Erectile Dysfunction

What Is Erectile Dysfunction?

Sexual dysfunction caused by the inability to develop or maintain an erection of the penis during sexual performance.¹

Causes:

ED is usually multifactorial, but is typically caused by psychological  causes or vascular disease. Some causes include:

• Psychological - depression, performance anxiety, stress
• Lifestyle - tobacco or illicit drug use, excessive alcohol consumption, lack of exercise
• Medical Conditions - epilepsy, neurologic disease, spinal cord injury, atherosclerosis, peripheral vascular disease, hypogonadism, diabetes, thyroid disease, hypertension, hyperlipidemia, chronic disease, trauma or injury, benign prostatic hyperplasia or penile plaques/ scarring and some medications¹

How do Erections Occur?

• Erections occur due to response to stimuli
• Stimulation causes a release of nitric oxide synthase which stimulates nitric oxide production
• This produces cyclic guanosine monophosphate (cGMP) and cyclic adenosine monophosphate (cAMP), which relaxes the smooth muscle in the arteries of the erectile tissue, therefore increasing blood flow and causing erection 
• PDE5 inhibitors (tadalafil, sildenafil) work on the conversion of cGMP to GTP which causes flaccidity allowing for an erection to occur^1,2

Treatment Options 

• PDE5 Inhibitors - Examples include tadalafil (Cialis) or sildenafil (Viagra)
  • Tadalafil is taken daily while sildenafil is taken 60 minutes before sexual activity
• Testosterone Replacement Therapy (TRT)
• Regenerative Therapies, such as stem cells1

Potential Side Effects of PDE5 Inhibitors 

• Common: muscle aches in the back (resolve in a few weeks, diarrhea, headache, myalgias, flushing and dyspepsia
• Rare: severe hypotension, stroke, vision or hearing loss, seizures or priapism
• These cannot be taken with nitrates¹

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