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 "Erection Dysfunction"

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Erection Dysfunction

At first, there was Vagina Monologues, in which women and their more aggressive feminist fellas, elevated to art form their age-old desire to be given equal rights with men, among other things, in our society. The monologues expanded and ramified to more personal concerns, the substance of which, was both embarrassing and liberating.

Now, there is Penis Talk, conceptualized in the same way, to bring to the fore the more intimate subjects a man would discuss only with his very best friend or trusted confidante. Psychologists are one in proclaiming that a man's insecurity may stem from his organ size, his redundant prepuce (read: uncircumcised) or his inability to sexually satisfy his wife.

Fortunately, the very insulting and demeaning word "impotence" is now replaced by the less threatening and possibly neutral term "erectile dysfunction" or ED.

Next to prostate cancer, erectile dysfunction has become a major concern in the promotion of men's health in recent years. The aging population is expected to triple from 606 million aged 60 years or older in 2000 to nearly 1.9 billion by the year 2050. There is a positive correlation between old age and ED, so it is predicted that worldwide prevalence of ED would reach 322 million by 2025, with majority living in the Asia-Pacific region, including the Philippines.

Dr. Ira Sharlip of the University of California in San Francisco, presented a paper during the 4th Asian and Oceanic Congress of Andrology in Malaysia, in which he enumerated the major risk factors for ED like endothelial dysfunction of blood vessels which in turn could be caused by age, cardiovascular diseases, hypertension, dyslipidemia, diabetes and the medicines to manage them, plus of course, smoking.

The renowned urologist focused on aging as the single most important factor for developing ED. Older men have lower testosterone, the male hormone which makes a boy turn into a man with all of his secondary sexual characteristics, maintain his sexual appetite or libido and give him rock-hard penile erection.

Be that as it may, it is logical therefore to recommend ART or androgen replacement therapy to older men because of hormone imbalance and aging but Dr. Sharlip also warns of prostate problems and liver toxicity in patients who receive testosterone replacement therapy. Thus, regarding the treatment of ED, the so-called phosphodiesterase-5 inhibitors (PDE5-I) like Vardenafil (Levitra) can be and are effective in elderly patients.

Dr. Inigo Saenz de Tejada of Madrid, Spain then painstakingly explained the biochemical and physiologic basis of erection of the penis. The most important chemical substances that induce as well as maintain erection are nitric oxide and cGMP or cyclic guanosine monophosphate which relax and dilate the corpora cavernosa and spongiosa of the penis, leading to their flooding and congestion with blood.

cGMP is inactivated by phosphodiestarase thus, if the person is given and inhibitor of the phosphodiesterase enzyme, then cGMP continues to perform its duties of maintaining erection. Dr. Saenz is known all over the world for his extensive research in sexual medicine. Comparing the three currently used PDE5 inhibitor, published values indicate the Vardenafil is 10-fold more potent than the others.

Another clinical study showed that a significant number of patients (34%) have a response (erection sufficient for the successful completion of intercourse) 16 minutes after administration of Levitra and an even higher (48%) response 25 minutes after taking Vardenafil. Another clinical study showed a highly significant effect 15 minutes after administration of Vardenafil that was sustained up to 8-12 hours after administration.

As a fitting finale, Dr. Herman van Ahlen of Germany shared with his colleagues data from three recent clinical studies. In a Long Term Efficiency and Safety Study, a double-blind, fixed-dose, parallel group extension of a 12-month study conducted in Europe, US and Canada, the efficacy and tolerability of the 10 and 20 mg doses of Vardenafil which was carried up to 2 years.

The rates of successful completion of intercourse more than quadrupled to 91% from the baseline rates. Moreover, Vardenafil improved the quality of erection in more than 90% of men. The most common treatment-emergent adverse events were headache, flushing, rhinitis or nasal congestion and dyspepsia, which were transient and mild to moderate in severity. Just like with other two PDE5 inhibitors, patients taking nitrate medications for their heart should not take Vardenafil.

Drew Voight

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