Erectile Dysfunction Drugs Affect Other Systems

Treating erectile dysfunction

Since the Food and Drug Administration gave Viagra� � (sildenafil) its approval in 1998, "erectile dysfunction" has become a household term � � � � � � � �" probably to the chagrin of many parents fielding questions from their kids watching TV. But with sildenafil and the subsequent introduction and marketing of Levitra� � (vardenafil) and Cialis� � (tadalafil), many men have found answers to a once-unmentionable condition.
"As more and more patients seek therapy for sexual dysfunction, it is increasingly important for clinicians in a wide range of specialties to become proficient in the mechanisms and systemic effects of these medications," said Ernst R. Schwarz, M.D., Ph.D., a cardiologist at Cedars-Sinai Medical Center who specializes in therapies for men who suffer from erectile dysfunction (ED) and have heart problems, diabetes, high blood pressure or other related conditions.
Schwarz and colleagues recently concluded a review of the medical literature, as well as their own research findings and clinical data, to determine what actually is known about the effects of long-term use of this class of drugs on various organ systems. Their findings appears in the June 8, 2006 issue of the International Journal of Impotence Research.
Studies so far suggest the drugs, called phosphodiesterase-5 inhibitors (PDE-5i), produce mostly beneficial results, and not just for erectile dysfunction. The FDA recently approved a reformulation of sildenafil for the treatment of primary pulmonary hypertension, a disease that tends to occur in young women, causing elevated blood pressures in the lung that can lead to heart failure and early death.
"When we look at all the different organ systems� � - the blood, the heart, the lungs, blood flow in the brain � � � � � � � �" there are hardly any negative side effects. In fact, just the opposite is true. There are beneficial effects for primary pulmonary hypertension, as well as for conditions such as heart failure and lack of oxygen in the heart," said Schwarz. "The only issue is that the data we have are from relatively short-term studies. Viagra has been on the market since 1998 and the other two PDE-5 inhibitors were approved by the FDA in 2003. Therefore, we do not have multi-year follow-up studies. On the other hand, the drugs have been on the market for several years now and there have been no reports of negative long-term effects."
While there are some differences among the three medications, they have many properties in common and work by limiting the activity of the enzyme phosphodiesterase-5, which is found in tissues and vessels of the penis, blood platelets, and smooth muscle of blood vessels. For the treatment of erectile dysfunction, the drugs' constraint of the enzyme's action results in increased levels of cyclic guanosine monophosphate (cGMP) and nitric oxide (NO), biochemicals that promote smooth muscle relaxation and increased blood flow in erectile tissue.
According to the article, PDE-5 inhibitors can be effective in treating erectile dysfunction even for many men who also have diabetes, those who are older, and those who have co-existing ischemic heart disease (reduced blood flow to the heart caused by plaque buildup in the arteries). Furthermore, say the authors, "since PDE-5 is found in smooth muscles of the systemic arteries and veins throughout the body, use of PDE-5i has been associated with various cardiovascular effects."
"The original intention was to develop PDE-5 inhibitors as a treatment for angina, chest pain that occurs when the heart is starved for oxygen," Schwarz said. "As such, their effects on the heart appear to be all beneficial. Nitrates and other substances commonly used to improve blood flow and oxygenation to the heart muscle have a side effect that we call the 'steal phenomenon,' in which blood is taken away from underperfused (flow-restricted) areas to improve blood flow in normal areas. In contrast, PDE-5 inhibitors actually improve blood flow even in areas where there is a blockage of an artery, thereby having a protective effect on the heart muscle."

Consumers Warned Not To Use Impotence Treatment Drug Deguozhanjiang

Health Canada is advising consumers not to use Deguozhanjiang is promoted as a sexual enhancement/erectile dysfunction product due to concerns about possible side-effects.
Deguozhanjiang contains sildenafil and tadalafil, prescription drugs used for the treatment of erectile dysfunction that should only be taken under the guidance of a health professional.
Possible Side Effects � � � � � �
Unsupervised use of tadalafil or sildenafil by patients with heart disease can result in serious cardiovascular side-effects such as sudden cardiac death, heart attack, stroke, hypertension, chest pain and abnormal heartbeat.
Additionally, use of tadalafil or sildenafil may be associated with other side-effects including temporary vision loss, seizure, prolonged erection, headache, flushing, nasal congestion and abdominal pain. Tadalafil or sildenafil should not be used by individuals taking any type of nitrate drug (e.g., nitroglycerine) due to the risk of developing potentially life-threatening low blood pressure.

