Treatment for erectile dysfunction

Fortunately for the male with diabetes with erectile dysfunction, numerous approaches to treatment exist, beginning with drugs, continuing with external devices to create an erection, and ending with implantable devices that provide a very satisfactory erection. Treatment is successful in 90 percent or more of men, but only 5 percent ever discuss the problem with their doctors. The following sections discuss these treatment options:

Viagra and similar medications

Viagra, also called sildenafil, has been specifically studied in males with diabetes and is successful in 70 percent of patients.

Viagra does not seem to affect diabetic control, but it is not free of side effects. Some men experience headaches, facial flushing, or indigestion, which generally decline with continued use of the drug. Viagra has also been found to cause a temporary color tinge to a man's vision, as well as increased sensitivity to light and blurred vision. These side effects also decline with continued use of the drug.

Viagra is taken no more than once a day, about an hour before sexual activity. While the starting dose is 50 milligrams for men, when diabetes is present, 100 mg is often required. The drug itself doesn't cause erections; an erection occurs only as a result of some kind of sexual stimulation. But Viagra does prevent an erection from subsiding so that it lasts longer. The effects of Viagra can last for four to six hours after taking it.

Pfizer, which makes Viagra, could not expect to have the playing field to itself for very long, given that the game is something most men want to play. Bayer Pharmaceuticals and GlaxoSmithKline have now brought vardenafil, which they call Levitra, to the marketplace. Its characteristics are very similar to Viagra but the dosage is 10 mg, which probably means 20 mg for men with diabetes.

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Eli Lilly and ICOS Corporation have brought out tadalafil, which they call Cialis. It works like Viagra and Levitra but stays active for 36 hours. In addition, its onset of action is 20 minutes, half the time of Viagra or Levitra. Cialis has been nicknamed the "weekender pill" because it permits spontaneous sexual activity from Friday to Sunday. The starting dose for Cialis is 20 mg, but, again, the male with diabetes may need to start at twice that amount.

Some men must not take Viagra or the other two drugs. Men who have chest pain often take nitrate drugs, the most common of which is nitroglycerine. The combination of Viagra and nitrates may cause a significant and possibly fatal drop in blood pressure.

In October 2007, the U.S. Food and Drug Administration began to receive reports of sudden loss of hearing in men taking the drugs described above. Some of the men also reported dizziness and ringing in the ear. The hearing loss was temporary in one third of cases and too recent in the others. It begins within hours to a day or two of starting these drugs. It involves only one ear. There have been only 29 cases among the millions who have taken the drugs beginning in 1996. If you experience hearing loss, take no more of the drug and report it to your doctor. Since the side effect is so rare, it should not prevent you from using the drugs, but you should be aware of it.

Injection into the penis

The patient himself can use two different kinds of injections to create an erection. The first one, a mixture of the drugs papaverine and phentolamine, has for the most part been replaced by alprostadil (Caverject or Edex), a chemical that relaxes the blood vessels in the penis to allow more flow. Alprostadil does not require sexual stimulation in order to work.

The drug is injected about 30 minutes before intercourse and no more than once in 24 hours and three times per week. An injection of either preparation gives a full erection lasting about an hour in 85 to 95 percent of men, except for those who have the most severe loss of blood flow to the penis.

Complications of injections are rare but include bruising, pain, and the formation of nodules at the injection site. A very rare complication is priapism, where the penis maintains its erection for many hours. If the erection lasts more than four hours, the patient must see his doctor to get an injection of a vasoconstrictor, a drug that squeezes down the arteries into the penis so that blood flow is interrupted.

Suppository in the penis

Alprostadil — the chemical that can be injected into the penis — also comes in a suppository form. The patient inserts a tube containing this small pill into the opening of the penis after urination. When the tube is fully in the opening, the man squeezes the top so that the pill exits the tube. This preparation, called MUSE, comes in several different strengths so that patients can use a higher dose if the lower dose does not result in a satisfactory erection. It may safely be used twice in 24 hours. A few men experience pain with this procedure. Sexual stimulation is unnecessary to achieve an erection.

Vacuum constriction devices

These tubes, which fit over the penis, create a closed space when pressed against the patient's body. A pump draws out the air in the tube, and blood rushes into the penis to replace the air. When the penis is erect, a rubber band is placed around the base of the penis to keep the blood inside it. Sometimes pain and numbness of the penis occur. Because a rubber band is constricting the penis, semen does not get through, so conception does not take place. The rubber band may be kept on for up to 30 minutes.

Implanted penile prostheses

If the patient doesn't like the idea of injecting himself in his penis or using a vacuum device, and if Viagra does not work for him, a prosthesis (an artificial substitute) can be implanted in the penis to give a very satisfactory erection. Prostheses come in several varieties. A semi-rigid type produces a permanent erection, but some men do not like the inconvenience of a permanent erection. An inflatable prosthesis involves a pump in the scrotal sac that contains fluid. The pump can be squeezed to transfer the fluid into balloons in the penis to stiffen it. When not pumped up, the penis appears normally soft. In the past few years, the surgery to insert these prostheses has become very satisfactory.

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