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Impotence treatment
Most physicians suggest that treatments for impotence proceed along a path moving from least invasive to most invasive. This implies cutting back on any harmful drugs is considered first. Psychotherapy and behavior modifications are considered next, followed by vacuum devices, oral drugs, locally injected drugs, and surgically implanted devices (and, in rare cases, surgery involving veins or arteries).
Psychotherapy
Experts often treat psychologically based impotence using techniques that decrease anxiety associated with intercourse. The patient's partner can help apply the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when physical impotence is being treated.
Drug Therapy
Drugs for treating impotence can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis. Sildenafil (Viagra) is approved for the treatment of impotence (also known as erectile dysfunction). It was the first oral medication for this purpose.
Its major mode of action is inhibition of the enzyme PDE5. Inhibiting this enzyme allows the cyclic GMP to stay around longer, thus maintaining erection. Viagra is not an aphrodisiac; it is not effective without sexual stimulation. It mainly enhances the normal physiologic erection.
Clinical trials using Viagra have been conducted in patients with vascular diseases, diabetes mellitus, spinal cord injuries, psychogenic causes, and after radical prostrate surgery. Some 70%-80% of men reported improved quality of their erections. Over 50% of patients were able to have successful vaginal penetration using Viagra.
Viagra is administered orally one hour prior to the anticipated sexual activity, preferably on an empty stomach. The absorption of Viagra can be decreased by a fatty meal.
Vacuum Devices
Mechanical vacuum devices cause erection by creating a partial vacuum around the penis, which draws blood into the penis, engorging it and expanding it. The devices have three components: a plastic cylinder, in which the penis is placed; a pump, which draws air out of the cylinder; and an elastic band, which is placed around the base of the penis, to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back into the body.