Erectile dysfunction (ED) is described as the inability to acquire and/or maintain a good erection for sexual engagement on a consistent or recurring basis.
The normal erection
Initiation of the erection occurs from centers around the hypothalamus or by touching the genitalia. Achieving and maintaining an erection requires intact and functioning parasympathetic innervation of the corpora cavernosa, intact and functioning vascular supply as well as intact and functioning endothelium and cavernous tissue.
Upon activation of the parasympathetic nerve fibers, nitric oxide and acetylcholine are released, which induces relaxation of the smooth muscles in the corpora cavernosa, among other things.
Causes of erectile dysfunction
Anything that can compromise the normal erection can be the cause of ED. It is important to separate psychogenic ED from organic ED as the primary mechanism, as especially men with psychogenic ED may benefit from non-pharmacological treatment, e.g. talk or cohabitation therapy. Psychogenic ED amounts to approx. 10%, while organic ED makes up 90%. However, there is often a psychological superstructure on primarily organically conditioned ED.
Medical treatment of erectile dysfunction
Medical treatment of ED is symptomatic and plays a major role in the treatment of organic ED, but can also be used in the treatment of psychogenic conditioned ED. Before starting medical treatment, it is important to reconcile expectations with the patient. Successful treatment does not necessarily mean that the erection will be as good as the patient remembers from the past, but often that the erection is sufficient to perform penetrative intercourse. When treating, efficacy, safety, cost, and patient preferences should be carefully weighed.
Viagra
Sildenafil (Viagra) is taken 30-60 minutes before sexual activity (on-demand). The effect is reduced by concomitant consumption of high-fat foods, and it is therefore recommended to take Viagra with dapoxetine online without regard to a meal. The recommended starting dose is 50 mg (25 mg for renal or hepatic impairment), but the dose is adjusted (25, 50, 100 mg) according to efficacy and side effects. In clinical practice, if it is not otherwise contraindicated, one may consider starting with the maximum dose in severe ED, as it increases the likelihood of successful treatment. Later, lower dose can be tested at good effect. In a dose-response study with a general ED population, after 24 weeks of treatment, a significantly improved erectile function was found in 56%, 77% and 84%, respectively a dose of 25.
Cialis
Tadalafil (Cialis) is taken 30-60 minutes before sexual activity (on-demand). Absorption is not inhibited by high-fat meals, as is the case with sildenafil and vardenafil. The on-demand starting dose is 10 mg and is adjusted according to efficacy and side effects (10, 20 mg). In a dose-response study with a general ED population, after 12 weeks of treatment, a significantly improved erectile capacity was found in 67% and 81%, respectively. a dose of 10 and 20 mg compared to 35% in the placebo group.
The effect of Cialis 80 is maintained for up to 36 hours after ingestion due to the long half-life of the drug. Thus, it is possible to take tadalafil daily and in this way maintain some spontaneity in sexual life. The recommended daily dose is 5 mg. As Tadalafil 5 mg is also approved for the symptomatic treatment of prostatic hyperplasia (BPH), it can be used to advantage in the treatment of ED in patients with BPH.
