Treating Erectile Dysfunction Men Who Do Not Respond to Medication
There are over 30 million Americans who suffer from erectile dysfunction (ED). Since 1998 oral therapy using Viagra, Levitra and Cialis, have been successfully used to treat ED. This article will describe what can be done to treat those men who do not respond to oral therapy.
A non-responder is defined as a man who does not achieve an erection adequate for sexual intimacy after at least four attempts using the highest tolerated drug dose and uses the drug properly with respect to timing relative to meals, alcohol ingestion, use of other medications and adequate sexual stimulation. Some men who take Viagra, Cialis or Levitra may not achieve an erection sufficient for intercourse but may begin to respond to the oral medication after the physician properly counsels the patient and addresses certain issues.
Treatment failures due to medication issues are commonly associated with drug side effects. These side effects include: headache, flushing, nasal congestion, and transient abnormal vision. The adverse effects the patient experiences may outweigh any potential benefit of taking the drug.
Clinical issues leading to treatment failures are often due to inadequate patient education by the doctor or his\her staff or inappropriate dosing of the medication. One of the most common failures of oral therapy may be the absence of sexual\genital stimulation prior to attempting sexual intercourse. These oral medications facilitate an erection; they do not act as an aphrodisiac or as an initiator of the erection. Other treatment failures include taking some of the drugs after a heavy meal especially a meal with a high fat content as a high fat meal may decrease absorption of the medication from the gastrointestinal tract.
Patient issues must also be addressed in the assessment of non-responders to oral therapy. The man may have unreasonable expectations of the drug, anxiety about intercourse after a prolonged period of abstinence, fear of the side effects or unaddressed psychological issues such as guilt or religious concerns about engaging in sexual intimacy.
For true non-responders there are other treatment options which can help most men remain sexually active.
Treatment of Non-responders
Physicians can successfully convert non-responders to satisfied patients who are able to engage in sexual intimacy with their partners. Useful treatments are: daily administration of these oral medications, dosage adjustment of the medications, changing to another medication, combination therapy using more than one drug, and, finally, more invasive measures like injection therapy, insertion of pellets into the urethra (the tube in the penis that transmits urine from the bladder to the outside of the body), or surgery.
The easiest solution and often the one overlooked by physicians is seeing that the oral medications are used properly. This means instructing the man to use the medication 30-45 minutes before engaging in sexual intimacy. Men also need to know that they must have genital stimulation in order for the medication to be effective. Patients need to try the medication at least 4 times before they consider themselves a non-responder.
Chronic daily administration of one of these oral medications may result in improved blood supply to the penis resulting in better erections. Furthermore, combination therapy has proven effective in treating some non-responders. The idea is to use two drugs with different mechanisms of action to improve efficacy. Commonly, Viagra is used in combination with pellets of prostaglandin that also increases the blood supply to the penis.
Other treatment options for non-responders include injections of a combination of drugs directly into the penis with a small needle that causes minimal pain and discomfort.
Surgery is usually considered only after all other options have failed. Penile prosthesis implantation has low infection and erosion rates. The two surgical options include the insertion of a semi-rigid rod or the implantation of a three-piece inflatable prosthesis.
Erectile dysfunction is a common problem that impacts millions of American men. First line therapy with oral medication has been very successful in most men. However, a significant number of men do not respond to the oral medications and yet can be treated with other options. The bottom line is that nearly all men who wish to have an erection adequate for sexual intimacy can do so with the therapies currently available.
Reprinted with permission from Neil Baum MD, neilbaum.com
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