The choice and selection of erectile dysfunction treatment methods depends on the specific clinical situation and is closely related to the causes of its occurrence. So, for example, in production of male sex hormones decrease therapy specialists will include appropriate hormonal medications taken under strict supervision of a physician or/and an endocrinologist; in case elevated prolactin levels prescribed him inhibitors; when confirming the fact of psychogenic impotence of nature sedative medications are prescribed.
When it comes to vessel diseases, a local negative pressure is artificially created using a special pump, which improves blood flow to the penis. Alternatively, an injection into the cavernous body of vasodilator drugs – papaverine, phentolamine and prostaglandin E1 can be made use of. Taking into account the fact that such intracavernous injection is anything but safe for the patient, because prolonged use, they often lead to the development of cavernous fibrosis, a curvature of the penis and worsening of erectile dysfunction course of development.
As for the pharmaceutical preparations, they have a positive impact on the blood vessels, increase blood pressure and tone of the entire body. It is believed that these features offer natural products such as has ginseng, Siberian ginseng and golden root; however, the primary choice of erectile dysfunction treatment drugs is narrowed to an inhibitor of phosphodiesterase of the fifth type – sildenafil citrate, globally known under Viagra brand name, introduced in medicinal practice in 1998 and effective in the vast majority of cases.
Five years after the appearance of this drug on a pharmaceutical market, a number of countries has approved several analogs for its use, such as tadalafil and vardenafil, commonly known as Cialis and Levitra accordingly.
The mechanism of action of drugs in this group is an indirect effect on the smooth muscles of the cavernous tissue, which results in relaxation of forming its elements, accompanied by the expansion of the sinusoidal spaces of the cavernous body and increasing blood flow to them. This, in turn, makes the tunica albuginea intrathecal squeeze venules and reduce the outflow of blood from the penis. The pressure in the penis is thus increased and physiological erection occurs. But as a cascade of biochemical reactions is triggered by erotic stimuli, sildenafil and its analogues thereof may operate only when a sufficient level of sexual arousal is achieved.
If any conservative methods are ineffective, demonstrate zero efficiency or for some reason unacceptable to the patient, surgical treatment may be the only available option. As a method of a last resort surgery is performed to restore normal blood supply to the corpora cavernosa of the penis by connecting it new (usually inferior epigastric) artery (called arterialization penis), or by limiting the venous outflow from the corpus cavernosum due to bandaging draining blocked veins.
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