Penile erectile dysfunction is a very old topic, and many medical predecessors in the past and present have devoted their lives and wisdom to try the ideal treatment method. In recent years, with the in-depth research on the physiology and pathology of penile erection, male doctors have made a revolutionary leap in their understanding of erectile dysfunction, and many new treatments have been successfully applied in the clinic. on March 27, 1998, the U.S. FDA approved the marketing of Viagra, which became an epochal milestone in the history of erectile dysfunction treatment. Subsequently, similar drugs, Cialis and Elidel, were also approved by the FDA and quickly used in the clinic to add to the treatment of erectile dysfunction. First let’s review the mechanism of penile erection again. In addition to erotic stimulation as a prerequisite for an erection, the penis must be filled with a sufficient amount of blood in the cavernous body of the penis. The filled blood is supplied by dilated arteries and accumulates in the gradually enlarging penile corpus cavernosum so that the penis can expand, lengthen and become erect. Studies have found that most clinical erectile dysfunction is due to poor blood supply, such as hypertension, hyperlipidemia, diabetes and other diseases can lead to varying degrees of poor blood supply to the penis, so most of the treatments commonly used today are also aimed at expanding the internal penile arteries and the corpus cavernosum. If you are diagnosed with erectile dysfunction after a systematic consultation, physical examination and relevant auxiliary examinations in the hospital, your doctor will recommend a detailed treatment plan according to your specific situation, which includes the treatment of the primary disease. For most patients, medication alone is effective. If this does not work, your doctor will recommend other treatment options. In addition, you and your partner can participate in a joint discussion to choose the best treatment. Of course, there are many treatments for male erectile dysfunction other than medication, and medication does not solve the problem for all patients with erectile dysfunction. In addition, there are advantages and disadvantages of each treatment method, and doctors should give each patient a different personalized treatment plan according to their actual situation in the clinical work. In order to give you a basic understanding of the various treatments for erectile dysfunction, so that you can have a more profound knowledge and understanding of the disease, we would like to introduce some of the current treatments for erectile dysfunction. The first line of treatment – oral drug therapy: (a) PDE5 inhibitors There are three PDE5 inhibitors available: Viagra, Cialis, and Elidel. All three drugs have the same mechanism of action and can be taken under medical supervision regardless of your age and the severity of your erectile dysfunction. However, it is important to fully understand the differences between the three drugs and how to take them to ensure safety and effectiveness before taking them. The mechanism of action of PDE5 inhibitor drug therapy: Under sexual stimulation, the human body produces an important neuromediator – nitric oxide (NO), NO into the penile cavernous smooth muscle cells, can make the cells produce a large number of guanosine cyclic phosphate, as guanosine cyclic phosphate can cause smooth muscle relaxation, resulting in the expansion of the cavernous body. Thus, a large amount of blood enters the penis and produces an erection. The cavernous smooth muscle cells of the penis contain an enzyme that is detrimental to erectile function, phosphodiesterase type 5, which breaks down the intracellular production of guanosine cyclophosphate, causing the smooth muscle of the cavernous body to contract again, reducing the amount of blood entering the cavernous body and thus affecting erection production. All three drugs, Viagra, Cialis and Elidel, selectively block type 5 phosphodiesterase in the smooth muscle cells of the penile corpus cavernosum, thus preventing the rapid breakdown of cyclic guanosine monophosphate and maintaining the dilated state of the penile corpus cavernosum, which facilitates erection production and maintenance, hence the name of these drugs as type 5 phosphodiesterase inhibitors (PDE5 inhibitors). After 30 minutes of taking the drug, when you receive sexual stimulation, the drug can keep the cavernous body of the penis in a fully expanded state, so that the penis has more adequate blood filling, and you can try to have sex at this time. Disadvantages of PDE5 inhibitor medication: 1. Can’t cure the root of erectile dysfunction (if you don’t take the medication, erectile difficulty still exists). 2, after taking the drug, if there is no sexual stimulation still can not get an erection. 3, the drug only plays a role in assisting the erection of the penis, and does not increase sexual pleasure. Side effects of PDE5 inhibitor medication: 1. If you are currently taking nitrates or alpha blockers, taking an oral PDE5 inhibitor will lower your blood pressure to dangerous levels. Nitrate drugs include nitroglycerin, poppers (inhaled stimulants); alpha blockers are commonly used for prostate disease or hypertension, such as Gottlieb, Cordova, and SANTAR. If you are not sure whether you are currently taking nitrates or alpha blockers, please consult your physician or pharmacist. 2. If you have a heart condition and have not tried to have sex for a long time, sexual intercourse may increase the burden on your heart. 3.Very few patients who take it will cause erection to last for a long time, such as more than 4 hours, blood stagnation in the penis, will damage the penile corpus cavernosum, and must go to the hospital for emergency treatment. 