A STAGGERING 50 per cent or more of men between 40 and 70 years have been shown, in most studies of different populations, to have some degree of erectile dysfunction (ED) or impotence.
The number of new cases per year (the incidence) in the US is estimated to be 26 per 1,000 men. Both the incidence and prevalence (the existing cases) increase with age, making ED primarily an age-dependent disease. Despite this, a significant proportion of men in their 60s and 70s are still able to have erections sufficient for intercourse, indicating that erectile dysfunction is not an inevitable consequence of ageing.
What makes two men of similar age so different in their ability to have an erection may be more a matter of lifestyle choices and the presence of diseases such as hypertension, diabetes, hyperlipidaemia (elevated fats in the blood), and coronary artery disease. A sedentary lifestyle without provision for regular aerobic exercise, dietary indiscretions, cigarette smoking and excessive alcohol consumption may eventually result in clogging of the blood vessels not only to the penis but to the heart, brain, kidneys, calf muscles and other organs.
Severe erectile dysfunction may be a marker for a future heart attack or stroke as ED is commonly a local manifestation of reduced blood flow due to atherosclerosis or narrowing of the arteries. In one study almost 30 per cent of men with severe ED had a heart attack or stroke within two years of diagnosis. Other less common causes include spinal cord injury, surgery that damages the erection nerves, hormone imbalances, drugs to treat high blood pressure and mental disorders, and scarring of the erectile tissues of the penis. Anxiety, depression, anger, stress and relational problems can also contribute significantly to erectile dysfunction.
TREATMENT
Erectile dysfunction, the persistent inability to attain or maintain an erection of sufficient rigidity for satisfactory sexual intercourse, can now be treated by a variety of effective and novel oral remedies some of which are available locally and some to be launched soon locally.
Sildenafil citrate (Viagra) is an oral preparation which is taken one hour prior to sexual stimulation and intercourse and works by enhancing the build up of a chemical substance in the penis which results in improved blood flow into the penis which is mostly what an erection is all about. Sexual stimulation after taking Viagra is necessary for the drug to work.
When used properly Viagra is a safe drug with minimal side effects. It should never be used by anyone on nitrates of whatever kind, and should be used with caution in persons with severe coronary artery disease, and only after consultation with a cardiologist.
Last week a new drug for the treatment of erectile dysfunction was officially launched in Jamaica. It is called apomorphine (Uprima) and has an excellent safety profile with no deaths whatsoever attributed to it. Uprima is taken below the tongue (sublingually) and onset of erection is within 20 minutes allowing for somewhat more spontaneity. It works by being absorbed through the membranes beneath the tongue into the bloodstream (within 10 minutes) whereupon it circulates to centres within the brain responsible for sexual arousal.
Once there, it stimulates these centres by acting on specific receptors and these centres in turn send signals to other brain centres as well as down the spinal cord to stimulate the nerves to the penis to produce an erection. It therefore has a totally different and complementary mechanism of action to Viagra which makes the possibility of drug combination potentially possible and interesting in terms of producing a rigid erection in a situation where either drug alone did not produce the desired effect.
Uprima is well tolerated at the prescribed doses of 2mg and 3mg, however possible side effects include nausea and dizziness. If the former occurs treatment need not be discontinued as it is usually a first dose effect and therefore short-lived. Uprima works best in men with mild to moderately severe erectile dysfunction. When starting Uprima it is recommended that six doses be given initially within a two-week period. This may be necessary to 'jump-start' the centres, which have been dormant, into action.
Uprima is cleared quickly from the blood and may therefore be taken more than once daily. Interestingly, Uprima may have a role in the treatment of women with sexual arousal disorders (problems with lubrication, engorgement and tingling of the female genitals along with a subjective sense of sexual excitement during arousal). In a small study Uprima was shown to improve subjective experiences of sexual arousal in women as well as increase vulval swelling and vaginal lubrication due to improved blood flow into the area. It also seemed to improve sexual desire in all but two women.
The two women it did not help had severe relational problems, something taking a pill cannot help. The addition of another effective oral drug in the treatment of ED makes this an exciting and hopeful time for men with ED, and although it is still early days yet, it appears so for women with sexual dysfunction as well.
- Dr. William D. Aiken, consultant urologist, University Hospital of the West Indies.
