|
|
|
New principle in therapy of erectile dysfunction: sildenafil
June 1998
Erectile dysfunction may have psychological as well as a variety of
organic causes. This necessitates in each case a careful medical evaluation.
Various commonly used drugs, as well as alcohol and narcotics, may interfere
with erection and should, whenever possible, be discontinued before starting
treatment. Organic diseases should be identified and, if feasible, specially
treated. In the remaining majority of afflicted men, psychological treatment
and partner counseling may produce an improvement, but ultimately what
is necessary remains an effective and safe medication. The drug, Sildenafil,
introduces a new therapeutic principle. During sexual nerve stimulation,
nitric oxide (NO) is released from nerves into the cells of the penile
erectile bodies. NO activates in turn its "second messenger",
the substance cyclic GMP, and the latter induces the vasorelaxation and
blood filling of the erectile bodies. Orally administered Sildenafil competitively
inhibits phosphodiesterase type 5, which physiologically inactivates cyclic
GMP in the erectile bodies. Thus, Sildenafil increases in men with erectile
dysfunction the NO-stimulated cyclic GMP concentration and, thereby, improves
erection. This new therapy is attractive because 1. Sildenafil is the first
pill (for oral use) with established efficacy that benefits most men with
insufficient erection; 2. compared with previous therapeutic approaches
(such as drug injections in the penis, instillations into the urinary duct,
vacuum pumps or even prostheses), Sildenafil is at least as effective,
is easy to take and appears well tolerated with no risk of a prolonged
erection; 3. remarkably, this medication stimulates erection only during
sexual arousal and, thus, has a rather "natural" effect, and
4. side effects (including headache, facial flushing and dyspepsia or epigastric
discomfort) were mostly of mild degree and transient, so that only 4% of
men interrupted treatment for this reason. Sildenafil does not need to
be taken daily, but may be taken, when needed, 1 hour before a planned
sexual activity. The new pill has the potential to enliven the boys "wunder
horn" with fresh sound.
Ther Umsch 1998 Jun;
Weidmann P
Hospital Europa, Marbella.
|
|
|
|
