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.