Summary of Recent Advances in the Understanding and Management of Erectile Dysfunction
A Review of the Latest Developments in the Science and Therapy of Erectile Dysfunction
Erectile dysfunction (ED) is a common and distressing condition that affects not only the individual but also his partner and relationship. ED is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance1. ED can have various causes, such as psychological, vascular, neurological, hormonal, or anatomical factors1. ED can also be associated with other medical conditions, such as diabetes, cardiovascular disease, hypertension, obesity, or metabolic syndrome1. ED can have a negative impact on a man’s well-being, self-esteem, and quality of life1.
Fortunately, there are many treatments available for ED that can improve a man’s sexual function and satisfaction. These treatments can be classified into non-invasive and invasive options1. Non-invasive treatments include lifestyle changes, oral medications, vacuum-assisted erectile devices, and intraurethral suppositories1. Invasive treatments include intracavernosal injections and surgically implanted prosthetic devices1. The choice of treatment depends on the severity, cause, and preference of the patient and his partner1.
Lifestyle changes are the first-line treatment for ED, as they can improve the overall health and vascular function of the patient1. Lifestyle changes include quitting smoking, reducing alcohol intake, losing weight, exercising regularly, managing stress, and treating any underlying medical conditions1.
Oral medications are the most commonly used treatment for ED, as they are effective, safe, and convenient1. Oral medications belong to a class of drugs called phosphodiesterase type 5 inhibitors (PDE5Is), which work by enhancing the effects of nitric oxide, a chemical that relaxes the smooth muscles of the penis and increases blood flow to the erectile tissue1. There are four PDE5Is available in the market: sildenafil, vardenafil, tadalafil, and avanafil1. They differ in their onset, duration, side effects, and interactions with other drugs1. PDE5Is are usually taken on demand before sexual activity, but tadalafil can also be taken daily for continuous efficacy1.
Vacuum-assisted erectile devices are mechanical devices that create a negative pressure around the penis and draw blood into the erectile tissue1. The erection is then maintained by placing a constriction ring at the base of the penis1. Vacuum-assisted erectile devices are effective, safe, and inexpensive1. However, they may also cause some discomfort, bruising, numbness, or loss of spontaneity1.
Intraurethral suppositories are small pellets that contain alprostadil, a synthetic form of prostaglandin E1, which is a vasodilator that widens the blood vessels of the penis and increases blood flow to the erectile tissue1. The pellet is inserted into the urethra using an applicator before sexual activity1. Intraurethral suppositories are easy to use and have few systemic side effects1. However, they may also cause some local irritation, pain, or bleeding in the urethra or penis1.
Intracavernosal injections are injections that deliver alprostadil or a combination of alprostadil with papaverine or phentolamine directly into the erectile tissue of the penis using a fine needle before sexual activity1. Intracavernosal injections are very effective and have a fast onset of action1. However, they may also cause some pain, bruising, infection, or priapism (a prolonged and painful erection) in the penis1.
Surgically implanted prosthetic devices are devices that consist of inflatable or malleable rods that are inserted into the corpora cavernosa of the penis through an incision in the scrotum or abdomen1. The inflatable device can be activated by a pump in the scrotum to produce an erection and deactivated by a release valve to return to a flaccid state1. The malleable device can be manually bent into an erect or flaccid position as desired1. Surgically implanted prosthetic devices are very effective and reliable and have high patient and partner satisfaction rates1. However, they may also cause some complications such as infection, erosion, or malfunction of the device1.
In addition to these established treatments for ED, there are also some novel therapies that are currently being developed and may offer new options for patients who do not respond to or tolerate the existing treatments1. Some of these novel therapies include:
- Shock-wave therapy: This is a non-invasive treatment that uses low-intensity sound waves to stimulate the growth of new blood vessels and improve the blood flow to the penis1. Shock-wave therapy is painless and has no side effects1. However, its long-term efficacy and safety are still under investigation1.
- External prosthetic devices: These are devices that are worn externally on the penis and provide mechanical support or stimulation to produce an erection1. Some examples are the belt penile prosthesis, which is a belt with a rigid rod that can be positioned behind the penis, and the external penile prosthesis, which is a silicone sleeve that can be inflated with air or water1. External prosthetic devices are easy to use and have no risk of infection or erosion1. However, they may also cause some discomfort, embarrassment, or loss of sensation1.
- Injection of stem cells or platelet-rich plasma: These are biological treatments that use the patient’s own cells or blood components to regenerate the erectile tissue and restore its function1. Stem cells are undifferentiated cells that can differentiate into various types of cells, such as endothelial cells or smooth muscle cells, that are essential for erection1. Platelet-rich plasma is a concentrated solution of platelets, which are blood cells that contain growth factors and cytokines that can promote healing and tissue regeneration1. Injection of stem cells or platelet-rich plasma is minimally invasive and has no risk of rejection or allergic reaction1. However, its efficacy and safety are still unclear and need more clinical trials1.
Conclusion
ED is a prevalent and bothersome condition that can affect a man’s quality of life and relationship. There are many treatments available for ED that can improve a man’s sexual function and satisfaction. These treatments can be non-invasive or invasive, depending on the severity, cause, and preference of the patient and his partner. There are also some novel therapies that are currently being developed and may offer new options for patients who do not respond to or tolerate the existing treatments. The current article seeks to highlight the advances in management and may eventually alter the treatment paradigm to allow more-inclusive care pathways.