4.After taking the drug, adverse reactions such as headache, facial flushing, nasal congestion, indigestion and transient facial color change may occur, but they are generally mild and may be relieved or disappear after several doses. Comparison of three PDE5 inhibitors Cialis (tadalafil) Elidel (vardenafil) Viagra (sildenafil) Dose 20mg/capsule 20mg/capsule 100mg/capsule Consult your physician when to take it 1 hour before sex 1 hour before sex Maintenance time 36 hours 5 hours 4 hours Maximum dose 1 capsule/day 1 capsule/day 1 capsule/day Side effects Back pain, muscle pain Epigastric discomfort dizziness, vertigo epigastric discomfort contraindications taking any nitrate or alpha-blocker taking any nitrate or alpha-blocker within 4 hours already taking any nitrate or alpha-blocker food rarely affected by food best taken on an empty stomach best taken on an empty stomach how to safely administer the drug –Although the application of PDE5 inhibitors is safe in most cases, vigilance is needed in the following cases: 1. Do not apply other treatments for erectile dysfunction at the same time without the consent of your physician. 2. Do not increase the dose or frequency of medication without your physician’s consent. 3. Tell your physician in detail about your previous medications and past medical history. 4. Tell your physician about the effects of the medication after drinking alcohol. PDE5 inhibitor patient medication Q&A 1.Q: Can people with cardiovascular disease take PDE5 inhibitors (Viagra, Cialis and Albuterol)? A: PDE5 inhibitors can cause a slight decrease in blood pressure and have no significant adverse effects on patients with coronary artery disease; no serious adverse effects have been reported so far. However, PDE5 inhibitors should be strictly prohibited for patients who are taking any dose of nitrate drugs regularly or intermittently, otherwise it will lead to a sharp drop in blood pressure. 2.Q: Is it addictive to take PDE5 inhibitors? A: Definitely speaking, taking PDE5 inhibitors will not become addictive. The underlying cause and severity of the patient’s condition are the main factors that determine whether the patient needs to take the medication for a long time and the amount of medication. 3.Q: Is PDE5 inhibitor an “aphrodisiac”? A: No. According to the principle of drug action of PDE5 inhibitors, these drugs will not promote sexual desire or make people become aroused, some people mistakenly believe that PDE5 inhibitors can do everything and are the panacea for erectile dysfunction, which is incorrect. For mild and moderate erectile dysfunction, the efficiency is 80~85%, while the efficiency of severe erectile dysfunction is only 40~50%. 4, Q: taking Viagra effect is not good, change to use cialis or albuterol must also have poor results? A: Not necessarily. Although the three PDE5 inhibitors belong to the same class of drugs, there are slight differences in their chemical structures, and these subtle differences can affect the pharmacokinetic characteristics of the drug and its absorption and metabolism in the body, thus directly affecting the effect of the drug. When you try one PDE5 inhibitor with poor results, you may want to switch to the other two, which may have unexpected effects. （In addition to the PDE5 inhibitors mentioned above, there is also sex hormone supplementation in drug therapy. Some patients with erectile dysfunction are due to low testosterone levels (androgens) in the body, and testosterone supplementation (commonly used is the oral drug Antel) may be effective for this group of patients. However, since testosterone supplementation can accelerate the progression of prostate cancer, a thorough examination of the patient’s condition should be performed before supplementing testosterone to rule out the possibility of prostate cancer. Second line of treatment (a) Vacuum negative pressure erection device The vacuum negative pressure erection device is one of the treatments that have been commonly used in the last decade to treat erectile dysfunction. The so-called vacuum negative pressure erection device is a design that uses physical principles to simulate the physiological phenomenon of penile erection, using a plastic cylinder over the penis, and then a manually controlled or electrically controlled vacuum suction device to suck the air out of the cylinder to make it a complete vacuum, so that the blood is introduced into the penile corpus cavernosum with the help of the negative pressure inside the cylinder, causing arterial congestion and making the penis erect. Then a well-designed, appropriately sized compression ring is placed at the base of the penis, causing venous compression, so that blood cannot flow back and the penis remains continuously erect, thus giving the patient enough erection time to perform sexual acts. The advantages of this method are that it is non-invasive, fast-acting, immediately available, does not require surgery or injections, and can be used for any cause of erectile dysfunction. However, the biggest disadvantage of this method is that it requires a certain amount of skill when using it and must be performed under the guidance of a doctor at the beginning, after all, it is not easy to perform a complex series of operations very skillfully when you are excited. Another disadvantage is that the use of compression rings to compress the root of the penis may cause purple stasis in the penis, and there may also be painful ejaculation. (ii) Intracavernosal drug injection This method uses vasodilating drugs and injects them into the cavernous body of the penis to engorge the cavernous body with blood in order to achieve an erection. At present, the commonly used injection drug is prostaglandin E1 (Kaiser). The injection method is as follows: first tie a rubber band to the root of the patient’s