Research on Bicycle Saddles and Sexual Health Comes of Age in The Journal of Sexual Medicine

Erectile Dysfunction

Steven Schrader, a prominent researcher in sexual and reproductive health, philosophized in a guest editorial of the September issue of The Journal of Sexual Medicine that it is time to move on - the current scientific focus on the relationship between bicycle riding and sexual health has now shifted.� � Whereas past research emphasized whether or not a causal relationship existed between bicycle riding on a saddle (cause) and erectile dysfunction (disease), Dr. Schrader now states that the next step of contemporary research on the subject should focus on intervention.
Dr. Schrader is a supervisory research biologist at the National Institute for Occupational Safety and Health (NIOSH).� � The statements in the editorial represent his professional opinion and do not necessarily reflect any policy statements by NIOSH.

Erectile Dysfunction Review

Dr. Schrader was asked to review three new articles on the topic published in the current issue of The Journal of Sexual Medicine entitled, "Bicycle Riding and Erectile Dysfunction: An Increase in Interest (and Concern)" by Huang et al, "Only the Nose Knows: Penile Hemodynamic Study of the Perineum - Saddle Interface in Men with Erectile Dysfunction Utilizing Bicycle Saddles and Seats with and without Nose Extensions" by Munarriz et al, and "Development of a New Geometric Bicycle Saddle for the Maintenance of Genital-Perineal Vascular Perfusion" by Breda et al.
These three peer-reviewed articles research the pathophysiology of the erectile dysfunction (ED) associated with bicycling.� � They together report that the high pressures in the perineum while straddling a saddle compress and temporarily occlude penile blood flow. They also hypothesized that the lining vessels of the compressed arteries become damaged, thus leading to potential permanent artery blockage.
However, not all men who ride bicycles will develop erectile dysfunction.� � One past study suggested that sexual health consequences adversely affect 5% of riders (based on survey data that would therefore include 1,000,000 riding men with erectile dysfunction).
"One would not expect that every bicyclist would suffer from� � erectile dysfunction any more than one would expect every smoker would get lung cancer," says Schrader.� � "The next steps are quite clear.� � Effective strategies based on sound ergonometrics and urogenital physiologic principles and testing are needed to reduce the risk of erectile dysfunction from bicycle riding." Schrader further concluded that "the health benefits from having unrestricted vascular flow to and from the penis are self-evident."
Dr. Schrader's ground-breaking research in 2002 reported on the hazards of bicycle riding in police officers.� � This past innovative research concluded that nighttime erections were of poorer quality in biking police officers compared to non-biking police officers. Furthermore, nighttime erection quality decreased as seat pressure increased and as the average number of hours in the saddle a day increased.
To better appreciate the scope of the problem, a 2002 National Survey of Pedestrian and Bicyclist Attitudes and Behaviors was sponsored by the US Department of Transportation's National Highway Traffic Safety Administration (NHTSA) and Bureau of Transportation Statistics, in part to gauge bicycle use. According to the survey, approximately 57 million people, 27.3% of the population age 16 or older, rode a bicycle at least once during the summer of 2002.
The guest editorial by Dr. Steven Schrader and the three peer-reviewed studies on bicycle riding and sexual health consequences are published in The Journal of Sexual Medicine.

