Erectile Dysfunction: Don’t Let It Get You Down
Erectile dysfunction (ED) is often a taboo subject, yet it is a fact of life for a significant proportion of people. If you suffer from ED, it is important to know that you are not alone. According to the Massachusetts Male Aging Study, the prevalence of erectile dysfunction in cisgender men is 52%. This study also showed that ED becomes increasingly frequent with age: about 40% of men are affected at the age of 40, and nearly 70% are affected at the age of 70.
Multiple Causes
General Health:
Conditions such as diabetes, hormonal disorders, multiple sclerosis, and diseases affecting the kidneys and vascular or neurological systems can contribute to ED. Surgery in the pelvic area, like a prostatectomy or spinal cord injury, can also cause ED. If ED occurs repeatedly in someone over 50, it should be discussed with a doctor, as it could be a sign of another health issue (heart problem, uncontrolled diabetes, etc.). Indeed, since sexual arteries are very small in diameter, when they narrow, it leads to erectile dysfunction (insufficient blood flow to the penis) and is considered a warning sign: two or three years later, the arteries of the brain or heart can also become narrowed. Therefore, a cardiovascular assessment is essential for people over 50 who experience repeated erection difficulties.
Lifestyle:
A high-fat diet and smoking can, among other things, clog arteries, thus affecting erection mechanisms. Excessive alcohol consumption can also negatively impact erection by inhibiting the nervous system. Adopting a balanced diet and regular exercise can help improve the situation.
Medications:
Certain medications, such as antihypertensives, antidepressants, anxiolytics, cancer treatments, and estrogens can impact erectile function. If you suspect your medication is the cause, it is crucial to consult your pharmacist or doctor before changing or stopping treatment.
Psychological Causes:
Psychological factors can also greatly disrupt erectile function. Common triggers, such as stress, performance anxiety, a new sexual relationship or experience, depression, and feelings of guilt, can all play a role in ED. An individual psychological approach can help to explore and understand the problem by analyzing cognitions (i.e., thoughts, expectations, and beliefs about sexuality). These thoughts are influenced by several factors: lived experiences, family history, social conventions, and more. When a doctor, in agreement with their patient, believes psychological factors are involved in ED, they generally recommend consulting a sexologist.
Available Treatments
In the case of an underlying disease, a physician will likely prescribe an appropriate treatment, as well as parallel treatment to improve erectile function.
Phosphodiesterase Type 5 Inhibitors (PDE5-I)
This class of prescription-only medications works by relaxing penile blood vessels. This increases blood flow and allows an erection to occur in responses to sexual stimulation. PDE5-Is are not aphrodisiacs, and sexual stimulation is necessary for the medication to work. Among this class of medications are “on-demand” treatments, which are taken occasionally in anticipation of sexual activity:
- Sildenafil (Viagra®) and its generic
- Tadalafil (Cialis®) and its generic
- Vardenafil (Levitra®) and its generic
These medications are taken occasionally in anticipation of sexual activity, and their effects begin about 30 minutes to 1 hour after ingestion. They are effective for a duration of 4 to 36 hours, depending on the medication. Viagra® has a shorter duration of action, generally up to 4–6 hours, while Cialis® can last up to 36 hours.
For people with an active sex life who desire unscheduled sexual intercourse, daily tadalafil (Cialis®) can be an option. However, the daily dosage is lower than the dosage indicated for occasional use and varies from 2.5 to 5 mg per day, as recommended by a doctor.
Side Effects and Contraindications
These medications are generally safe for most people. There are some side effects associated with these drugs, but they are usually well tolerated. Taking the smallest effective dose usually avoids experiencing uncomfortable effects.
Common adverse effects include: headaches, flushing, nasal congestion, and gastric reflux. There are also contraindications that must be evaluated by your doctor, who will assess your condition and establish the safety of these medications for your health.
Dosage
The dose can vary based on several factors, including age, general health status, and tolerance to side effects. It is crucial not to take more than the recommended dose, as this can increase the risk of adverse effects and complications.
Drug Interactions
Certain interactions between these and other drugs can be dangerous. For example, certain drugs and grapefruit consumption can increase the levels of ED medications in the blood, thus increasing the risk of side effects. In addition, nitrates (nitroglycerin medication or poppers) are contraindicated with ED medications due to the risk of a dangerous drop in blood pressure. For personalized advice on drug interactions, please consult our pharmacists.
Cost
The cost of ED medications can vary from one pharmacy to another. For example, Viagra® (sildenafil) may cost about $10 per dose, and Cialis® (tadalafil) may cost about $15 per dose. It is important to note that most private insurance plans do not cover these medications, and they are never covered by the public plan (RAMQ).
Intraurethral Treatment
This kind of medication is administered in the form of mini-suppositories introduced into the urethral meatus (Muse® device), following which an erection occurs. This is a simple and interesting alternative for the 30% of people for whom tablet medications are ineffective.
What About Injectable Medications for ED?
Injectable medications like Caverject® (alprostadil) and Tri-Mix® (a combination of phentolamine, papaverine, and alprostadil) are treatment options for people who do not respond well to oral or mini-suppository medications, or who cannot take them due to contraindications. With this treatment, penile rigidity is achieved even in the absence of sexual stimulation and lasts about an hour.
- Mode of Administration: these medications are injected directly into the corpora cavernosa of the penis using a small needle.
- Rapidity and Duration of Action: the effect generally begins within 5 to 20 minutes after injection and can last up to an hour.
- Stimulation Required: unlike oral medications, these injections generally do not require sexual stimulation to work.
- Side Effects and Precautions: as with any medication, there are risks of side effects, including local pain, bruising, or, in rare cases, a prolonged erection requiring medical intervention.
Testosterone
If erectile dysfunction is caused by hypogonadism (an abnormal decrease in testosterone), meaning that the production of sex hormones by the testicles is low, hormonal treatment with testosterone may be considered. However, this approach is only effective at restoring functional erections in about one-third of cases.
Are Medications the Only Remedy for ED?
No. Sexologists can greatly assist in treating the condition by addressing the psychological and emotional factors that can contribute to ED.
Erectile dysfunction (ED) is often a taboo subject, yet it is a fact of life for a significant proportion of people. If you suffer from ED, it is important to know that you are not alone.
Getting a Prescription
If you think you may need treatment for ED, the first step is to consult with a healthcare professional. There is no shame in addressing this delicate subject with your doctor. In fact, it’s a proactive and responsible step to exclude other potential health problems that could be causing the ED.
Remember that sexual well-being is not limited to the quality of an erection; communication and intimacy with your partner are also essential components of a satisfying sex life.
For personalized advice and more information on ED treatments, our pharmacists are at your disposal to guide and inform you.