penis with appropriate tension, disinfect the skin with an alcohol cotton ball at the proximal 2 centimeters of the coronal sulcus, then dilute 10-20ug of prostaglandin E1 in 2ml of saline, pierce the penile corpus cavernosum with a 26 gauge needle, inject the drug slowly, press the injection site with your finger for 2 minutes after the injection, and then cut off the rubber band tied to the root of the penis. The drug usually takes effect about 10 minutes after injection. Wait for the penis to become erect naturally, and when the erection is sufficient, sex can begin. Intracavernous drug injections are not only effective, but they are also effective for most patients. The biggest inconvenience of this method is its correctness and skillfulness. For patients who have failed to apply PDE5 inhibitors, if this method is to be used, the first injection should be done under the guidance of a physician, who should also evaluate the appropriate dose of the drug used. The advantages of this treatment method are obvious effect and fast onset of action. The disadvantages are invasiveness (injection), high skill, post-injection pain and possible deformation of the penis after long-term injection. In addition, there are a few patients who have prolonged erection of the penis after injection of the drug, which cannot subside on its own and can cause hypoxic necrosis of the cavernous body, so if the penis is erect for more than one hour after injection, you should quickly go to the hospital. Since the erection triggered by intracavernosal drug injection does not require sexual stimulation and does not need to have normal nerve conduction pathways, but only relies on the chemical reaction of the receptors on the smooth muscle of the penile corpus cavernosum, this method is also effective for psychological erectile dysfunction and neurogenic erectile dysfunction. Third line of treatment (a) Deep dorsal penile vein ligation In order to make more blood accumulate in the cavernous body of the penis during erection, erection is improved by ligating the veins that return blood to the dorsal side of the penis. Although this procedure is effective, it usually works well for a short period of time after the procedure and loses its effectiveness after a year or two. This is because the real cause of erectile dysfunction may lie primarily in the inadequate supply of blood to the arteries rather than in the lesions of the veins themselves. It is certainly not a bad option when it comes to choosing a treatment. It is particularly effective in patients with congenital or traumatic venous atresia, so special attention should be paid to the indications for surgery in the selection of patients. (B) Penile erectile device implantation (also known as penile prosthesis implantation) For patients with erectile dysfunction who are not treated by drugs or other methods, penile erectile device implantation is also a good choice. This surgery has been carried out in China for nearly a decade, and the most cases are currently carried out by Professor Xin Zhongcheng of the Male Center of Peking University Hospital, with a total of nearly 800 cases and a success rate of 99%, and a total satisfaction rate of more than 90% in follow-ups over ten years. Penile erector implantation is the surgical implantation of an artificial penis in the cavernous cavity of the penis. Through surgical procedures, a penile prosthesis can be implanted in the cavernous body of the penis, which can assist in erection during sexual intercourse. Erection devices are designed in various materials, each with its own ingenuity and drawbacks. Therefore, patients should understand the working principles and characteristics of various types of erectors before the surgery to facilitate the selection. The doctor will tell you about the advantages and disadvantages of the procedure and the various precautions to take, as well as how soon you can start having sex after the procedure. The types of penile erectors currently on the market can be divided into two categories: non-expandable and expandable. There are two types of expandable erectors: mechanical expandable erectors and liquid inflated erectors. Non-expandable erectors are easy to use, so you can straighten the erector before sex and bend it after sex, but compared to expandable erectors, they have a less natural appearance when the penis is weak. After the implantation of the expandable penile erector, the penis looks more natural whether the penis is weak or erect. By squeezing the control pump, the fluid in the reservoir capsule can be filled into the cylinder located in the penile corpus cavernosum, and the penis will be weak after sex by pressing the relaxation valve. In the past, some patients expected that the penile erector implant would enhance their desire and orgasm, but it is important to note that the penile erector is only used to help with erection and does not directly enhance sexual desire or orgasm. In addition, penile erectile device implantation is an invasive treatment and has a certain rate of surgical complications, such as pain, size discrepancy, protrusion, infection, and about 5% of patients may experience erectile device failure after surgery. Due to the continuous research and understanding of penile erection, there are various methods of treating erectile dysfunction in recent years. The application of oral medication is an epoch-making progress, of course, it is listed as the first line of treatment in the selection, and if oral medication is ineffective or unsuitable, the second line of treatment or the third line of treatment can be chosen. There are advantages and disadvantages of each treatment method. It is best to be evaluated in detail by a specialist and to discuss various treatment methods in order to choose the most suitable one.