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Erectile dysfunction affects a significant proportion of the male population, making it a common urological disorder. It is defined as the inability to obtain or maintain an erection that is sufficient for satisfactory sexual intercourse. Many factors contribute to erectile physiology and pathophysiology. Much of the current understanding of erectile physiology was acquired in the 1980s and 1990s...
Erectile dysfunction (ED) is a pervasive problem among men worldwide. The National Institutes of Health Consensus Conference defined ED as the “consistent inability to attain or maintain a penile erection, or both, sufficient for adequate sexual relations” (1).
The second messengers cyclic 3′,5′ adenosine monophosphate (cAMP) and cyclic 3′,5′ guanosine monophosphate (cGMP) play a key role in mediating a variety of functional responses to hormones and other cellular transmitters. Phosphodiesterases (PDEs) are intracellular enzymes that specifically catalyze the hydrolysis of these second messengers. By counterbalancing the enzymes adenylyl cyclase and guanylyl...
In 1988, a new class of drugs was heralded by the release of sildenafil citrate, an orally administered, potent, and selective phosphodiesterase type 5 (PDE5) inhibitor.
Tadalafil (Cialis®) is an oral medication indicated for the treatment of erectile dysfunction (ED). This chapter reviews the current state of knowledge of the pharmacodynamics, pharmacokinetics, effectiveness, and safety of tadalafil. Data are derived from clinical trials involving more than 5700 men with mild to severe ED of various causes regardless of the presence of major comorbidities, such as...
There can be little doubt that the introduction into clinical practice of oral phosphodiesterase type 5 (PDE5) inhibitors has had a major and positive impact on the quality of life in men with erectile dysfunction (ED) of various causes. PDE5 inhibitors have largely supplanted less subjectively appealing local treatments for ED, such as vacuum constriction devices, penile self-injection therapy, transurethral...
Appropriate management of erectile dysfunction (ED) is the same for providers of all specialties. With the advent of oral agents as first-line therapy for the treatment of ED, the path to discussion of ED and its treatment often winds through the primary care clinician’s office. (The term primary care clinician [PCC] is intended to include physicians, nurse practitioners, and physician’s assistants...
Since the introduction of effective oral therapy for erectile dysfunction (ED) in 1998, there has been a marked change in diagnostic and treatment patterns among physicians who see patients with ED. Initially after the approval of sildenafil, the great majority of prescriptions were written by urologists. Now, as primary care physicians have become increasingly sophisticated in their knowledge of...
“Is impotence an arterial disorder?” When Virag et al. (1) asked this question in their Lancet article in 1985, an important association between atherogenic risk factors and erectile dysfunction (ED) was brought to our attention. In 440 men with ED, atherogenic risk factors were significantly more common than in a male population of similar age. Smoking (64%), diabetes mellitus (30%), and hyperlipidemia...
Approximately 35 to 75% of men with diabetes mellitus (DM) have erectile dysfunction (ED). ED occurs about 5 to 10 yr earlier in men with diabetes than in age-matched controls (1). In a cross-sectional survey of 541 men with diabetes at a community-based clinic, the prevalence of ED increased progressively with age, from 6% in men aged 20 to 24 yr to 52% in those aged 55 to 59 yr (2). After the age...
It is estimated that 20 to 30 million American men suffer from some degree of erectile dysfunction (ED) (1). As the male population ages and awareness of the problem increases, this number is expected to at least double by 2025 (2).
A rekindling of interest in androgen supplementation therapy has occurred in the last decade. Undoubtedly this is a result of the increasing recognition and acceptance of issues of men’s health, which in many ways are closely related to the aging process. This interest has not been limited to health care professionals and the pharmaceutical industry but has extensively included the lay press and the...
Success in developing an understanding of the vascular and neural biology of the penis and its pathology has shaped modern sexual medicine. The most recent and pervasive contribution to this progression has been the rise of the phosphodiesterase (PDE) inhibitors as a highly successful therapeutic strategy. The extrapenile tissues of the neurovascular-genital axis (NVGA), also known as the cerebroneurogenital...
Oral pharmacotherapy fails to provide an adequate erection in approx 30 to 35% of all patients tried on this initial therapy, and at higher rates in those patients who have diabetes mellitus and those who have had radical pelvic cancer surgery. In those patients with initial success from oral pharmacotherapy, there have been few reports of complete tachyphylaxis, although many who are started on lower...
No conversation on dietary supplements, prescription drugs, or any conventional intervention for erectile dysfunction (ED) should ever begin without discussing lifestyle changes that may favorably impact the risk of ED A basic analogy to this situation exists for cholesterol reduction, where diet or lifestyle changes are generally the initial interventions utilized and drug therapy follows if lifestyle...
Rapid ejaculation is one of the most common male sexual disorders and has been estimated to occur in 4 to 39% of men in the general community (1–5). The Diagnostic and Statistical Manual of Psychiatry (DSM-IV) defines it as “persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it ...” which is associated with “.....
Prostate cancer and its treatment invoke the fear of “castration” and death in many men. Every man has heard of notable men with prostate cancer (Table 1).
Female sexual dysfunction (FSD) is a complex set of conditions associated with multiple anatomical, physiological, biological, medical, and psychological factors. It can be age-related and appears to be highly prevalent, affecting 20 to 50% of women (1). Data from the National Health and Social Life Survey (NHSLS), a large representative sample of US women, reported that one-third of women experienced...
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