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9
Therapy
Among the treatment options for ED, medical and
surgical treatments can be mentioned. In every case, it
will be important to identify those "modifiable" factors,
generally linked to behavioural factors, and those
"non-modifiable". Consequently, in all cases in which
there are living habits or diseases that are associated
with ED, the correction of these factors is an essential
prerequisite of each treatment. Endocrine therapy
involves the normalization of testosterone levels in
cases of hypogonadism or reduction in the levels of
prolactin in the case of hyperprolactinemia. Appropriate
options to the patient should be given so that he and his
partner can choose one of their preference.
Non-surgical therapies of DE
The psycho-sexual therapy
is a possible approach in all
cases in which there are clear relationship problems
within the couple. Where there was this clear need, the
pair must be sent to consultation from a psychologist.
The vacuum device
( negative pressure device) consists
of a plastic cylinder that is placed around the penis and
pressed against the pubis , and connected to a manual
or electric vacuum cleaner that generates the vacuum
within the cylinder and facilitate the blood flow to the
penis through the pressure difference. Once the blood
has swelled the penis, an elastic ring placed to the base
prevents the outflow of the organ and maintains an
erection, but it must be removed no later than 30
minutes in order to reduce the risk of injury by
compression and the trigger reactions of thrombosis
and haemorrhages in the penis structure. If any benefit
is present drug or surgical treatment should be
undertaken.
Drug Therapy
The main oral drugs for ED are called phosphodiesterase
type 5 inhibitors, as well as Sildenafil, Tadalafil,
Vardenafil and Avanafil. These drugs do not induce
"automatic" erections” after taking it, but they increase
the penile erectile response to natural erogenous
stimuli: this makes the erectile response much more
similar to that spontaneous compared to other forms of
therapy. The main difference between these drugs is due
to the pharmacokinetics that causes a different speed of
action and duration of the drug. Sildenafil, vardenafil
and avanafil are those which act more quickly (about 30
minutes after administration), and which are more
quickly metabolized by the body (3-6 hours). Sildenafil
has also shown to have interactions with food and
alcohol and, therefore, should be taken on an empty
stomach. Tadalafil, on the contrary, has a slower onset
of action but a longer duration. An absolute
contraindication to the use of these drugs is the
concomitant use of nitro compounds, which are
substances commonly used for the treatment of angina
pectoris.