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Erection Disorders: New in Treatments

The range of drugs against erectile dysfunction is expanding. After sildenafil (Viagra®), tadalafil (Cialis®) and vardenafil (Levitra®), avanafil (Stendra®) comes on the market with a strong argument: a faster effect than its competitors.

Nearly one in three American people over the age of 40 are complaining today about a poor quality erection. A disorder against which three drugs have existed so far: Viagra®, Cialis®, and Levitra ®. Three allies rather effective since two men out of three were able to find a normal sexuality thanks to them.

The avanafil, which will be available from 7 April 2014, belongs to the same family as its predecessors: that of PDE5 inhibitors, inhibitors designed to fight against erectile dysfunction.

Mode of action of drugs against erectile dysfunction

To understand well, we must return to the mechanism of an erection. During sexual stimulation, nerve signals are sent from the brain to the penis. The male blood vessels dilate to allow the blood to flow into the cavernous body, causing the penis to harden. But when the nerves or the tissues of the penis are damaged by age, by surgery or by a disease such as diabetes, for example, this mechanism stops.

Inhibitory drugs are effective when the disorder is at the level of the penis. They act by blocking an enzyme (phosphodiesterase type 5) that is too present in certain erection dysfunctions. This enzyme prevents the relaxation of the blood vessels and therefore slows down the influx of blood into the cavernous bodies.

What’s up with avanafil?

If the molecules are different, all these drugs on the market have the same mode of action. The manufacturer of avanafil, therefore, put on another argument to convince consumers: with this pill, hugs can begin 15 minutes only after taking. ” It’s better than Viagra® that works an hour later, Levitra® with which you have to wait 45 minutes or Cialis®, which takes a few hours to reach its effectiveness, ” explains Dr. Raphaël Sellam, andrologist and urologist.

Efficient faster, the drug would be also longer, promises the manufacturer.

” The ideal would be a duration of action that exceeds 8 or 10 hours,” says Dr. Sellam, which would be a clear improvement over its competitors “.

Falling prices?

The agreement was tacit, but it was good for everyone: the three drugs that had been on the market so far were all sold at the same price, 10 euros a pill. The newcomer disturbs a little the deal by announcing a price of 6 euros per tablet.

But the real price war has already begun since the summer of 2013. Generic Viagra® has indeed arrived on the market at a price of 2 euros per stamp. The cost of an erection is clearly downward.

Erection troubles: keep your head up

Attention taboo! Two to three million French people may be concerned, erectile dysfunction remains a difficult subject to address. And the consequences for the couple sometimes disastrous. Synonym of personal weakness, impotence is simply a physiological disorder.

The mechanism of erection

may drop, libido diminishes and the penis lowers. But contrary to popular belief, erectile dysfunction is only of psychological origin in 20% of cases.

The penis consists of three erectile bodies: two cavernous bodies and a spongy body. The two cavernous bodies are large cylinder-shaped reservoirs, containing veins and arteries. The spongy body contains the urethra, through which urine and sperm can flow.

Most of the time, cavernous bodies are poor in blood and penile volume is low. During an excitation, sensory signals reach the brain. The centers of erection send orders that pass through the spinal cord to the penis thanks to the erector nerves. These nerves are directly connected to the arteries and corpora cavernosa of the penis. As a result, the arteries dilate, the spongy tissue becomes filled with blood, and the penis gradually becomes erect.

Anything that can alter the blood supply to the penile vessels can prevent erection: cardiovascular disease such as high blood pressure, neurological damage following a stroke, erectile nerve damage following an operation of the prostate.

Causes of dysfunction

Any abnormal vessels or nerves that play a role in erection can lead to erectile dysfunction. High blood pressure and cardiovascular diseases are often involved. Neurological conditions, such as multiple sclerosis or Parkinson’s disease, can also lead to impotence. Metabolic diseases, such as metabolic syndrome, dyslipidemias (excess lipid) are also involved, and among them is diabetes remains the main cause of impotence. It attacks the blood vessels and nerves. The erectile dysfunction three to four times more common in people with diabetes. Surgery at the pelvis level, especially the removal of the prostate, also affects erection. A depression is often accompanied by sexual dysfunction.