Erectile Dysfunction Warning Sign For Heart Risk

Two newest studies suggest that in men with diabetes erectile dysfunction is a serious warning sign of developing major heart diseases.
A study by Hong Kong researchers examined 2306 men with diabetes and no signs of heart disease. They found that those with erectile dysfunction are 58% more likely to develop cardiac condition within four years than those with no sexual problems.
Another study by Italian researchers examined 291 men with diabetes and early coronary heart disease. They found that those with sexual problems are twice as likely to develop major cardiac conditions and even stroke than those with no sexual problems.
Researchers already recognize several factor putting at risk both heart and sexual health. Among these factors they especially mention smoking, cholesterol, diabetes and high blood pressure. Another latest study also found found that drugs for erectile dysfunction treatment, such as Viaga, can improve heart blood flow. This research comes with a new knowledge that erectile dysfunction is a significant warning sign of cardiovascular risk, even when other risk factors are properly treated and controlled.
Two researches urge that men with diabetes and erectile dysfunction need a special and aggressive treatment to cut risk factors for heart risk, because these men have the highest risk for developing cardiovascular problems.

Group Therapy Helps Men With Impotence

Group therapy can help men with erectile dysfunction even if they are already using popular drugs like Viagra.
Group therapy could even be a feasible alternative to some treatments for impotence.
While the number of men studied overall was small, the reviewers found that group therapy appeared to be about as successful as suction devices and injections in terms of promoting erections. One analysis showed therapy worked for nearly two-thirds of participants.
The findings spotlight the importance of "integrating sex therapy and other psychological techniques into office practice" to help impotent patients, said lead author Tamara Melnik, professor of psychiatry at the University of S� � o Paulo in Brazil.
The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
Before the days of Viagra and its sibling drugs, many considered erectile dysfunction to be a difficult-to-treat psychological disorder. Now, drugs allow millions of men to achieve normal erections by allowing blood to flow more freely to the penis; the more serious side effects are rare.
However, drugs are not always an automatic cure for men with erectile dysfunction, especially those whose impotence relates to psychological factors.
A 2001 study of 115 impotent men found that psychological factors were responsible for the problems in 43 percent of the men and physical factors were responsible for problems in another 43 percent. In the rest of the men, researchers blamed impotence on a combination of mental and physical factors.
In the new review, Melnik and colleagues examined 11 studies from the last 32 years to compare the value of group therapy to other treatments such as oral drugs, injections and suction devices.
The review studies nearly 400 men: 141 received group therapy, 109 took drugs, 68 took drugs and took part in psychotherapy, 20 used "vacuum" (suction) devices and 59 were in control groups that did not receive any treatment.
Half of the men in the studies were from the United States and the average age of the men was 47.4 years.
By pooling data from five of the studies, the researchers found that 36 of 55 men who took part in group therapy reported successful intercourse compared with 5 of 45 who were on waiting lists and had no treatment, Melnik said.
The researchers also combined data from two similar studies from 2000 and 2005 and found that men who took Viagra in conjunction with group therapy were more likely to report successful intercourse than those who took the drug alone.
The total number of men in the two studies was small � � " just 71.
The review authors did not find much difference in erection success rates between those who tried injections or suction devices and those who took part in group therapy alone.
According to Melnik, the goal of group therapy is to help men gain confidence and reduce anxiety. Most men feel comfortable in the setting of group therapy because they can share their difficulties with other men who have the same problem, Melnik said.
"Most people only wonder about the easiest and most rapid way to reach remission of erectile dysfunction," Melnik said. "Group therapy takes more time than using medication, but in some cases dealing with psychological aspects is fundamental to achieving a successful outcome and maintaining the results."
The review does not examine issues of cost nor how group therapy expenses compare to those of other treatments. The review authors did not look at the availability of group therapy for erectile dysfunction patients.
Hossein Sadeghi-Nejad, M.D., a New Jersey urologist, said psychological factors play a role in some cases of impotence. While drugs like Viagra can help people with erectile dysfunction caused by mental factors, the medications "do not work unless the patient is in the right frame of mind," said Sadeghi-Nejad, director of the Center for Male Reproductive Medicine at Hackensack University Medical Center.
Indeed, while some people assume that Viagra and other drugs cause erections on their own, sexual stimulation is still necessary. Moreover, as generations of psychologists have discovered, mental issues can wreak havoc on a person's sexual thoughts and sensations.