Trends in Pharmacological Sciences
ReviewPharmacotherapy for erectile dysfunction
Section snippets
Physiology of normal penile erection
The process of penile erection is dependent on an intact central and peripheral nervous system. To understand the etiologies of ED, it is essential to understand the neural and vascular pathways that function during penile erection. Normal erectile function involves three synergistic and simultaneous processes: (1) a neurologically mediated increase in penile arterial inflow; (2) relaxation of cavernosal smooth muscle; and (3) restriction of venous outflow from the penis. ED occurs as a result
Vasoactive intracavernous and transurethral injection therapy
In the early 1980s, Virag and Brindley were the first to report on the clinical efficacy of intracavernosal injections of pharmacological agents to induce penile erection 17., 18.. Since that time, intracavernosal injections of vasoactive agents have been the most reliable and effective therapy for male ED. However, intracavernosal injection can cause pain, hypotension and a local fibrotic reaction in the penis 19. Direct injection of vasoactive agents into corpora cavernosa bypasses the
Oral pharmacological therapies
There has been a profound change in the current strategies for the pharmacological treatment of ED with the advent of effective oral erectogenic drugs. In the past, the first-line therapies for men suffering from ED were intracavernous and intraurethral pharmacological regimens. However, these agents have now become second-line therapies behind the oral agents. In the past, fear of injections and concern about other adverse effects from intracavernous therapy prevented several patients from
Gene therapy for ED
Somatic gene therapy can be defined as the ability to introduce genetic material into an appropriate cell type in vivo, thus altering gene expression of that cell to produce a therapeutic effect. It has been suggested that the penis is an ideal organ for the use of gene therapy because of its external location, easy accessibility and the low turnover rate of vascular smooth muscle cells, thus allowing a desired gene to be expressed for long periods of time without affecting the systemic
Concluding remarks
The increased public awareness of male sexual dysfunction will undoubtedly advance our understanding of the physiological mechanisms of erectile function and promote the development of new, more effective oral and local agents for the treatment of ED. The recent use of effective oral agents as first-line therapy in most ED patients has been established. Although sildenafil can cause serious adverse reactions in some individuals, such as patients with coronary disease taking nitrates, it has
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