Viagra revolutionized the treatment of erectile dysfunction. In fact, the term "ED" first gained popularity when former senator Bob Dole went on television to promote Viagra.
It may come as a surprise, but Viagra is not the only treatment for this problem. Decades before Viagra was developed, doctors could prescribe mechanical devices that used a vacuum to induce erections. The plastic tube fit over the penis; when air was pumped out, it encouraged blood to rush in and fill the central hollow space of the penis, creating an erection. A special rubber band kept the blood in place to facilitate intercourse.
The "penis pump" was not the only pre-Viagra treatment option. There were implants that required surgery. Doctors could also prescribe a medication to be injected into the penis through a very fine needle.
One form of erection injection has been approved by the FDA under the name Caverject. This has a success rate of close to 90 percent. Despite such an impressive track record (better than Viagra), Caverject was slow to catch on. Many men were squeamish about injecting themselves. In addition, rare complications such as bruising, prolonged erections and the development of fibrous tissue causing penile curvature (Peyronie's) were possible.
The same ingredient, alprostadil, is also available in a different form. A micro-suppository to be inserted into the urethra side steps the problems with injection. This medication, called MUSE, brings on an erection within five to ten minutes. Drawbacks to MUSE include pain in the penis or testicles, dizziness, headache and a burning sensation.
But despite their rapid onset and high rate of effectiveness, none of these treatments caught on like Viagra. Taking a pill is easier.
Now Viagra is about to have competition. The FDA has given a green light to a second oral compound for erectile dysfunction. Vardenafil is expected to be launched early next year under the brand name Levitra. Like Viagra, it works through a complex biochemical cascade.
A new study shows that roughly 70 percent of the men taking Levitra are able to achieve normal functioning. The most common side effects are headache and flushing. Other reactions reported include runny nose, heartburn, accidental injury and flu symptoms.
As a result of the huge success of Viagra, drug companies are working on a variety of other ways to treat erectile dysfunction. Products like Uprima and Vasomax are still undergoing testing.
Men aren't the only ones interested in better sex. Female sexual dysfunction often goes underreported, but as more treatment options become available, women are likely to clamor for drugs that will improve libido and sexual satisfaction. Pharmaceutical firms are eager to oblige.
For readers who would like to know more about future treatments and how to use current options, we have prepared Guides to Female Sexuality, Treating Sexual Dysfunction and Drugs that Affect Sexuality.
Monday, February 4, 2008
Monday, January 28, 2008
Two New Erectile Dysfunction Drugs: How They Measure Up Against Viagra
Since Viagra was approved by the FDA in 1998, the number of men diagnosed with erectile dysfunction in the United States has increased by 250 percent. So there is no wonder why two new drugs for the condition have recently hit the market. The January issue of Harvard Health Letter examines Levitra and Cialis and assesses how these drugs measure up against the groundbreaking Viagra. Levitra offers a much smaller dose, 10 milligrams (mg), compared with the usual starting dose of 50 mg for Viagra. Levitra may also work faster- 25-30 minutes compared with an hour for Viagra. Cialis, on the other hand, stays active in the body much longer than the other two drugs 24-36 hours-compared to 4-5 hours for Viagra and Levitra.
The January Harvard Health Letter also examines the three drugs' similarities:
* They all work by relaxing smooth muscle cells, thereby widening blood vessels.
* None of the drugs automatically produce an erection. Rather, they make an erection possible with sexual arousal.
* Resulting side effects are comparable and may include headaches, heartburn, and flushing.
* The FDA advises against mixing these drugs with alpha blockers and nitrate medications.
Even with the introduction of these two new drugs, the decision to medicate erectile dysfunction should be carefully considered with a physician and will vary among male patients.
The January Harvard Health Letter also examines the three drugs' similarities:
* They all work by relaxing smooth muscle cells, thereby widening blood vessels.
* None of the drugs automatically produce an erection. Rather, they make an erection possible with sexual arousal.
* Resulting side effects are comparable and may include headaches, heartburn, and flushing.
* The FDA advises against mixing these drugs with alpha blockers and nitrate medications.
Even with the introduction of these two new drugs, the decision to medicate erectile dysfunction should be carefully considered with a physician and will vary among male patients.
