
  • dysfunction of the thyroid gland, hyperprolactinemia, hypercorticism, etc.
• damage to the pelvic nerves (for example, after removal of the prostate gland) ^[4]
• insufficient blood supply to the penis,
• psychological problems ^[5] .
• side effects of already taken medicines (for example, antihypertensives),
• lifestyle (excessive use of alcohol, drugs, smoking, persistent masturbation) ^{[6] [7]}

Drugs for the treatment of erectile dysfunction is not the only way used to solve this problem. Among these methods include the following:

• elimination of the cause of erectile dysfunction,
• exercise, especially aerobics ^[8]
• medical advice. When a psychological reason is suspected or not excluded in the inability to produce an erection, as well as to help cope with a depressed state, the need for medical advice is considered.
• household preparations and medications for the treatment of erectile dysfunction,
• vacuum treatment, ^[9]
• surgical methods ^[10] .

As you can see, at the first stages, when the reasons underlying the violation of the ability to have sexual intercourse due to the lack of hardening of the penis are eliminated, medications, as a rule, are not used. Rather, the underlying disease is treated and medical advice is given. Treatment with drugs.

The main group of drugs is phosphodiesterase 5 (PDE-5) inhibitors , one of the phosphodiesterases (PDE) of cyclic nucleotides that catalyze the hydrolysis of cAMP and cGMP nucleotides. PDEs exist in different molecular forms and are unevenly distributed throughout the body: for example, PDE-1 is found in the smooth muscle fibers of blood vessels, brain, heart, lungs, and PDE-6 in the retina. PDE-5 is found not only in the smooth muscle fibers of the cavernous bodies of the penis, but also in the lungs and gastrointestinal tract. When taking PDE-5 inhibitors, the action of the corresponding enzyme is blocked, which, in turn, leads to an increase in the amount of cyclic GMF and relaxation of smooth muscles in the arteries of the penis. The latter helps to fill the cavernous bodies of the penis with blood. Drugs of this group have an effect only when a man is sexually aroused, they do not lead to an erection in the absence of sexual arousal. Depending on the drug, the tablet is taken in 20 minutes. - 1 hour before the expected sexual intercourse. The drug can have an effect within 3-36 hours. Part of the physiological process that occurs during an erection involves the release of nitric oxide into the circulatory system of the corpora cavernosa, as a result of sexual arousal. Nitric oxide activates the enzyme guanylate cyclase, which manifests itself in an increase in the levels of cyclic guanosine monophosphate (cGMP), which leads to the relaxation of smooth muscles in the blood vessels supplying the corpora cavernosa, leading to an increase in blood flow and erection. Phosphodiesterase 5 inhibitors inhibit the decomposition of cGMP using type 5 phosphodiesterase (PDE 5), increasing blood flow to the penis during sexual arousal. Additionally, the effectiveness of the action of nitric oxide, which physiologically expands the blood vessels of the cavernous bodies in the penis, is enhanced.

Probably the most commonly used drug is alcohol, which, at low concentrations in the blood, disinhibits, and at high concentrations impairs the ability to achieve an erection. Using tobacco (such as cigarette smoking) also inhibits sexual function; the incidence of impotence is 85% higher in male smokers compared to non-smokers. The use of certain androgen hormones can also change levels of sexual arousal and levels of sexual aggression. Many other drugs, both authorized and illegal, after prolonged use to increase the onset of an erection and increase its intensity, have side effects, of which the most frequent was a decrease in sexual desire. For example, a number of illegal drugs known abroad as MDMA enhance sensory and erotic sensations, although they suppress sexual intercourse itself by causing a temporary disturbance in erection. Other similar drugs, such as GHB, are notorious for using unsuspecting prey in a state of insensibility or severe suppression and become easy prey for sexual predators. Many antidepressants and antipsychotic drugs have a side effect of reducing sexual desire.

• The earliest attempts to treat impairments in the ability of a man’s penis to increase in volume, to harden and to straighten for a time sufficient to perform sexual intercourse date back to the era of Muslim doctors and pharmacists in the medieval Islamic world. They were the first to prescribe drugs for this problem and developed several treatments for this condition, including a single drug treatment method or a combination method when they were prescribed either a drug or a food product. Most of these drugs were oral, although some patients were also treated with topical and transurethral methods. Muslim doctors and pharmacists included Muhammad ibn Zakaria Razi , Tabib bin Kura, Ibn Al-Jazzar, Avicenna ( Canon of Medicine ), Averroes , Ibn Al-Baitar and Ibn al-Nafis (Complete Book on Medicine). ^[eleven]
• In the 1920s and 1930s in the United States, Dr. John R. Brinkley began a boom in healing male impotence. His radio programs as a way to restore male qualities were recommended by expensive goat gland implants and injections of mercury chromium, including surgeries by surgeon Serge Voronoff . After the Kansas Medical Committee revoked his medical license and the Federal Radio Commission refused to renew his radio license (both episodes occurred in 1930), Brinkley moved his operations to Mexico, directly across the Texas border, where he opened a medical clinic and where he broadcast his ads in the United States using a cross-border speaker.
• Since the 1970s, surgeons began to provide patients with inflatable implants in the penis.
• Modern drug therapy for erectile dysfunction made significant progress in 1983, when British physiologist Giles Brindley | pulled down his trousers and demonstrated a penile-induced erection of his penis to a shocked audience at the American Urological Association. The drug Brindley injected into his penis was a non-specific vasodilator alpha-blocker, the mechanism of action of which was clearly due to the relaxation of smooth muscles in the body of the penis. The effect discovered by Brindley established the basis for the later development of specific, safe, oral, effective drug treatments ^[12] .

In the Anatomical-therapeutic-chemical classification, these drugs are in

• The main anatomical group G is the genitourinary system and sex hormones ,

• Therapeutic-pharmacological group G04 Preparations for the treatment of urological diseases

• G04BE drug group Drugs for the treatment of erectile dysfunction ^[13]

When this happens, vacuum agents and surgical treatment are used to achieve an erection.

• Vacuum treatment for impaired erection consists in placing the penis in a vacuum cylindrical device, which stimulates additional blood flow to the penis. At the root in size of the penis, a compression ring is applied, which helps maintain the achieved erection ^[14] . A device of this type is sometimes called a "pump" for the penis, it is used immediately before sexual intercourse. Several types of vacuum treatment accessories approved by the U.S. Food and Drug Administration are available on prescription. Pumps of this type should be distinguished from pumps supplied without compression rings, which are used not for temporary treatment of erectile dysfunction, but in a claim to increase the length and volume of the penis with frequent use or for masturbation.
• Surgical treatment is used if other methods have been ineffective. In a few cases, a vascular problem can be the basis of erectile dysfunction, then the vascular system of the cavernous bodies is reconstructed. In a more thorough approach, inflatable or resilient implants, cartilage or silicone rods are placed in the penis surgically, which are irreversible and expensive. All these mechanical methods, based on the simple principles of hydraulics and mechanics, are quite reliable, but have their drawbacks ^[10] .