Erectile Dysfunction Discussion

Causes of Erectile Dysfunction

ED has two classifications.

1. Psychogenic: the origin of ED comes from influences in the mind or psychological.
2. Organic: there is a physical factor behind the condition.

The most common is organic. This usually results in a lack of adequate blood supply to the penis during the need for an erection or the penis' inability to maintain an erection sufficient for penetration during sexual intercourse.

Current Treatments

Pill Form

Viagra®, Cialis® & Levitra® are three approved tablets currently available. They need to be taken 20 minutes to 1 hour before sexual intercourse. The period of time over which they work can vary between 3 hours up to 36 hours.

Prostaglandin/alprostadil

Can be injected into the penis before sexual intercourse.

Vacuum Erection Device

Also known as "the pump", it is a plactic cylindrical tube placed over the penis with a pump mechanism that removes the air from the tube. This creates a vacuum which works to draw blood into the penis helping it attain an erection. Then a constriction device is placed at the base of the penis to retain enough blood in the penis for sexual intercourse.

Hormone Replacement Therapy

Low testosterone has been treated with transdermal patches, topical ointments or intramuscular injections.

Surgery

The last resort, end of the line treatment for ED is the implantation of rods into each of the penis' two erection chambers called the corpora cavernosa.

Combination Therapy

Prostaglandin/PGE1, the principle active ingredient in trimix uses an energy pathway known as cyclic adenosine monophosphate (cAMP). PDE5 inhibitors such as Viagra®, Cialis® and Levitra® use the same energy pathway known as cyclic guanosine monophosphate (cGMP). For patients who have failed either of these therapies individually, it has been observed that the combination of using both at the same time may be a viable option.

Combination Therapy

Relaxation of the smoth muscles in the penis' erection chambers, the corpora cavernosa, is a critical step in attaining an erection. This relaxation is in part regulated by cyclic adenosine monophosphate or cAMP and cyclic guanosine monophosphate or cGMP.

Prostaglandin E/alprostadil, a principle active ingredient in TriMix-gel™, uses the energy pathway known as cyclic adenosine monophosphate (cAMP). PDE5 inhibitors such as Viagra®, Cialis® and Levitra® use the energy pathway known as cyclic guanosine monophosphate (cGMP).

For patients who failed on Viagra®, Levitra® or Cialis® tablets and who have failed on prostaglandin/alprostadil based medications, combining these two may be more effective for patients where these treatments have failed on monotherapy. Since both cAMP and cGMP mediated vasodilation can lead to penile erection, combining therapies that incorporate both pathways may succeed when single therapies fail. (Nehra A et al International Journal of Impotence Research. 2002 Feb:14 Suppl 1;S38-42)

Viagra®, Levitra® or Cialis® used with TriMix-gel™ in combination therapy may be a viable alternative when both modalities have failed in monotherapy.

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