Thursday, January 24, 2008
Testosterone and memory.
Testosterone may improve mental function, from the Harvard Men’s Health Watch
When we think about the powers of testosterone, we usually do not consider mental processes. However, research suggests that testosterone levels may affect men’s cognitive performance, reports the January 2008 issue of Harvard Men’s Health Watch.
All the body’s attributes change with age, and mental functions are no exception. Memory is the most fragile mental function. With age, new learning is slower, new information is processed less carefully, and details often slip. These changes give rise to the “senior moment” in healthy elders and to cognitive impairment and dementia in others.
Testosterone levels decline with age, just when memory begins to slow. Might falling hormone levels account for some of the problem? Perhaps, says Harvard Men’s Health Watch. The data are far from conclusive, but studies have found some connections. For instance, higher testosterone levels in midlife have been linked to better preservation of tissue in some parts of the brain. And in older men, higher testosterone levels have been associated with better performance on cognitive tests.
If higher testosterone levels are associated with better mental function, do treatments that reduce testosterone lead to cognitive decline? Three studies linked impaired performance on cognitive tests with androgen deprivation therapy, which is sometimes used in treating prostate cancer. However, the effects were modest and certainly should not deter men from receiving this treatment if needed.
This research also raises the question of whether testosterone therapy might improve mental function in healthy older men, or even in those with cognitive impairment. Only a few small, short-term studies have examined this, and some have reported subtle improvements on cognitive tests. However, high testosterone levels may have harmful effects as well. Harvard Men’s Health Watch suggests that until more research findings are available, men should not use testosterone or any other androgen to improve mental function.
When we think about the powers of testosterone, we usually do not consider mental processes. However, research suggests that testosterone levels may affect men’s cognitive performance, reports the January 2008 issue of Harvard Men’s Health Watch.
All the body’s attributes change with age, and mental functions are no exception. Memory is the most fragile mental function. With age, new learning is slower, new information is processed less carefully, and details often slip. These changes give rise to the “senior moment” in healthy elders and to cognitive impairment and dementia in others.
Testosterone levels decline with age, just when memory begins to slow. Might falling hormone levels account for some of the problem? Perhaps, says Harvard Men’s Health Watch. The data are far from conclusive, but studies have found some connections. For instance, higher testosterone levels in midlife have been linked to better preservation of tissue in some parts of the brain. And in older men, higher testosterone levels have been associated with better performance on cognitive tests.
If higher testosterone levels are associated with better mental function, do treatments that reduce testosterone lead to cognitive decline? Three studies linked impaired performance on cognitive tests with androgen deprivation therapy, which is sometimes used in treating prostate cancer. However, the effects were modest and certainly should not deter men from receiving this treatment if needed.
This research also raises the question of whether testosterone therapy might improve mental function in healthy older men, or even in those with cognitive impairment. Only a few small, short-term studies have examined this, and some have reported subtle improvements on cognitive tests. However, high testosterone levels may have harmful effects as well. Harvard Men’s Health Watch suggests that until more research findings are available, men should not use testosterone or any other androgen to improve mental function.
Friday, January 18, 2008
Cialis improves sexual function for prostate cancer survivors.
October 2 -- In the first randomized trial of its kind, Tadalafil, a drug typically prescribed for erectile dysfunction in men, has been proven to increase the sexual function of prostate cancer survivors, according to a study released today from the International Journal of Radiation Oncology*Biology*Physics, the official journal of ASTRO.
Prostate cancer is the most commonly diagnosed cancer in men, with an estimated 235,000 Americans expected to be diagnosed with it this year. In its early stage, prostate cancer can be treated with surgery and radiation therapy or a combination of the two. With more advanced cancer, treatment options can vary.
The walnut-sized prostate is located near the tubes that carry urine and semen. After treatment, some patients report trouble achieving an erection sufficient for sexual activity, also called erectile dysfunction or ED. In this study, doctors wanted to test whether the drug Tadalafil, which sells under the brand name Cialis, would help prostate cancer survivors with ED who were treated with three-dimensional conformal radiation therapy (3D-CRT). This is the first randomized, placebo-controlled, double-blind trial to examine Tadalafil's lasting effect in treating patients who have ED after radiation therapy for prostate cancer.