Some treatments, such as antidepressants or prostate treatments, can also help the development of impotence. Some transient erectile dysfunction can be caused by an unhealthy lifestyle: smoking, alcohol, drugs, fatigue and stress mismatch with a fulfilling sex life!

In the end and contrary to popular belief, erectile dysfunction is only of psychological origin in 20% of cases! Performance anxiety, certain life events (divorce, unemployment, retirement …), anxiety often have a negative impact, like marital conflicts or a lack of knowledge of sexuality and the weight of religion.

Erection troubles: how to fix it?

The first solution is to take drugs, such as the famous molecule, sildenafil, which strengthen the erection. If this is not enough, injections of substances that stimulate the erection, alprostadil, directly into a cavernous body should be done. This active ingredient can now be applied in cream in the urinary meatus (the orifice through which sperm and urine flow).

There is also a technique called a vacuum, which creates the vacuum around the penis and allows it to swell occasionally sexual intercourse. A latex ring is installed at the end of a tube, it will block the reflux of blood from the penis once the erection is sufficient. The patient then only has to chase the air from inside the tube, thanks to a pump that operates, until an erection. Inexpensive, this device requires some learning and good communication between partners.

Bertrand has had surgery on the prostate and since then has problems with impotence. He tested the injections without success and now tries the vacuum.

The penile prosthesis

For some men, it is no longer possible to have natural erections after cancer, diabetes or trauma. It is then possible to implant a penile prosthesis in the penis. It is a heavy surgical procedure, irreversible and proposed as a last resort to allow these men to recover an erection.

The penile prosthesis represents the last resort (about 750 interventions per year in France). Mals accepted if it is proposed from the outset, the patients put all their hopes in the surgical treatment, after unsuccessfully testing other therapeutics.

The operation will replace the cavernous bodies by cylinders with adjustable thickness. A small balloon placed in the bladder adjusts the volume of the prosthesis.

The penile implant costs around 2,800 euros for an average life of ten years. It is taken care of by the Social Security if it is posed following a prostatectomy.

Sexologist to the rescue

Erectile dysfunction, premature ejaculation, difficulty in ejaculation, decreased desire, difficulties in reaching orgasm, pain during penetration … are the most frequent reasons for consultation.

Many couples face difficulties in their sex life, without ever daring to talk about it, often for months or even years. A sexologist, a specialist practitioner of sexual disorders can help solve the sexual problems of all those who do not live a fulfilling sexuality.

Erectile dysfunction: a new cream treatment

Since June 1, 2015, a new treatment is available in pharmacies on prescription. It is a cream to apply locally at the penis.

For the moment, this treatment is not reimbursed but according to the laboratory, a reimbursement of 15% is expected in July 2015 on the same conditions as for intracavernous injections: diabetics, prostate cancer, multiple sclerosis. plaques, paralysis …

” This cream contains a product called alprostadil, which corresponds to prostaglandin E1, and is known to have a vasodilating effect, that is to say, that this cream will promote the opening of the arteries. it promotes the opening of the arteries, it will promote blood filling of the penis and thus facilitate erection, “says Dr. Gilbert Bou Jaoudé, sexologist.

With a small syringe, a drop of cream is deposited on the urinary port. The cream is absorbed in the glans, it then passes from the urethra to the spongy body and spreads to the cavernous body. The effect appears in the next five to thirty minutes. Accompanied by sexual stimulation, erection is facilitated for one to two hours depending on the patient.

As with all treatments for erectile dysfunction, the cream is contraindicated in people with cardiovascular problems. Its use is also prohibited in case of injury, injury or local infection. In addition to these contraindications, the cream has some side effects such as burns, tingling …

Adverse effects pointed by the High Authority of Health but nothing alarming according to Dr. Bou Jaoudé, who was asked by the laboratory to give its opinion on the proper use of this new treatment: ” According to studies, Only 5% of users stop treatment because of side effects, which means that in 95% of cases, the person supports the treatment even if we notice a little unpleasant sensations .

And while it is not recommended to use this cream more than three times a week, it changes a lot for patients with erectile dysfunction. Delivered only on prescription, each dose of cream costs 10 euros and several uses are necessary before observing an optimal result on the erection.

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