In the 1950s, if a man approached his doctor about erectile dysfunction (ED), he was likely told it was all in his head and referred to a psychotherapist. By the 1990s, the approach had changed dramatically.
The advancing pathology and science of ED has shown that in most cases, ED has physical not mental causes, and ED patients today have numerous treatment options. John J. Kowalczyk, DO, FACOS, department of urology, Good Samaritan Hospital, Los Angeles, California, spoke about advances in ED treatment at the 106th Annual Convention and Scientific Seminar of the American Osteopathic Association, Osteopathic Medicine: Providing a Lifetime of Quality Care, which was held October 21-25, 2001, in San Diego, California.
“In the 1950s, sex therapy was the standard treatment option for men with ED,” stated Kowalczyk, explaining a timeline of ED treatment development. “By the 1960s, the first rigid prosthesis hit the market. By 1970, there were inflatable prosthesis as well as vacuum devices. In 1985, intracorporeal injections became available, in 1990, intraurethral therapy, and by 1998, oral agents hit the market.
“We now have a better understanding of the molecular biology of the erectile mechanism; as such, we are better able to develop treatment strategies that are more effective and specific than ever before,” continued Kowalczyk.
Current treatment strategies incorporate improvements in all of the old strategies. Penile prosthesis are still a mainstay therapeutic option. Modern implants are better designed, safer, and provide improved patient satisfaction.
External mechanical devices are still available although Kowalczyk reported that these are not a preferred treatment option as the dissatisfaction and dropout rate for these products is extremely high.
Intracorporeal agents (intracavernosal injections) have also improved since the mid-1980s, but still, for some patients, this process is not their favorite treatment option. Intracorporeal therapy requires the patient to inject his penis with an agent that produces an erection. While the therapy is 80% effective, having to do the injection disquieting for some men and there is the potential for scarring from repeated injections.
Intraurethral agents still have an important role in the treatment of ED. These agents are inserted into the urethra where they dissolve and are absorbed by the urethral mucosa. This treatment does not require needles, it is patient specific, and it is 63% effective. It may, however, cause burning and discomfort, occasional hypersensitivity of the glans, or painful erections.
“As would be expected, painful erections are not conducive to improved sexual relations, and the men who suffer these side effects generally do not stay with this treatment option,” stated Kowalczyk.
Oral therapy, with the market release of Viagra (sildenafil) in America, has taken the treatment of ED public and made it easier to talk about. Across the country, six pills per second are being sold to patients with ED. The good news for ED sufferers is that the post-marketing experience is consistent with clinical trial results.
“There are pros and cons for the use of sildenafil for the treatment of ED,” remarked Kowalczyk. “Not every patient is capable of taking this drug because of cardiovascular risk factors, and there is a certain percentage of treatment failures. Sildenafil is also a systemic drug with action that is not specific to the penis.
“On the positive side, it is an oral drug, which facilitates administration. It is discrete and noninvasive, a definite bonus for many patients.”
Because of the numerous treatment options, researchers are now working on combination therapies that may have improved efficacy with a reduction of side effects. A lower dose of sildenafil combined with a lower dose of intraurethral MUSE is currently in Phase III clinical trials.
There are several new oral drugs that are expected to hit the market within the next two years. Scientists are working hard to find drugs that will be more patient specific and have fewer side effects, both local and systemic.
“With all the new research, we can tell our ED patients that there are options other than what they may have already tried,” concluded Kowalczyk. “Many of these patients have been put on Viagra, but for those patients who are not candidates, or who have failed Viagra, they should still hold out; there are other treatment options that may work for them, and technology is advancing rapidly.”