Nearly 360 patients were treated for prostate cancer at the Erasmus MC-Daniel den Hoed Cancer Center in The Netherlands between 1998 and 2002. Among them, 60 patients complaining of erectile dysfunction after radiation therapy were included. Patients were eligible if they were treated with 3D-CRT at least 12 months before the study entry, agreed not to use any other treatment for ED and agreed to make at least one sexual intercourse attempt every week during the 12-week trial. Patients were given an initial 4-week course of no treatment at all; however, patients had to attempt sexual activity at least once a week in this 4-week period.
Patients were given 20mg of Tadalafil or a placebo for 6 weeks. Patients were allowed to take the drug or placebo at-will with no restrictions on food or alcohol, but no more than once per day. The men were instructed that the drug would be effective for as long as 36 hours after dosing. After the first 6-week period of the trial, participants were moved onto alternative treatment; patients who were given placebo were switched to Tadalafil and vice versa.
Doctors found that successful intercourse was reported in 48 percent of the survivors who took Tadalafil versus the 9 percent of the men who were given placebo. There was also a reported improvement of the quality of erections in 67 percent of the patients versus only 20 percent of the placebo group.
"Fortunately, prostate cancer is a very curable disease with most patients living at least five years after diagnosis. Now that we've proven we can beat the disease, it's imperative that we work to help maintain the quality of life for the men who survive it, including preserving their sexual function," said Luca Incrocci, M.D., Ph.D., lead author of the study. Dr. Incrocci is a radiation oncologist at the Erasmus MC-Daniel den Hoed Cancer Center in The Netherlands. "This study proves that the drug Cialis is effective in helping men maintain their sexual health."
Prostate cancer is the most commonly diagnosed cancer in men, with an estimated 235,000 Americans expected to be diagnosed with it this year. In its early stage, prostate cancer can be treated with surgery and radiation therapy or a combination of the two. With more advanced cancer, treatment options can vary.
The walnut-sized prostate is located near the tubes that carry urine and semen. After treatment, some patients report trouble achieving an erection sufficient for sexual activity, also called erectile dysfunction or ED. In this study, doctors wanted to test whether the drug Tadalafil, which sells under the brand name Cialis, would help prostate cancer survivors with ED who were treated with three-dimensional conformal radiation therapy (3D-CRT). This is the first randomized, placebo-controlled, double-blind trial to examine Tadalafil's lasting effect in treating patients who have ED after radiation therapy for prostate cancer.
Nearly 360 patients were treated for prostate cancer at the Erasmus MC-Daniel den Hoed Cancer Center in The Netherlands between 1998 and 2002. Among them, 60 patients complaining of erectile dysfunction after radiation therapy were included. Patients were eligible if they were treated with 3D-CRT at least 12 months before the study entry, agreed not to use any other treatment for ED and agreed to make at least one sexual intercourse attempt every week during the 12-week trial. Patients were given an initial 4-week course of no treatment at all; however, patients had to attempt sexual activity at least once a week in this 4-week period.
Patients were given 20mg of Tadalafil or a placebo for 6 weeks. Patients were allowed to take the drug or placebo at-will with no restrictions on food or alcohol, but no more than once per day. The men were instructed that the drug would be effective for as long as 36 hours after dosing. After the first 6-week period of the trial, participants were moved onto alternative treatment; patients who were given placebo were switched to Tadalafil and vice versa.
Doctors found that successful intercourse was reported in 48 percent of the survivors who took Tadalafil versus the 9 percent of the men who were given placebo. There was also a reported improvement of the quality of erections in 67 percent of the patients versus only 20 percent of the placebo group.
"Fortunately, prostate cancer is a very curable disease with most patients living at least five years after diagnosis. Now that we've proven we can beat the disease, it's imperative that we work to help maintain the quality of life for the men who survive it, including preserving their sexual function," said Luca Incrocci, M.D., Ph.D., lead author of the study. Dr. Incrocci is a radiation oncologist at the Erasmus MC-Daniel den Hoed Cancer Center in The Netherlands. "This study proves that the drug Cialis is effective in helping men maintain their sexual health."
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