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Erectile dysfunction, in which cases are medications prescribed?

February 23, 2018

Different causes, different treatments. Erectile dysfunction is a multifactorial disorder and it is one of the most common disorders in the male sexual sphere. In other words, there are numerous causes that can determine it and, sometimes, the specific cause can guide the choice of its treatment. One of the ways in which action can be taken to improve the sexual and functional well being of the affected individual is drug therapy. We talk about this topic with Dr. Alessandro Pizzocaro, andrologist of the Operating Unit of Endocrinology at Humanitas.


The disorder

Erectile dysfunction is a debilitating condition that has a considerable impact on human quality of life. It may impair your psychophysical wellbeing, with the risk of anxiety and depression or a reduction in self-esteem, for example. Of course, it can also affect fertility.

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The inability to achieve or maintain an erection to complete a sexual intercourse is what characterizes erectile dysfunction, which can therefore be complete or partial. Erectile dysfunction is not a disease, but rather the symptom of frequent diseases such as diabetes, cardiovascular disease and testosterone reduction as age progresses.


The drugs

Before dealing with a treatment, it is important to understand what is hidden behind erectile dysfunction, to identify the risk factors so that they are eliminated, mainly because some of these pathologies can compromise not only the quality but also the quantity of life. For example, it has been shown that in several cases patients with heart attacks in previous years were already experiencing erectile dysfunction. Discovering the cardiovascular problem from a resulting erectile dysfunction can save the patient’s life.


However, it is important to correct the symptom with medications that in most cases are harmless and have little side effects. Drug medication is one of the possible treatments for erectile dysfunction: Impotence medications are taken orally and help the patient achieve and maintain erection. The medicines act on the musculature of the blood vessels and penile microcirculation by favoring the flow of blood into the cavernous bodies of the penis in the presence of an erectile stimulus. The drugs inhibit the phosphodiesterase-5 enzyme and act on a natural erection mechanism.


The main side effects, generally present in less than one in ten people, are stomach burning, headaches, hot flashes, nasal congestion and muscle pain. Although they may cause discomfort, these effects will generally decrease over time as the medication is taken. Their intake is absolutely contraindicated if the individual is taking nitrates for the treatment of heart pain (angina pectoris).


In Italy, these drugs are taken under strict medical instructions. Medicinal products may only be purchased on prescription. Recently, one country – Great Britain – has made a countercurrent choice by announcing the decision to release one of the most common drugs for the treatment of erectile dysfunction as “over-the-counter” drugs.


The decision was motivated by the desire to prevent patients from turning to the “black market” and buying illegal drugs: “No matter how harmless, with well-defined and easily identifiable contraindications, the liberalization of 5-phosphodiesterase over-the-counter inhibiting drugs could lead to an underestimation of the causes of erectile dysfunction, including cardiovascular risk, diabetes, and testosterone reduction. Sometimes, if they are not recognized and treated, these causes can lead to a reduction in quantity and quality of life. Therefore, before buying a 5-phosphodiesterase inhibitor drug, you should discuss it with your doctor or andrologist to find the right diagnostic and therapeutic route. The battle against online medications is waged every day by explaining to users that online commerce could be harmful because the quantity and quality of the medication is not assured.


Body and mind

Generally speaking, patients who are prescribed oral therapy are older patients. The risk of onset of erectile dysfunction is in fact linked not only to ageing but also to the coexistence of risk factors that increase with age such as being overweight, hypertension, diabetes, cardiovascular disease as well as testosterone reduction that occurs gradually with age. Finally, the intake of some drugs may also have erectile dysfunction as a side effect, including a surgical intervention for the treatment of prostate cancer.


It is also important to correct the lifestyle: addiction to cigarette smoking, being overweight, excessive alcohol intake, drug use and sedentary lifestyle are the behaviors that must be avoided in order to enjoy the most enduring sexual well-being possible.


However, erectile dysfunction is a multifactorial disorder because it can result not only from organic causes already listed but also from mood disorders, depression, and anxiety. In younger subjects the origin of the dysfunction is to be traced in these factors and in many cases its treatment requires the intervention of a specialist with psycho-sexual counseling.

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